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Kniola A, Ludwig NN, Singh V, Bradley C, Carpenter L, Dillon EF, Kanne S, Kim SH, Parish-Morris J, Snyder LG, Wodka EL. Delayed Milestones and Demographic Factors Relate to the Accuracy of Autism Screening in Females Using Spoken Language. J Autism Dev Disord 2024:10.1007/s10803-024-06579-w. [PMID: 39377898 DOI: 10.1007/s10803-024-06579-w] [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: 09/19/2024] [Indexed: 10/09/2024]
Abstract
Examine how milestone development, demographics, and emotional/behavioral functioning predict autistic females meeting the cutoff on a commonly used Autism screening tool (Social Communication Questionnaire: SCQ). We hypothesized that autistic girls with fewer developmental delays, whose parents have lower education, or are Black or Multiracial would be less likely to meet the SCQ cutoff. Further, those with more symptoms of Withdrawal/Depression, Social Problems, Thought Problems, and Attention Problems on the (Child Behavioral Checklist: CBCL) would be more likely to screen positive. A subset of participants enrolled in a large national cohort (SPARK) were included (5,946 autistic females). A cutoff score on the SCQ of 11 was used to form groups: Meet (M: N = 5,186) and Not Meeting (NM: N = 760). Autistic girls who had delayed toileting and motor milestones and whose parents attained higher education were more likely to screen positive. Girls who scored within the clinical range on the CBCL Thought Problems and Attention Problems syndrome scales were more likely to screen positive. Race and reported symptoms on the Withdrawn/Depressed and Social Problems syndrome scales did not relate to screening status. Results further support the existing literature suggesting that autistic girls must present with more significant delays/symptoms to be screened and diagnosed with autism, which can could impact their access to early intervention services and future skill development. Future research should examine additional factors that specifically put females at a disadvantage for being accurately identified, particularly for those who are speaking and/or of average cognitive ability.
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Affiliation(s)
- Ashley Kniola
- Center for Neuropsychological and Psychological Assessment, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Natasha N Ludwig
- Center for Neuropsychological and Psychological Assessment, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vini Singh
- Center for Autism Services, Science and Innovation, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Catherine Bradley
- Developmental-Behavioral Pediatrics, Medical University of South Carolina, Charleston, USA
| | - Laura Carpenter
- Developmental-Behavioral Pediatrics, Medical University of South Carolina, Charleston, USA
| | - Emily F Dillon
- Department of Life Sciences, Carroll University, Waukesha, USA
| | - Stephen Kanne
- Center for Autism and the Developing Brain, Weill Cornell Medical College, New York, USA
| | - So Hyun Kim
- School of Psychology, Korea University, Seoul, Korea
| | - Julia Parish-Morris
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Ericka L Wodka
- Center for Neuropsychological and Psychological Assessment, Kennedy Krieger Institute, Baltimore, MD, USA.
- Center for Autism Services, Science and Innovation, Kennedy Krieger Institute, Baltimore, MD, USA.
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Li C, Cheung WC, Burke MM, Taylor JL, DaWalt LS. Examining the associations among knowledge, empowerment, and advocacy among parents of transition-aged youth with autism. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:2080-2089. [PMID: 38270137 PMCID: PMC11269520 DOI: 10.1177/13623613231221126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
LAY ABSTRACT Parents of individuals with autism face many challenges in finding appropriate services and support for their children, and they also play an important role in advocating for their children's rights and needs. Despite the increasing availability of advocacy programs, it is still uncertain how to best encourage parents to advocate for their children. This study explored the connection between parents' knowledge and sense of empowerment, and how these factors relate to three types of advocacy activities (i.e. individual, peer, and systemic). The findings reveal that feeling empowered has a greater impact on advocacy than simply having knowledge. In addition, the study found that individual advocacy correlates to more peer advocacy, which also correlates to more systemic advocacy. These results can help researchers and professionals to better develop programs to increase parent advocacy and, in turn, help improve the lives of individuals with autism.
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Bradshaw J, Eberth JM, Zgodic A, Federico A, Flory K, McLain AC. County-Level Prevalence Estimates of Autism Spectrum Disorder in Children in the United States. J Autism Dev Disord 2024; 54:2710-2718. [PMID: 37142898 PMCID: PMC11019892 DOI: 10.1007/s10803-023-05920-z] [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: 02/02/2023] [Indexed: 05/06/2023]
Abstract
Prevalence estimates of autism spectrum disorder (ASD) point to geographic and socioeconomic disparities in identification and diagnosis. Estimating national prevalence rates can limit understanding of local disparities, especially in rural areas where disproportionately higher rates of poverty and decreased healthcare access exist. Using a small area estimation approach from the 2016-2018 National Survey of Children's Health (N = 70,913), we identified geographic differences in ASD prevalence, ranging from 4.38% in the Mid-Atlantic to 2.71% in the West South-Central region. Cluster analyses revealed "hot spots" in parts of the Southeast, East coast, and Northeast. This geographic clustering of prevalence estimates suggests that local or state-level differences in policies, service accessibility, and sociodemographics may play an important role in identification and diagnosis of ASD.County-Level Prevalence Estimates of Autism Spectrum Disorder in Children in the United States.
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Affiliation(s)
- Jessica Bradshaw
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
- Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA
| | - Anja Zgodic
- Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA
| | - Alexis Federico
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Kate Flory
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Alexander C McLain
- Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, 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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5
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Gallin Z, Kolevzon AM, Reichenberg A, Hankerson SH, Kolevzon A. Racial Differences in the Prevalence of Autism Spectrum Disorder: A Systematic Review. J Autism Dev Disord 2024:10.1007/s10803-024-06403-5. [PMID: 38941049 DOI: 10.1007/s10803-024-06403-5] [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: 05/08/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE Racial differences in prevalence rates of autism spectrum disorder (ASD) have shifted in the United States (US) since the 1990s. This review addresses the nature and context of this shift and discusses potential contributing factors and areas for future research. METHODS Seventeen population-based epidemiological birth cohort studies on ASD prevalence in the US that included race as a variable are included in the review. Studies were identified via a keyword search on PubMed. To be included, studies were required to include race or ethnicity as a variable in the prevalence estimates, include at least 1000 cases with autism, and be published in English by June 3rd, 2023. RESULTS Results suggest that in nearly all birth cohorts prior to 2010, ASD prevalence rates were highest among White children. ASD prevalence rates among Black, Hispanic, and Asian/Pacific Islander (API) children (22.3, 22.5, and 22.2 per 1000, respectively) surpassed prevalence rates among White children (21.2 per 1000) in the 2010 birth cohort and continued to increase in the 2012 birth cohorts. CONCLUSIONS There are persistent racial differences in ASD prevalence in the US, and these differences were inverted after 2010, when ASD prevalence among Black, Hispanic, & API children surpassed ASD prevalence among White children. Possible drivers of this racial repatterning of ASD prevalence include changes in ASD screening and diagnosis, changes to health insurance policy, changes to immigration policy, and increased education attainment by minority groups.
