1
|
Alehagen L, Bölte S, Black MH. Application of the international classification of functioning, disability, and health in autism and attention-deficit hyperactivity disorder: A scoping review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241272044. [PMID: 39183470 DOI: 10.1177/13623613241272044] [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: 08/27/2024]
Abstract
LAY ABSTRACT The International Classification of Functioning, Disability, and Health (ICF) is a framework designed by the World Health Organization (WHO) to help different sectors, such as healthcare, social services, education, and policy, understand how people with health-related issues function (do the things they want to and need to do) in their daily lives. This framework has also been used to guide clinical practice and research in autism and attention-deficit hyperactivity disorder (ADHD). To make it more practical, shorter versions of the ICF called Core Sets have been developed. We wanted to explore how the ICF and the ICF Core Sets have been used in research relating to autism and ADHD. We looked at the research that had been previously published on this topic by conducting a systematic search and review. Seventy-eight studies meeting our criteria were included in our review. Results show that the ICF has been applied in many ways across various contexts. However, most of the research has focused on autism, mainly involving children. The review highlights that although the ICF was used in some studies, the underlying philosophies of the framework were not always followed. The medical perspective still influenced the way research was done and interpreted. Nevertheless, using the ICF in the right way can help shift research on neurodevelopmental conditions like autism and ADHD toward a more holistic approach, moving away from solely focusing on medical aspects.
Collapse
Affiliation(s)
| | - Sven Bölte
- Karolinska Institutet and Region Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Sweden
- Curtin University, Australia
| | | |
Collapse
|
2
|
Ingersoll B, Espinel A, Nauman J, Broder-Fingert S, Carter AS, Sheldrick RC, Stone WL, Wainer AL. Using virtual multiteam systems to conduct a multisite randomized clinical trial in the part C early intervention system: Benefits, challenges, and lessons learned. Contemp Clin Trials 2024; 143:107585. [PMID: 38821261 PMCID: PMC11283943 DOI: 10.1016/j.cct.2024.107585] [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: 09/14/2023] [Revised: 02/13/2024] [Accepted: 05/28/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND/AIMS COVID-19 necessitated a shift to virtual data collection for many research projects, providing the opportunity for novel approaches to carrying out multi-site clinical trials. Virtual multiteam systems (VMTS) are a type of team structure in which multiple geographically dispersed teams collaborate using technology-mediated communication. The article presents a case study of our use of VMTS, in response to COVID-19, to carry out a multisite randomized hybrid effectiveness-implementation trial of a caregiver-implemented intervention. METHODS We describe how we modified our team structure from predominantly site-specific, co-located teams to predominantly cross-site, virtual teams. We then present examples of how we have conducted the two primary data collection activities virtually. To demonstrate the feasibility of this approach, we present participant demographic information, the percent of cross-site data collection activities, and fidelity data. RESULTS In the first 20 months of data collection, we have enrolled 108 EI providers and 132 families, with 17% and 9% attrition respectively. The family sample is highly diverse in terms of race/ethnicity, parent education, and household income. The majority of provider training activities and roughly 50% of family assessment activities have been conducted cross-site. Fidelity is high, with no differences across site. CONCLUSIONS Our data illustrate the feasibility of using virtual teams, training, and assessment in a multisite clinical trial in the Part C system. We discuss the strengths and challenges of this approach, as well as lessons learned to facilitate the planning of future multisite randomized clinical trials which may benefit from this approach. CLINICAL TRIALS NCT05114538.
Collapse
Affiliation(s)
- Brooke Ingersoll
- Department of Psychology, Michigan State University, 316 Physics Rd., Room 105B, East Lansing, MI 48824, USA.