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Affiliation(s)
- Zachary Gallin
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Abraham Reichenberg
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sidney H Hankerson
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Sciences & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexander Kolevzon
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Vela JC, Ramos N, Fielding C, Elizondo D. Exploring Latine Parent Leaders' and a Program Coordinator's Lived Experiences with a Culturally Adapted Parent-Directed Training Program. J Autism Dev Disord 2024:10.1007/s10803-024-06270-0. [PMID: 38443658 DOI: 10.1007/s10803-024-06270-0] [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: 01/28/2024] [Indexed: 03/07/2024]
Abstract
The purpose of the current study was to explore the lived experiences among parent leaders and a program coordinator who participated in a parent-directed training program to support other Latine parents of children with autism spectrum disorder. We used qualitative methods to explore 4 Latine parent leaders' and 1 program coordinator's experiences with a parent-directed training program to support other Latine parents who have children with autism spectrum disorder. We interviewed parent leaders and a program coordinator to learn about their lived experiences as leaders in a parent-directed training program. The following themes emerged from Interpretative Phenomenological Analysis data analysis: (a) personal growth, (b) leadership development, (c) sense of connection and community, (d) contributing to a larger and meaningful purpose, and (e) applying knowledge and skills to help other parents. A culturally adapted parent-directed training program has the potential to positively influence Latine parent leaders who are prepared to support parents of children with ASD. There were positive program impacts on parent leaders regarding personal growth, leadership development, connection and community, contribution to a larger purpose, and use of knowledge and skills to help other parents. We also discovered the importance of building a safe community for Latine parent leaders and other parents who have children with ASD in a parent-directed training program.
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Affiliation(s)
- Javier Cavazos Vela
- University of Texas Rio Grande Valley, 1201 W. University Drive, EDUC 3.102H, Edinburg, TX, 78539, USA.
| | - Noe Ramos
- University of Texas Rio Grande Valley, 1201 W. University Drive, EDUC 3.102H, Edinburg, TX, 78539, USA
| | - Cheryl Fielding
- University of Texas Rio Grande Valley, 1201 W. University Drive, EDUC 3.102H, Edinburg, TX, 78539, USA
| | - Denisse Elizondo
- University of Texas Rio Grande Valley, 1201 W. University Drive, EDUC 3.102H, Edinburg, TX, 78539, USA
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Paiva GCDC, de Paula JJ, Costa DDS, Alvim-Soares A, Santos DAFE, Jales JS, Romano-Silva MA, de Miranda DM. Parent training for disruptive behavior symptoms in attention deficit hyperactivity disorder: a randomized clinical trial. Front Psychol 2024; 15:1293244. [PMID: 38434955 PMCID: PMC10906662 DOI: 10.3389/fpsyg.2024.1293244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/08/2024] [Indexed: 03/05/2024] Open
Abstract
Background Attention-Deficit/Hyperactivity Disorder (ADHD) affects 5% of children and 2.5% of adults worldwide. Comorbidities are frequent, and Oppositional Defiant Disorder (ODD) reaches 50%. Family environment is crucial for the severity of behaviors and for prognosis. In middle-income countries, access to treatment is challenging, with more untreated children than those under treatment. Face-to-face behavioral parent training (PT) is a well-established intervention to improve child behavior and parenting. Method A clinical trial was designed to compare PT-online and face-to-face effects to a waiting list group. Outcomes were the ADHD and ODD symptoms, parental stress and styles, and quality of life. Families were allocated into three groups: standard treatment (ST), ST + PT online, and ST + Face-to-Face PT. We used repeated measures ANOVA for pre × post treatment analysis corrected for multiple comparisons. Results and discussion Parent training was effective in reducing symptoms of ADHD (p = 0.030) and ODD (p = 0.026) irrespective of modality (p = 1.000). The combination of ST and PT was also associated with better quality of life in the physical domain for patients (p = 0.009) and their parents (p = 0.050). In addition to preliminary data, online intervention seems effective for parenting and improving social acceptance of children. The potential to reach many by an online strategy with a self-directed platform may imply effectiveness with a low cost for public health to support parents' symptoms management.
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Affiliation(s)
- Gabrielle Chequer de Castro Paiva
- Programa de Pós-Graduação em Medicina Molecular da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Faculty of Medicine, Research Center of Impulsivity and Attention, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Jonas Jardim de Paula
- Programa de Pós-Graduação em Medicina Molecular da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Departamento de Saúde Mental, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Danielle de Souza Costa
- Faculty of Medicine, Research Center of Impulsivity and Attention, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Departamento de Saúde Mental, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Antônio Alvim-Soares
- Faculty of Medicine, Research Center of Impulsivity and Attention, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Departamento de Saúde Mental, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Julia Silva Jales
- Faculty of Medicine, Research Center of Impulsivity and Attention, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Marco Aurélio Romano-Silva
- Programa de Pós-Graduação em Medicina Molecular da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Departamento de Saúde Mental, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Débora Marques de Miranda
- Programa de Pós-Graduação em Medicina Molecular da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Faculty of Medicine, Research Center of Impulsivity and Attention, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Departamento de Pediatria, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Sánchez Pedroche A, Valera-Pozo M, Mateus Moreno A, Lara Díaz MF, Aguilar-Mediavilla E, Adrover-Roig D. Is language impaired in Spanish-speaking children with autism spectrum disorder level 1? AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2024; 9:23969415241275931. [PMID: 39221433 PMCID: PMC11363034 DOI: 10.1177/23969415241275931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
The current diagnostic criteria for the autism spectrum disorder (ASD) include the possibility to specify concomitant language difficulties. Purpose Our main aim was to explore whether children with ASD-Level 1 (ASD-L1) present difficulties in the acquisition of structural language, as little work has been done in this regard so far. As a secondary aim we evaluated the degree to which the potential language impairment in ASD is directly associated with their social communication deficits or it represents a distinct deficit. Methods To further clarify the nature and characteristics of putative language difficulties in ASD-L1, we evaluated language skills in 89 children and preadolescents diagnosed with ASD-L1, and a group of typically developing participants (TD). All of them were between 8 and 13 years old and had similar socioeconomic backgrounds. Results Children with ASD-L1 obtained lower scores than those in TD group in repeating sentences, in finding the semantic relationships between words, and in applying word structure rules (morphology). Congruently, the core language standard score was lower in the ASD-L1 group, and the proportion of language delay was significantly higher in the ASD-L1 group than in the control group. Conclusion Language scores were associated with autistic traits; thus, language performance in ASD-L1 is closely related to autistic symptoms. These results are discussed according to the literature on linguistic deficits in ASD-L1 and their relations with phonological working memory.
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Affiliation(s)
- Alberto Sánchez Pedroche
- Department of Applied Pedagogy and Educational Psychology, Institute of Research and Innovation in Education (IRIE), University of Balearic Islands, Palma, Spain
| | - Mario Valera-Pozo
- Department of Applied Pedagogy and Educational Psychology, Institute of Research and Innovation in Education (IRIE), University of Balearic Islands, Palma, Spain
| | - Angelica Mateus Moreno
- Human Communication Department, Faculty of Medicine, Universidad Nacional de Colombia, Bogotà, Colombia
| | - Maria Fernanda Lara Díaz
- Human Communication Department, Faculty of Medicine, Universidad Nacional de Colombia, Bogotà, Colombia
| | | | - Daniel Adrover-Roig
- Department of Applied Pedagogy and Educational Psychology, Institute of Research and Innovation in Education (IRIE), University of Balearic Islands, Palma, Spain
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Maenner MJ, Warren Z, Williams AR, Amoakohene E, Bakian AV, Bilder DA, Durkin MS, Fitzgerald RT, Furnier SM, Hughes MM, Ladd-Acosta CM, McArthur D, Pas ET, Salinas A, Vehorn A, Williams S, Esler A, Grzybowski A, Hall-Lande J, Nguyen RH, Pierce K, Zahorodny W, Hudson A, Hallas L, Mancilla KC, Patrick M, Shenouda J, Sidwell K, DiRienzo M, Gutierrez J, Spivey MH, Lopez M, Pettygrove S, Schwenk YD, Washington A, Shaw KA. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020. MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES (WASHINGTON, D.C. : 2002) 2023; 72:1-14. [PMID: 36952288 PMCID: PMC10042614 DOI: 10.15585/mmwr.ss7202a1] [Citation(s) in RCA: 509] [Impact Index Per Article: 509.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Problem/Condition Autism spectrum disorder (ASD). Period Covered 2020. Description of System The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance program that provides estimates of the prevalence of ASD among children aged 8 years. In 2020, there were 11 ADDM Network sites across the United States (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin). To ascertain ASD among children aged 8 years, ADDM Network staff review and abstract developmental evaluations and records from community medical and educational service providers. A child met the case definition if their record documented 1) an ASD diagnostic statement in an evaluation, 2) a classification of ASD in special education, or 3) an ASD International Classification of Diseases (ICD) code. Results For 2020, across all 11 ADDM sites, ASD prevalence per 1,000 children aged 8 years ranged from 23.1 in Maryland to 44.9 in California. The overall ASD prevalence was 27.6 per 1,000 (one in 36) children aged 8 years and was 3.8 times as prevalent among boys as among girls (43.0 versus 11.4). Overall, ASD prevalence was lower among non-Hispanic White children (24.3) and children of two or more races (22.9) than among non-Hispanic Black or African American (Black), Hispanic, and non-Hispanic Asian or Pacific Islander (A/PI) children (29.3, 31.6, and 33.4 respectively). ASD prevalence among non-Hispanic American Indian or Alaska Native (AI/AN) children (26.5) was similar to that of other racial and ethnic groups. ASD prevalence was associated with lower household income at three sites, with no association at the other sites.Across sites, the ASD prevalence per 1,000 children aged 8 years based exclusively on documented ASD diagnostic statements was 20.6 (range = 17.1 in Wisconsin to 35.4 in California). Of the 6,245 children who met the ASD case definition, 74.7% had a documented diagnostic statement of ASD, 65.2% had a documented ASD special education classification, 71.6% had a documented ASD ICD code, and 37.4% had all three types of ASD indicators. The median age of earliest known ASD diagnosis was 49 months and ranged from 36 months in California to 59 months in Minnesota.Among the 4,165 (66.7%) children with ASD with information on cognitive ability, 37.9% were classified as having an intellectual disability. Intellectual disability was present among 50.8% of Black, 41.5% of A/PI, 37.8% of two or more races, 34.9% of Hispanic, 34.8% of AI/AN, and 31.8% of White children with ASD. Overall, children with intellectual disability had earlier median ages of ASD diagnosis (43 months) than those without intellectual disability (53 months). Interpretation For 2020, one in 36 children aged 8 years (approximately 4% of boys and 1% of girls) was estimated to have ASD. These estimates are higher than previous ADDM Network estimates during 2000-2018. For the first time among children aged 8 years, the prevalence of ASD was lower among White children than among other racial and ethnic groups, reversing the direction of racial and ethnic differences in ASD prevalence observed in the past. Black children with ASD were still more likely than White children with ASD to have a co-occurring intellectual disability. Public Health Action The continued increase among children identified with ASD, particularly among non-White children and girls, highlights the need for enhanced infrastructure to provide equitable diagnostic, treatment, and support services for all children with ASD. Similar to previous reporting periods, findings varied considerably across network sites, indicating the need for additional research to understand the nature of such differences and potentially apply successful identification strategies across states.