| | - Anthuanet Espinel
- Department of Psychology, Michigan State University, 316 Physics Rd., Room 105B, East Lansing, MI 48824, USA
| | - Julia Nauman
- Department of Psychology, Michigan State University, 316 Physics Rd., Room 105B, East Lansing, MI 48824, USA
| | | | - Alice S Carter
- Department of Psychology, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA 02125, USA
| | | | - Wendy L Stone
- Department of Psychology, University of Washington, Guthrie Hall Box 351525, Seattle, WA 98195, USA
| | - Allison L Wainer
- Autism Assessment, Research, and Treatment Center, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 603, Chicago, IL 60612, USA
| |
Collapse
|
3
|
Pickard KE, Hendrix NM, Greenfield ES, Yohannes M. Using Causative Methods to Determine System-Level Factors Driving the Uptake and Use of Evidence-Based Practices in a Public Early Intervention System. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:554-566. [PMID: 38431889 DOI: 10.1007/s10488-024-01346-6] [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: 01/18/2024] [Indexed: 03/05/2024]
Abstract
Part C Early Intervention (EI) systems are an entry point to services for autistic toddlers and can be leveraged to facilitate access to autism evidence-based practices (EBPs). However, EI systems are complex and limited research has examined how an EI system's infrastructure (i.e. system-level factors) impacts the adoption and implementation of EBPs. To address this gap, 36 EI providers and 9 EI administrators completed a semi-structured interview or focus group about factors impacting the implementation of autism EBPs. Qualitative analysis included a combination of grounded theory and causative coding. Analyses were refined by input from providers, administrators, and family stakeholders in the form of round tables and presentations at the state's interagency coordinating council. Primary themes centered on: (1) the costs associated with independent contracting structures; (2) operational demands; (3) workforce stability; (4) communication consistency; and (5) implementation supports for EBP implementation. Causative coding helped to demonstrate the perceived relationships between these factors and underscored the important role of incentivization structures, collaboration opportunities, and championing in supporting the use of EBPs within a system that primarily uses independent contracting structures. The current study extends previous research by demonstrating how several system-level factors are perceived to play a role in the adoption and implementation of EBPs by independently contracted EI providers. These findings underscore the need for implementation strategies, such as incentivization strategies and social network building, to increase providers' implementation of autism EBPs within EI systems.
Collapse
Affiliation(s)
- Katherine E Pickard
- Department of Pediatrics, Division of Autism and Related Disabilities, Emory University School of Medicine, Atlanta, USA.
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, USA.
| | - Nicole M Hendrix
- Department of Pediatrics, Division of Autism and Related Disabilities, Emory University School of Medicine, Atlanta, USA
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, USA
| | - Elizabeth S Greenfield
- Department of Pediatrics, Division of Autism and Related Disabilities, Emory University School of Medicine, Atlanta, USA
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, USA
| | - Millena Yohannes
- Department of Pediatrics, Division of Autism and Related Disabilities, Emory University School of Medicine, Atlanta, USA
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, USA
| |
Collapse
|
4
|
Emerson LM, Monk R, van der Meer L, Sutherland D, McLay L. Autistic Co-Led Community Priorities for Future Autism Research in Aotearoa New Zealand. AUTISM IN ADULTHOOD 2024; 6:141-151. [PMID: 39139510 PMCID: PMC11317798 DOI: 10.1089/aut.2022.0109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Background Previous studies of community priorities for autism research have been limited by low representation of autistic people and thus a bias toward the views of families and professionals. We aimed to determine the first community-led priorities for autism research in Aotearoa New Zealand (NZ). Methods Autistic people were essential partners in the project, from inception and design through to methods and outputs. We gathered the views of the autistic and autism communities (including family, practitioners, and researchers) through focus groups (n = 55) and an online survey (n = 450). Almost 40% of the survey respondents indicated that they were autistic. Results The findings across the focus groups and survey highlighted the importance of research that centralizes the experiences and needs of autistic people, particularly of autistic New Zealanders, including culturally specific research for Māori and Pacific peoples. All five priority topics for autistic adults were also priorities for at least one other group: (1) Health, mental health, and well-being of autistic people (all groups); (2) Services across the life span (autistic adults, health care/disability, and education practitioners); (3) Needs of autistic people in Aotearoa NZ (autistic adults, whānau); (4) Perspectives from autistic people with a diverse range of support needs (autistic adults; education practitioners); (5) Quality of life of autistic people in Aotearoa NZ (autistic adults; health care/disability practitioners). Conclusions We discuss the advantages of autistic involvement in research, and how these community priorities can inform future research and policy in NZ.