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Bulkley JE, Varga AM, Dickerson JF, Crawford P, Croen LA, Daida YG, Fombonne E, Hatch B, Lee A, Massolo M, Vaughn K, Lynch FL. A framework for measuring the cost to families of caring for children's health: the design, methodology, and study population of the r-Kids study. BMC Pediatr 2023; 23:128. [PMID: 36941585 PMCID: PMC10025806 DOI: 10.1186/s12887-023-03893-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 02/06/2023] [Indexed: 03/22/2023] Open
Abstract
BACKGROUND All families experience financial and time costs related to caring for their children's health. Understanding the economic burden faced by families of children with chronic health conditions (CHC) is crucial for designing effective policies to support families. METHODS In this prospective study we used electronic health records to identify children between 3 and 17 years old with autism spectrum disorder (ASD), asthma, or neither (control) from three Kaiser Permanente regions and several community health centers in the OCHIN network. We oversampled children from racial and ethnic minority groups. Parent/guardian respondents completed surveys three times, approximately four months apart. The surveys included the Family Economic Impact Inventory (measuring financial, time, and employment costs of caring for a child's health), and standardized measures of children's quality of life, behavioral problems, and symptom severity for children with ASD or asthma. We also assessed parenting stress and parent physical and mental health. All materials were provided in English and Spanish. RESULTS Of the 1,461 families that enrolled (564 ASD, 468 asthma, 429 control), children were predominantly male (79%), with a mean age of 9.0 years, and racially and ethnically diverse (43% non-Hispanic white; 22% Hispanic; 35% Asian, Black, Native Hawaiian, or another race/ethnicity). The majority of survey respondents were female (86%), had a college degree (62%), and were married/partnered (79%). ASD group respondents were less likely to be employed (73%) than those in the asthma or control groups (both 80%; p = .023). Only 32% of the control group reported a household income ≤ $4,000/month compared with 41% of asthma and 38% of ASD families (p = .006). CONCLUSIONS Utilizing a novel measure assessing family economic burden, we successfully collected survey responses from a large and diverse sample of families. Drawing upon the conceptual framework, survey measures, and self-report data described herein we will conduct future analyses to examine the economic burdens related to CHC and the incremental differences in these burdens between health groups. This information will help policy makers to design more equitable health and social policies that could reduce the burden on families.
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Affiliation(s)
- Joanna E Bulkley
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA.
| | - Alexandra M Varga
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - John F Dickerson
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - Phil Crawford
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - Lisa A Croen
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Yihe G Daida
- Kaiser Permanente Center for Integrated Health Care Research, Honolulu, HI, USA
| | - Eric Fombonne
- Oregon Health & Science University, Portland, OR, USA
| | - Brigit Hatch
- Oregon Health & Science University, Portland, OR, USA
- OCHIN, Inc, Portland, OR, USA
| | | | - Maria Massolo
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Katherine Vaughn
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - Frances L Lynch
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
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Hoffmann JA, Alegría M, Alvarez K, Anosike A, Shah PP, Simon KM, Lee LK. Disparities in Pediatric Mental and Behavioral Health Conditions. Pediatrics 2022; 150:e2022058227. [PMID: 36106466 PMCID: PMC9800023 DOI: 10.1542/peds.2022-058227] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 12/31/2022] Open
Abstract
Mental and behavioral health conditions are common among children and adolescents in the United States. The purpose of this state-of the-art review article is to describe inequities in mental and behavioral health care access and outcomes for children and adolescents, characterize mechanisms behind the inequities, and discuss strategies to decrease them. Understanding the mechanisms underlying these inequities is essential to inform strategies to mitigate these health disparities. Half of United States children with a treatable mental health disorder do not receive treatment from a mental health professional. Children and adolescents in racial, ethnic, sexual, sex, and other minority groups experience inequities in access to care and disparities in outcomes for mental and behavioral health conditions. Suicide rates are nearly twice as high in Black compared to White boys 5 to 11 years old and have been increasing disproportionately among adolescent Black girls 12 to 17 years old. Children identifying as a sexual minority have >3 times increased odds of attempting suicide compared to heterosexual peers. Adverse experiences of children living as part of a minority group, including racism and discrimination, have immediate and lasting effects on mental health. Poverty and an uneven geographic distribution of resources also contribute to inequities in access and disparities in outcomes for mental and behavioral health conditions. Strategies to address inequities in mental and behavioral health among United States children include investing in a diverse workforce of mental health professionals, improving access to school-based services, ensuring equitable access to telehealth, and conducting quality improvement with rigorous attention to equity.
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Affiliation(s)
- Jennifer A. Hoffmann
- . Division of Emergency Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine; Chicago, IL
| | - Margarita Alegría
- . Disparities Research Unit, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Kiara Alvarez
- . Disparities Research Unit, Massachusetts General Hospital, Department of Medicine, Harvard Medical School, Boston, MA
| | - Amara Anosike
- . Office of Government Relations, Boston Children’s Hospital, Boston, MA
| | | | - Kevin M. Simon
- . Adolescent Substance use and Addiction Program, Boston Children’s Hospital, Boston, Massachusetts; Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts; Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Boston, MA, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Lois K. Lee
- . Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA
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12
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Luelmo P, Larios R, Castellon F. Latinx caregivers and autism identification: what we know a scoping review. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 70:571-581. [PMID: 38983495 PMCID: PMC11229736 DOI: 10.1080/20473869.2022.2114777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 08/14/2022] [Indexed: 07/11/2024]
Abstract
This is a scoping review driven by the broad research question: What are Latinx caregivers' specific facilitators and challenges, if any, in getting a timely diagnosis/identification for their child with autism? Our search resulted in 128 articles across various disciplines. A total of 43 articles were included in the final article set. Employing an inductive process, the experiences of Latinx caregiver(s) in obtaining a diagnosis/identification were coded and categorized. From that process, three broad themes were identified: (1) Diagnosis/identification barriers and facilitators (2) System changes and (3) Cultural adaptations and intersectionality. These themes represent the myriad of considerations that have been purported in the existing body of literature to frame an understanding of the experiences that Latinx/Hispanic caregivers encounter as they seek to obtain an autism diagnosis/identification for their child.
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Affiliation(s)
- Paul Luelmo
- Department of Special Education, San Diego State University, San Diego, CA, USA
| | - Rosalinda Larios
- Department of Special Education, California State Fullerton, Fullerton, CA, USA
| | - Fernanda Castellon
- Department of Education, University of California, Los Angeles, Los Angeles, CA, USA
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13
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Williams EDG, Smith MJ, Sherwood K, Lovelace TS, Bishop L. Brief Report: Initial Evidence of Depressive Symptom Disparities among Black and White Transition Age Autistic Youth. J Autism Dev Disord 2022; 52:3740-3745. [PMID: 34417653 PMCID: PMC8858325 DOI: 10.1007/s10803-021-05242-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
Abstract
The lived experience of being autistic and being Black in America both put youth at higher risk for developing depressive symptoms. However, there is a dearth of research examining potential disparities in autistic youth with depression. The current study examined disparities in depressive symptoms among a sample of Black and White autistic youth between the ages of 16 and 26 years old. Using analysis of covariance this study found that the Black autistic youth had significantly higher depressive symptoms than White autistic youth (m = 7.3, sd = 4.4 vs. m = 3.8, sd = 3.6; t = 2.6, p = 0.013). This study presents initial evidence of a significant racial disparity between Black and White autistic youth depressive symptoms.