Collapse
Affiliation(s)
- Lisa Marie Emerson
- Te Kaupeka Oranga—Faculty of Health, Te Whare Wānanga o Waitaha—University of Canterbury, Ōtautahi—Christchurch, Aotearoa, New Zealand
- Autism Research Collaborative Aotearoa New Zealand, Te Whare Wānanga o Waitaha—University of Canterbury, Aotearoa, New Zealand
| | - Ruth Monk
- Te Kaupeka Oranga—Faculty of Health, Te Whare Wānanga o Waitaha—University of Canterbury, Ōtautahi—Christchurch, Aotearoa, New Zealand
- Autism Research Collaborative Aotearoa New Zealand, Te Whare Wānanga o Waitaha—University of Canterbury, Aotearoa, New Zealand
| | - Larah van der Meer
- Autism, New Zealand
- School of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Dean Sutherland
- School of Psychology, Speech and Hearing, Te Whare Wānanga o Waitaha—University of Canterbury, Ōtautahi—Christchurch, Aotearoa, New Zealand
| | - Laurie McLay
- Te Kaupeka Oranga—Faculty of Health, Te Whare Wānanga o Waitaha—University of Canterbury, Ōtautahi—Christchurch, Aotearoa, New Zealand
- Autism Research Collaborative Aotearoa New Zealand, Te Whare Wānanga o Waitaha—University of Canterbury, Aotearoa, New Zealand
| |
Collapse
|
5
|
Yan X, Li Y, Li Q, Li Q, Xu G, Lu J, Yang W. Prevalence of Autism Spectrum Disorder Among Children and Adolescents in the United States from 2021 to 2022. J Autism Dev Disord 2024:10.1007/s10803-024-06390-7. [PMID: 38778000 DOI: 10.1007/s10803-024-06390-7] [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: 05/01/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE The prevalence of autism spectrum disorder (ASD) among children and adolescents seem to be high in countries around the world, and it's worth understanding the latest prevalence and trends of ASD in children and adolescents. The purpose of this study was to examine the latest prevalence and decade trend of ASD among individuals aged 3-17 years in the United States. METHODS A total of 13,198 individuals aged 3-17 years were included. Annual data were examined from the National Health Interview Survey (2021-2022). Weighted prevalence for each of the selected developmental disabilities were calculated. RESULTS This cross-sectional study estimated the weighted prevalence of autism spectrum disorder were 3.05, 3.79, and 3.42% among individuals aged 3-17 years in the US in 2021, 2022, and the 2-year overall, respectively. We also observed a decade-long upward trend even after adjusting for demographic characteristics (P for trend < .05). CONCLUSION The results of this study showed that the prevalence of ASD among children and adolescents aged 3-17 years in the United States remained high and has increased over the past decade. The further investigation is necessary to evaluate potential modifiable risk factors and causes of ASD.
Collapse
Affiliation(s)
- Xiaofang Yan
- Department of Child and Adolescent Health, School of Public Health, Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Yanmei Li
- Department of Child and Adolescent Health, School of Public Health, Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Qishan Li
- Department of Child and Adolescent Health, School of Public Health, Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Qian Li
- Department of Child and Adolescent Health, School of Public Health, Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Guifeng Xu
- Department of Pediatrics, The First Affiliated Hospital, University of Science and Technology of China, Hefei, China
| | - Jinhua Lu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangdong Province, Guangzhou Medical University, Guangzhou, 510623, China.
| | - Wenhan Yang
- Department of Child and Adolescent Health, School of Public Health, Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, China.
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Cage E, Crompton CJ, Dantas S, Strachan K, Birch R, Robinson M, Morgan-Appel S, MacKenzie-Nash C, Gallagher A, Botha M. What are the autism research priorities of autistic adults in Scotland? AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613231222656. [PMID: 38311602 DOI: 10.1177/13623613231222656] [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: 02/06/2024]
Abstract
LAY ABSTRACT Although research has the potential to improve autistic people's lives, lots of funding goes towards research looking at topics which autistic people say has little impact in their everyday lives. Autistic people's lives can be different depending on where they live, and Scotland is a unique country in many ways. We wanted to find out which topics autistic people in Scotland want to see research on. Our team of autistic and non-autistic researchers (including university-based and community researchers) created a survey where 225 autistic adults rated and ranked the importance of possible research topics and shared their thoughts on what topics mattered to them. The five most important topics were mental health and well-being, identifying and diagnosing autistic people, support services (including healthcare and social care), non-autistic people's knowledge and attitudes and issues impacting autistic women. The three least important topics were genetics or biological aspects of autism, autism treatments/interventions and causes of autism. Our findings indicate that autistic people in Scotland want research to focus on things that matter to their day-to-day lives. Also, the Scottish government says they will be listening to autistic people in their latest policy plans, and we believe that considering autistic people's research priorities is an important part of this. Our findings also add to growing calls for change to happen in how and what autism researchers do research on.
Collapse
Affiliation(s)
| | | | | | | | - Rachel Birch
- Striving to Transform Autism Research Together - Scotland (STARTS) Network, UK
| | - Mark Robinson
- Striving to Transform Autism Research Together - Scotland (STARTS) Network, UK
| | - Stasa Morgan-Appel
- Striving to Transform Autism Research Together - Scotland (STARTS) Network, UK
| | | | - Aaron Gallagher
- Striving to Transform Autism Research Together - Scotland (STARTS) Network, UK
| | | |
Collapse
|
8
|
Ji S, Ma D, Pan L, Wang W, Peng X, Amos JT, Ingabire HN, Li M, Wang Y, Yao D, Ren P. Automated Prediction of Infant Cognitive Development Risk by Video: A Pilot Study. IEEE J Biomed Health Inform 2024; 28:690-701. [PMID: 37053059 DOI: 10.1109/jbhi.2023.3266350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
OBJECTIVE Cognition is an essential human function, and its development in infancy is crucial. Traditionally, pediatricians used clinical observation or medical imaging to assess infants' current cognitive development (CD) status. The object of pediatricians' greater concern is however their future outcomes, because high-risk infants can be identified early in life for intervention. However, this opportunity has not yet been realized. Fortunately, some recent studies have shown that the general movement (GM) performance of infants around 3-4 months after birth might reflect their future CD status, which gives us an opportunity to achieve this goal by cameras and artificial intelligence. METHODS First, infants' GM videos were recorded by cameras, from which a series of features reflecting their bilateral movement symmetry (BMS) were extracted. Then, after at least eight months of natural growth, the infants' CD status was evaluated by the Bayley Infant Development Scale, and they were divided into high-risk and low-risk groups. Finally, the BMS features extracted from the early recorded GM videos were fed into the classifiers, using late infant CD risk assessment as the prediction target. RESULTS The area under the curve, recall and precision values reached 0.830, 0.832, and 0.823 for two-group classification, respectively. CONCLUSION This pilot study demonstrates that it is possible to automatically predict the CD of infants around the age of one year based on their GMs recorded early in life. SIGNIFICANCE This study not only helps clinicians better understand infant CD mechanisms, but also provides an economical, portable and non-invasive way to screen infants at high-risk early to facilitate their recovery.
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Cervantes PE, Conlon GR, Seag DEM, Feder M, Lang Q, Meril S, Baroni A, Li A, Hoagwood KE, Horwitz SM. Mental health service availability for autistic youth in New York City: An examination of the developmental disability and mental health service systems. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:704-713. [PMID: 35893840 PMCID: PMC9880247 DOI: 10.1177/13623613221112202] [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] [Indexed: 01/31/2023]
Abstract
LAY ABSTRACT Autistic children and adolescents experience high rates of co-occurring mental health conditions, including depression and suicidality, which are frequently identified by stakeholders as treatment priorities. Unfortunately, accessing community-based mental health care is often difficult for autistic youth and their families. The first obstacle families confront is finding a provider that offers mental health treatment to autistic youth within the many service systems involved in supporting the autism community. The mental health and developmental disability systems are two of the most commonly accessed, and previous work has shown there is often confusion over which of these systems is responsible for providing mental health care to autistic individuals. In this study, we conducted a telephone survey to determine the availability of outpatient mental health services for autistic youth with depressive symptoms or suicidal thoughts or behaviors in New York City across the state's mental health and developmental disability systems. Results showed that while a greater percentage of clinics in the mental health system compared with in the developmental disability system offered outpatient mental health services to autistic youth (47.1% vs 25.0%), many more did not offer care to autistic youth and there were very few options overall. Therefore, it is important that changes to policy are made to increase the availability of services and that mental health care providers' knowledge and confidence in working with autistic youth are improved.