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Affiliation(s)
| | - Matthew J Smith
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Kari Sherwood
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Temple S Lovelace
- Department of Counseling, Psychology, and Special Education, Duquesne University, Pittsburgh, PA, USA
| | - Lauren Bishop
- Waisman Center, University of Wisconsin, Madison, WI, USA
- Sandra Rosenbaum School of Social Work, University of Wisconsin, Madison, WI, USA
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14
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Russ SA, Hotez E, Berghaus M, Hoover C, Verbiest S, Schor EL, Halfon N. Building a Life Course Intervention Research Framework. Pediatrics 2022; 149:186923. [PMID: 35503325 PMCID: PMC9847427 DOI: 10.1542/peds.2021-053509e] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To report on first steps toward building a Life Course Intervention Research Framework (LCIRF) to guide researchers studying interventions to improve lifelong health. METHODS The Life Course Intervention Research Network, a collaborative national network of >75 researchers, service providers, community representatives and thought leaders, participated in an iterative review process. Building on the revised Medical Research Council Guidance for Developing and Evaluating Complex Interventions, they identified 12 additional key models with features for inclusion in the LCIRF, then incorporated the 12 characteristics identified by the Life Course Intervention Research Network as actionable features of Life Course Interventions to produce the new LCIRF. RESULTS The LCIRF sets out a detailed step-wise approach to intervention development: (1) conceptualization and planning, (2) design, (3) implementation, (4) evaluation, and (5) spreading and scaling of interventions. Each step is infused with life course intervention characteristics including a focus on (1) collaborative codesign (2) health optimization, (3) supporting emerging health development capabilities (4) strategic timing, (5) multilevel approaches, and (6) health equity. Key features include a detailed transdisciplinary knowledge synthesis to inform intervention development; formation of strong partnerships with family, community, and youth representatives in intervention codesign; a means of testing the impact of each intervention on biobehavioral processes underlying emerging health trajectories; and close attention to intervention context. CONCLUSIONS This first iteration of the LCIRF has been largely expert driven. Next steps will involve widespread partner engagement in framework refinement and further development. Implementation will require changes to the way intervention studies are organized and funded.
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Affiliation(s)
- Shirley A. Russ
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, Los Angeles, California,Departments of Pediatrics,Address correspondence to Shirley Russ, MD, 10960 Wilshire Blvd Suite 960, Los Angeles, CA 90024. E-mail:
| | - Emily Hotez
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, Los Angeles, California,Medicine, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Mary Berghaus
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, Los Angeles, California,Departments of Pediatrics
| | | | - Sarah Verbiest
- School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Neal Halfon
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, Los Angeles, California,Departments of Pediatrics,Department of Health Policy and Management, Fielding School of Public Health,Department of Public Policy, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California
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15
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Affiliation(s)
- Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, Tennessee
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16
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Hsu YH, Chen CW, Lin YJ, Li CY. Urban-Rural Disparity in the Incidence of Diagnosed Autism Spectrum Disorder in Taiwan: A 10-Year National Birth Cohort Follow-up Study. J Autism Dev Disord 2022; 53:2127-2137. [PMID: 35132529 DOI: 10.1007/s10803-022-05453-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 12/15/2022]
Abstract
Autism spectrum disorder (ASD) is reportedly more prevalent in urban areas partly because of better accessibility and affordability to healthcare. With universal health insurance coverage in Taiwan, a previous study has shown no urban-rural disparity in the utilization rate of a child's preventive healthcare. Under this circumstance, we followed a birth cohort of 176,273 live births from 2006 to 2015 to detect the differences in ASD incidence between urbanicities. After adjusting for socioeconomic factors, children were 1.28 (95% confidence interval (CI): 1.13-1.44) and 1.54 (95% CI: 1.36-1.75) more likely to acquire ASD in satellite and urban areas compared with those in rural areas, respectively. A gradient association between parental educational attainment and ASD incidence was also noted. Greater ASD incidences in more urbanized areas and more advanced educated parents' children were detected under a circumstance with low barriers to healthcare.
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Affiliation(s)
- Yuu-Hueih Hsu
- Department of Public Health, National Cheng Kung University, No. 138, Shengli Rd., North Dist., Tainan, 704302, Taiwan
| | - Chi-Wen Chen
- College of Nursing, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Taipei, 112, Taiwan
| | - Yuh-Jyh Lin
- Department of Pediatrics, National Cheng Kung University Hospital, No. 138, Shengli Rd., North Dist., Tainan, 704302, Taiwan
| | - Chung-Yi Li
- Department of Public Health, National Cheng Kung University, No. 138, Shengli Rd., North Dist., Tainan, 704302, Taiwan. .,Department of Public Health, College of Public Health, China Medical University, No. 91, Hsueh-Shih Rd., Taichung, 40402, Taiwan. .,Department of Healthcare Administration, College of Medical and Health Science, Asia University, No. 500, Lioufeng Rd., Wufeng, Taichung, 41354, Taiwan.
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17
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Shenouda J, Barrett E, Davidow AL, Halperin W, Silenzio VMB, Zahorodny W. Prevalence of autism spectrum disorder in a large, diverse metropolitan area: Variation by sociodemographic factors. Autism Res 2022; 15:146-155. [PMID: 34672116 PMCID: PMC8755586 DOI: 10.1002/aur.2628] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/28/2021] [Accepted: 09/30/2021] [Indexed: 01/03/2023]
Abstract
Autism spectrum disorder (ASD) prevalence estimates have varied by region. In this study, ASD prevalence, based on active case finding from multiple sources, was determined at the county and school district levels in the New Jersey metropolitan area. Among children born in 2008, residing in a four-county area and enrolled in public school in 2016, ASD prevalence was estimated to be 36 per 1000, but was significantly higher in one region-54 per 1000 and greater than 70 per 1000, in multiple school districts. Significant variation in ASD prevalence by race/ethnicity, socioeconomic status (SES), and school district size was identified. Highest prevalence was in mid-SES communities, contrary to expectation. Prevalence among Hispanic children was lower than expected, indicating a disparity in identification. Comprehensive surveillance should provide estimates at the county and town levels to appreciate ASD trends, identify disparities in detection or treatment, and explore factors influencing change in prevalence. LAY SUMMARY: We found autism prevalence to be 3.6% in New Jersey overall, but higher in one region (5.4%) and in multiple areas approaching 7.0%. We identified significant variation in autism spectrum disorder (ASD) prevalence by race/ethnicity, socioeconomic status (SES) and school district size. Mapping prevalence in smaller, well-specified, regions may be useful to better understand the true scope of ASD, disparities in ASD detection and the factors impacting ASD prevalence estimation.
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Affiliation(s)
- Josephine Shenouda
- Department of Biostatistics and Epidemiology, Rutgers – School of Public Health, 170 Frelinghuysen Rd, Piscataway, NJ 08854,Department of Pediatrics, Rutgers – New Jersey Medical School, 185 South Orange Ave F-511, Newark, NJ 07103
| | - Emily Barrett
- Department of Biostatistics and Epidemiology, Rutgers – School of Public Health, 170 Frelinghuysen Rd, Piscataway, NJ 08854,Environmental and Occupational Health Sciences Institute, Rutgers School of Public Health, 170 Frelinghuysen Rd, Piscataway, NJ 08854
| | - Amy L. Davidow
- Department of Biostatistics and Epidemiology, Rutgers – School of Public Health, 170 Frelinghuysen Rd, Piscataway, NJ 08854
| | - William Halperin
- Department of Biostatistics and Epidemiology, Rutgers – School of Public Health, 170 Frelinghuysen Rd, Piscataway, NJ 08854
| | - Vincent M. B. Silenzio
- Department of Urban-Global Public Health, Rutgers School of Public Health, 170 Frelinghuysen Rd, Piscataway, NJ 08854
| | - Walter Zahorodny
- Department of Pediatrics, Rutgers – New Jersey Medical School, 185 South Orange Ave F-511, Newark, NJ 07103
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18
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Hanley A, Nguyen QC, Badawi DG, Chen J, Ma T, Slopen N. The diagnostic odyssey of autism: a cross-sectional study of 3 age cohorts of children from the 2016-2018 National Survey of Children's Health. Child Adolesc Psychiatry Ment Health 2021; 15:58. [PMID: 34629109 PMCID: PMC8504038 DOI: 10.1186/s13034-021-00409-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/20/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Autism prevalence has increased rapidly in recent years, however, nationally representative estimates on the ages of first identification and intervention are out of date. Objectives: (1) To estimate the ages at which children with autism receive their first diagnosis, intervention plan, and developmental services; and (2) To evaluate differences in ages at events by birth cohort and sociodemographic characteristics. METHODS Using cross-sectional data from the 2016-2018 National Survey of Children's Health (NSCH), we examined associations via linear regression among a sample of 2303 children aged 2-17 years old, who had ever been diagnosed with autism and either (1) ever had a plan for special education or early intervention, or (2) ever received special services to meet developmental needs. Exposures included age cohort, child, household and healthcare provider characteristics. RESULTS Most children in the study sample (n = 2303) were over age 6 years, male, of non-Hispanic white race/ethnicity and had mild/moderate autism. Mean ages (years) at first diagnosis was 4.56 (SE = 0.13); first plan was 4.43 (SE = 0.11); and first services was 4.10 (SE = 0.11). After adjustment for exposures and survey year, the middle childhood cohort was 18 months older at first intervention (β = 1.49, 95% CI, 1.18-1.81), and adolescents were 38 months older at first diagnosis (β = 3.16, 95% CI, 2.72-3.60) compared to those in early childhood. Younger ages at events were observed among: Hispanic/Latinx as compared to white children, those with moderate or severe symptoms as compared to mild symptoms, and children who received their diagnosis from a specialist as compared to psychologists or psychiatrists. CONCLUSIONS Children with autism receive their first diagnosis, intervention plans and developmental services at younger ages than they had in the past. Future research is needed to identify the mechanisms for these improvements in early identification and intervention to accelerate additional progress.
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Affiliation(s)
- Allison Hanley
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | - Quynh C Nguyen
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | - Deborah Golant Badawi
- Division of Developmental-Behavioral Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jie Chen
- Department of Health Policy and Management, University of Maryland, College Park, MD, USA
| | - Tianzhou Ma
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, 02115, USA.
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19
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Blaxill M, Rogers T, Nevison C. Autism Tsunami: the Impact of Rising Prevalence on the Societal Cost of Autism in the United States. J Autism Dev Disord 2021; 52:2627-2643. [PMID: 34278527 PMCID: PMC9114071 DOI: 10.1007/s10803-021-05120-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2021] [Indexed: 11/25/2022]
Abstract
The cost of ASD in the U.S. is estimated using a forecast model that for the first time accounts for the true historical increase in ASD. Model inputs include ASD prevalence, census population projections, six cost categories, ten age brackets, inflation projections, and three future prevalence scenarios. Future ASD costs increase dramatically: total base-case costs of $223 (175–271) billion/year are estimated in 2020; $589 billion/year in 2030, $1.36 trillion/year in 2040, and $5.54 (4.29–6.78) trillion/year by 2060, with substantial potential savings through ASD prevention. Rising prevalence, the shift from child to adult-dominated costs, the transfer of costs from parents onto government, and the soaring total costs raise pressing policy questions and demand an urgent focus on prevention strategies.
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Affiliation(s)
| | | | - Cynthia Nevison
- Institute for Alpine and Arctic Research, University of Colorado, Boulder, CO, USA
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20
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Finkelman MD, Wei T, Lowe SR. Computer-Based Testing to Shorten the Social Communication Questionnaire (SCQ): a Proof- of-Principle Study of the Lifetime and Current Forms. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021. [DOI: 10.1007/s10862-020-09853-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Are Developmental Monitoring and Screening Better Together for Early Autism Identification Across Race and Ethnic Groups? J Autism Dev Disord 2021; 52:203-218. [PMID: 33666797 DOI: 10.1007/s10803-021-04943-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
National Surveys of Children's Health (NSCH, 2016-2018) data were analyzed to determine if conjoint monitoring and screening showed stronger associations with children under 5 identified with ASD compared to monitoring alone, screening alone or no monitoring or screening; and investigate relationships between monitoring and screening across racial/ethnic subgroups. 86 of 332 children with ASD received their diagnosis in a timeframe suggesting potential monitoring and screening for identification purposes. Analyses showed that conjoint monitoring and screening and monitoring alone, but not screening alone, was associated with early identified ASD cases across race groups. Caution is warranted as interpreting NSCH monitoring and screening items solely for identification purposes is inaccurate in many cases. More research on monitoring with screening is needed.