Collapse
Affiliation(s)
- Paige E. Cervantes
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Greta R. Conlon
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Dana E. M. Seag
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Michael Feder
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Qortni Lang
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Samantha Meril
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Annie Li
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Kimberly E. Hoagwood
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Sarah M. Horwitz
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| |
Collapse
|
11
|
Heyworth M, Brett S, den Houting J, Magiati I, Steward R, Urbanowicz A, Stears M, Pellicano E. "I'm the Family Ringmaster and Juggler": Autistic Parents' Experiences of Parenting During the COVID-19 Pandemic. AUTISM IN ADULTHOOD 2023; 5:24-36. [PMID: 36941857 PMCID: PMC10024268 DOI: 10.1089/aut.2021.0097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Little is known about autistic parenthood. The literature that exists suggests that autistic parents can find it difficult to manage the everyday demands of parenting and domestic life. While emerging research has also highlighted more positive parenting experiences, greater understanding of autistic parenthood is needed. Objective This study sought to understand autistic parents' parenting experiences during the initial phase of the COVID-19 pandemic. Methods Thirty-five Australian autistic parents (95% women) of autistic children (aged 4-25 years) took part in semi-structured interviews designed to elicit their experiences of life during lockdown. We used reflexive thematic analysis using an inductive (bottom-up) approach to identify patterned meanings within the data set. Results Autistic parents repeatedly spoke of how the lockdown brought some initial relief from the intensity of their usual lives caring for their children. Nevertheless, most autistic parents felt that the "cumulative stress" of trying to juggle everything during lockdown proved very challenging, which eventually took its toll on parents' mental health. Parents were aware that they needed support but found it difficult to reach out to their usual social supports (including autistic friends) for help, and formal supports were virtually nonexistent. Consequently, they felt "very much forgotten." Nevertheless, they described how their connections with their children grew stronger over lockdown as they focused on nurturing their children's "mental health ahead of everything else." Conclusions Our analysis shows how challenging conventional life can be for autistic parents. Parenting requires grappling with a distinctive set of demands, which are usually partially manageable through the informal supports many autistic parents draw upon. The relative absence of informal supports during the pandemic, however, left them reliant on more formal supports, which were not forthcoming. Research is urgently needed to identify the most effective formal supports for autistic parents, ideally in partnership with autistic parents themselves.
Collapse
Affiliation(s)
- Melanie Heyworth
- Macquarie School of Education, Macquarie University, Sydney, Australia
- Reframing Autism, Sydney, Australia
| | - Simon Brett
- Macquarie School of Education, Macquarie University, Sydney, Australia
| | - Jacquiline den Houting
- Macquarie School of Education, Macquarie University, Sydney, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Australia
| | - Iliana Magiati
- School of Psychological Science, University of Western Australia, Perth, Australia
| | | | | | - Marc Stears
- Sydney Policy Lab, University of Sydney, Sydney, Australia
| | - Elizabeth Pellicano
- Macquarie School of Education, Macquarie University, Sydney, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Australia
| |
Collapse
|
12
|
Roux AM, Shea LL, Steinberg H, Rast JE, Anderson KA, Hotez E, Rosenau K, Kuo A, Assing-Murray E, Shattuck PT. Evidence from the Autism Transitions Research Project (2017-2022): Capstone review and services research recommendations. Autism Res 2023; 16:480-496. [PMID: 36622799 DOI: 10.1002/aur.2890] [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: 10/04/2022] [Accepted: 12/28/2022] [Indexed: 01/10/2023]
Abstract
Few funding sources have explicitly supported systems-wide research to identify mechanisms for improving access, service delivery, outcomes and wellbeing for autistic transition-age youth and young adults. We aimed to integrate findings from research produced through a five-year federal Autism Transition Research Project (ATRP) cooperative agreement. This capstone review sought to: (1) map the body of scientific evidence that emerged from this federal award, and (2) identify remaining evidence gaps to inform future autism transition services research. We used scoping review methods to assess 31 ATRP-funded published scientific studies. We charted study characteristics, topical domains, socio-ecological levels of variables, focus on equity, and inclusion of autistic participants. We evaluated how these topics were addressed across studies to identify continued gaps in the evidence base. Compared to prior published reviews and research agendas, we found improvements in characterization of study participants, broader examination of socio-ecological correlates, and examination of multiple outcome domains. However, we also identified continued deficits in inclusion of autistic study participants, use of multisectoral data, and research with a strong focus on equity. Our recommended priorities for autism transition services research to facilitate healthy life outcomes and wellbeing included: continued analysis of population-level data and improved data infrastructure; development of service delivery methods and interventions that target marginalized groups; expanded research to inform improvements in the performance and coordination of complex service ecosystems that interface with autistic youth; and bolstering the roles of autistic research participants.