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22
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Yuan J, Li M, Lu ZK. Racial/Ethnic Disparities in the Prevalence and Trends of Autism Spectrum Disorder in US Children and Adolescents. JAMA Netw Open 2021; 4:e210771. [PMID: 33666658 PMCID: PMC7936258 DOI: 10.1001/jamanetworkopen.2021.0771] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This cross-sectional study uses data from the National Health Interview Survey to assess racial/ethnic disparities in the prevalence and trends of autism spectrum disorder among US children and adolescents.
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Affiliation(s)
- Jing Yuan
- Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, Fudan University, Shanghai, China
| | - Minghui Li
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis
| | - Z. Kevin Lu
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia
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23
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Nevison C, Parker W. California Autism Prevalence by County and Race/Ethnicity: Declining Trends Among Wealthy Whites. J Autism Dev Disord 2021; 50:4011-4021. [PMID: 32193763 PMCID: PMC7557477 DOI: 10.1007/s10803-020-04460-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
County-level ASD prevalence was estimated using an age-resolved snapshot from the California Department of Developmental Services (DDS) for birth years 1993–2013. ASD prevalence increased among all children across birth years 1993–2000 but plateaued or declined thereafter among whites from wealthy counties. In contrast, ASD rates increased continuously across 1993–2013 among whites from lower income counties and Hispanics from all counties. Both white ASD prevalence and rate of change in prevalence were inversely correlated to county income from birth year 2000–2013 but not 1993–2000. These disparate trends within the dataset suggest that wealthy white parents, starting around 2000, may have begun opting out of DDS in favor of private care and/or making changes that effectively lowered their children’s risk of ASD.
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Affiliation(s)
- Cynthia Nevison
- Institute for Alpine and Arctic Research, University of Colorado, Campus Box 450, Boulder, 80309-0450, USA.
| | - William Parker
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
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24
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Winter AS, Fountain C, Cheslack-Postava K, Bearman PS. The social patterning of autism diagnoses reversed in California between 1992 and 2018. Proc Natl Acad Sci U S A 2020; 117:30295-30302. [PMID: 33199592 DOI: 10.1073/pnas.2015762117/-/dcsupplemental] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023] Open
Abstract
As rates of autism diagnosis increased dramatically over the past number of decades, prevalence rates were generally highest among Whites and among those of higher socioeconomic status (SES). Using a unique, population-level dataset, we find that rates of autism diagnosis continued to be on the rise in recent years, but who is diagnosed changed during the study period. Our data consist of birth records of all 13,272,573 children born in the state of California in 1992 through 2016 linked to autism caseload records for January 1992 through November 2019 from California's Department of Developmental Services. California's diagnosed autism incidence rate rose from 0.49 per 1,000 3-6 y olds in 1998 to 3.49 per 1,000 3-6 y olds in 2018, a 612% increase. However, diagnosed incidence rates did not rise uniformly across sociodemographic groups. By 2018, children of Black and Asian mothers were diagnosed at higher rates than children of non-Hispanic White mothers. Furthermore, among children of non-Hispanic White and Asian mothers, children of lower SES were diagnosed at higher rates than children of higher SES. These changes align with sociological theories of health disparities and contain important clues for more fully understanding the autism epidemic.
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Affiliation(s)
- Alix S Winter
- Interdisciplinary Center for Innovative Theory and Empirics, Columbia University, New York, NY 10027
| | - Christine Fountain
- Department of Sociology & Anthropology, Fordham University at Lincoln Center, New York, NY 10023
| | | | - Peter S Bearman
- Interdisciplinary Center for Innovative Theory and Empirics, Columbia University, New York, NY 10027;
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25
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Winter AS, Fountain C, Cheslack-Postava K, Bearman PS. The social patterning of autism diagnoses reversed in California between 1992 and 2018. Proc Natl Acad Sci U S A 2020; 117:30295-30302. [PMID: 33199592 PMCID: PMC7720167 DOI: 10.1073/pnas.2015762117] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
As rates of autism diagnosis increased dramatically over the past number of decades, prevalence rates were generally highest among Whites and among those of higher socioeconomic status (SES). Using a unique, population-level dataset, we find that rates of autism diagnosis continued to be on the rise in recent years, but who is diagnosed changed during the study period. Our data consist of birth records of all 13,272,573 children born in the state of California in 1992 through 2016 linked to autism caseload records for January 1992 through November 2019 from California's Department of Developmental Services. California's diagnosed autism incidence rate rose from 0.49 per 1,000 3-6 y olds in 1998 to 3.49 per 1,000 3-6 y olds in 2018, a 612% increase. However, diagnosed incidence rates did not rise uniformly across sociodemographic groups. By 2018, children of Black and Asian mothers were diagnosed at higher rates than children of non-Hispanic White mothers. Furthermore, among children of non-Hispanic White and Asian mothers, children of lower SES were diagnosed at higher rates than children of higher SES. These changes align with sociological theories of health disparities and contain important clues for more fully understanding the autism epidemic.
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Affiliation(s)
- Alix S Winter
- Interdisciplinary Center for Innovative Theory and Empirics, Columbia University, New York, NY 10027
| | - Christine Fountain
- Department of Sociology & Anthropology, Fordham University at Lincoln Center, New York, NY 10023
| | | | - Peter S Bearman
- Interdisciplinary Center for Innovative Theory and Empirics, Columbia University, New York, NY 10027;
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26
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Hunter SK, Hoffman MC, McCarthy L, D’Alessandro A, Wyrwa A, Noonan K, Christians U, Nakimuli-Mpungu E, Zeisel SH, Law AJ, Freedman R. Black American Maternal Prenatal Choline, Offspring Gestational Age at Birth, and Developmental Predisposition to Mental Illness. Schizophr Bull 2020; 47:896-905. [PMID: 33184653 PMCID: PMC8266582 DOI: 10.1093/schbul/sbaa171] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Black Americans have increased risk for schizophrenia and other mental illnesses with prenatal origins. Prenatal choline promotes infant brain development and behavioral outcomes, but choline has not been specifically assessed in Black Americans. Pregnant women (N = 183, N = 25 Black Americans) enrolled in a study of prenatal stressors and interactions with prenatal choline. Black American women had lower 16-week gestation plasma choline than Whites. Lower choline was not related to obesity, income, or metabolic genotypes. Pregnant women in rural Uganda have higher choline levels than Black American women. Black Americans' lower choline was associated with higher hair cortisol, indicative of higher stress. Lower maternal choline was associated with offsprings' lower gestational age at birth and with decreased auditory P50 inhibition, a marker of inhibitory neuron development. Behavioral development was assessed on the Infant Behavior Questionnaire-R-SF (IBQ-R) at 3 months. Lower Black American maternal gestational choline was associated with lower infant IBQ-R Orienting/Regulation, indicating decreased attention and relation to caregivers. Additional evidence for developmental effects of choline in Black Americans comes from a randomized clinical trial of gestational phosphatidylcholine supplementation versus placebo that included 15 Black Americans. Phosphatidylcholine increased gestational age at birth and newborn P50 inhibition and decreased Social Withdrawn and Attention problems at 40 months of age in Black Americans' offspring compared to placebo. Inhibitory and behavioral deficits associated with lower prenatal choline in offspring of Black American women indicate potential developmental predispositions to later mental illnesses that might be ameliorated by prenatal choline or phosphatidylcholine supplementation.
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Affiliation(s)
- Sharon K Hunter
- Department of Psychiatry, University of Colorado School of
Medicine, Aurora, CO
| | - M Camille Hoffman
- Department of Psychiatry, University of Colorado School of
Medicine, Aurora, CO,Department of Obstetrics and Gynecology, Division of Maternal and Fetal
Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Lizbeth McCarthy
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal
Medicine, University of Colorado School of Medicine, Aurora, CO,Department of Obstetrics and Gynecology, Denver Health Medical
Center, Denver, CO
| | - Angelo D’Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado
School of Medicine, Aurora, CO
| | - Anna Wyrwa
- Department of Psychiatry, University of Colorado School of
Medicine, Aurora, CO
| | - Kathleen Noonan
- Department of Psychiatry, University of Colorado School of
Medicine, Aurora, CO
| | - Uwe Christians
- Department of Anesthesiology, iC42 Clinical Research and Development,
University of Colorado School of Medicine, Aurora, CO
| | - Etheldreda Nakimuli-Mpungu
- Department of Psychiatry, School of Medicine, Makerere University College of
Health Sciences. Kampala, Uganda
| | - Steven H Zeisel
- Departments of Nutrition and Pediatrics, University of North
Carolina, Chapel Hill, NC
| | - Amanda J Law
- Department of Psychiatry, University of Colorado School of
Medicine, Aurora, CO,Department of Cell and Developmental Biology, University of Colorado School of
Medicine, Aurora, CO
| | - Robert Freedman
- Department of Psychiatry, University of Colorado School of
Medicine, Aurora, CO,To whom correspondence should be addressed; Department of Psychiatry F-546,
University of Colorado Denver School of Medicine, Anschutz Medical Center, Aurora, CO
80045, US; tel: 720-224-4638, fax: 303-724-4960, e-mail:
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27
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Durkin MS, Wolfe BL. Trends in Autism Prevalence in the U.S.: A Lagging Economic Indicator? J Autism Dev Disord 2020; 50:1095-1096. [PMID: 31802318 DOI: 10.1007/s10803-019-04322-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Maureen S Durkin
- Department of Population Health Sciences, University of Wisconsin-Madison, 707C WARF, 610 Walnut Street, Madison, WI, 53726, USA.
| | - Barbara L Wolfe
- Department of Population Health Sciences, University of Wisconsin-Madison, 707C WARF, 610 Walnut Street, Madison, WI, 53726, USA
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28
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Garcia Primo P, Weber C, Posada de la Paz M, Fellinger J, Dirmhirn A, Holzinger D. Explaining Age at Autism Spectrum Diagnosis in Children with Migrant and Non-Migrant Background in Austria. Brain Sci 2020; 10:brainsci10070448. [PMID: 32674382 PMCID: PMC7407505 DOI: 10.3390/brainsci10070448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/31/2022] Open
Abstract
This study explored (i) differences in age at Autism Spectrum Disorder (ASD) diagnosis between children with and without a migrant background in the main diagnostic centre for ASD in Upper Austria (ii) factors related to the age at diagnosis and (iii) whether specific factors differed between the two groups. A retrospective chart analysis included all children who received their first diagnosis before the age of 10 years (n = 211) between 2013 and 2018. Children with a migrant background were diagnosed 13 months earlier than those without (r = 0.278, p < 0.001), and had more severe delays in language, more severe autism, no Asperger’s syndrome, lower parental educational level and more frequent referrals by paediatricians. For the total sample, expressive language delay, severity of restricted and repetitive behaviours, higher nonverbal development, and paediatric referrals explained earlier diagnoses. There was a stronger effect of parental education and weaker effect of language impairment on age at ASD diagnosis in children with a migrant background. In conclusion, no delay in diagnosing ASD in children with a migrant background in a country with universal health care and an established system of paediatric developmental surveillance was found. Awareness of ASD, including Asperger’s syndrome, should be raised among families and healthcare professionals.
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Affiliation(s)
- Patricia Garcia Primo
- Research Institute of Developmental Medicine, Johannes Kepler University, 4020 Linz, Austria; (P.G.P.); (C.W.); (J.F.); (D.H.)
| | - Christoph Weber
- Research Institute of Developmental Medicine, Johannes Kepler University, 4020 Linz, Austria; (P.G.P.); (C.W.); (J.F.); (D.H.)
- Department for Inclusive Education, University of Education Upper Austria, 4020 Linz, Austria
| | - Manuel Posada de la Paz
- Institute of Rare Diseases Research (IIER) & CIBERER, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence:
| | - Johannes Fellinger
- Research Institute of Developmental Medicine, Johannes Kepler University, 4020 Linz, Austria; (P.G.P.); (C.W.); (J.F.); (D.H.)
- Institut für Sinnes- und Sprachneurologie, Konventhospital Barmherzige Brüder, 4020 Linz, Austria;
- Division of Social Psychiatry, Medical University of Vienna, 1010 Vienna, Austria
| | - Anna Dirmhirn
- Institut für Sinnes- und Sprachneurologie, Konventhospital Barmherzige Brüder, 4020 Linz, Austria;
| | - Daniel Holzinger
- Research Institute of Developmental Medicine, Johannes Kepler University, 4020 Linz, Austria; (P.G.P.); (C.W.); (J.F.); (D.H.)
- Institut für Sinnes- und Sprachneurologie, Konventhospital Barmherzige Brüder, 4020 Linz, Austria;
- Institute of Linguistics, Karl-Franzens University of Graz, 8010 Graz, Austria
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