Collapse
Affiliation(s)
- Anne M Roux
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Lindsay L Shea
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Hillary Steinberg
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Jessica E Rast
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Kristy A Anderson
- School of Social Work, Florida State University, Tallahassee, Florida, USA
| | - Emily Hotez
- Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Kashia Rosenau
- Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Alice Kuo
- Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Evva Assing-Murray
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland, USA
| | | |
Collapse
|
13
|
Emerson LM, Pellicano E, Monk R, Lim M, Heaton J, McLay L. A portfolio analysis of autism research funding in Aotearoa New Zealand 2007-2021. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:13623613231155954. [PMID: 36802870 PMCID: PMC10576894 DOI: 10.1177/13623613231155954] [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] [Indexed: 02/22/2023]
Abstract
LAY ABSTRACT We aimed to document the areas of autism research that have previously been funded in Aotearoa New Zealand. We searched for research grants awarded to autism research in Aotearoa New Zealand between 2007 and 2021. We compared the funding distribution in Aotearoa New Zealand to other countries. We asked people from the autistic community and broader autism community whether they were satisfied with this funding pattern, and whether it aligned with what is important to them and to autistic people. We found that the majority of funding for autism research was awarded to biology research (67%). Members of the autistic and autism communities were dissatisfied with the funding distribution, and expressed a lack of alignment with what is important to them. People from the community indicated that the funding distribution did not address the priorities of autistic people, and that it indicated a lack of engagement with autistic people. Autism research funding needs to reflect the priorities of the autistic and autism communities. Autistic people need to be included in autism research and related funding decisions.
Collapse
Affiliation(s)
| | | | - Ruth Monk
- University of Canterbury, New Zealand
| | | | | | | |
Collapse
|
14
|
Bottema-Beutel K. We must improve the low standards underlying "evidence-based practice". AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:269-274. [PMID: 36588301 DOI: 10.1177/13623613221146441] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
15
|
Zakirova-Engstrand R, Roll-Pettersson L, Andersson K, Larsson H, Allodi Westling M, Hirvikoski T. Group Psychoeducational Intervention for Grandparents of Young Children with ASD: An Open Feasibility Study. J Autism Dev Disord 2023; 53:808-824. [PMID: 34247300 PMCID: PMC8272608 DOI: 10.1007/s10803-021-05189-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 11/28/2022]
Abstract
This initial open feasibility trial reports on feasibility and preliminary effectiveness of the manualized, group-based psychoeducational intervention for grandparents of preschool-aged children with ASD provided by the outpatient habilitation services in Stockholm, Sweden. One hundred and twenty non-custodial grandparents participated in a 6-h intervention program. The study demonstrated good feasibility: 114 (95%) grandparents completed both pre- and post-intervention measures and evaluations and reported high intervention acceptability. The results also indicated that grandparents increased their knowledge about ASD from pre-intervention to post-intervention, gained skills about strategies of supporting their grandchildren and adult children, and appreciated the opportunity to meet and share experiences with other grandparents. Follow-up with a randomized controlled trial design is needed to firmly establish efficacy of this intervention.
Collapse
Affiliation(s)
| | | | | | - Helena Larsson
- Habilitation & Health, Stockholm County Council, Stockholm, Sweden
| | | | - Tatja Hirvikoski
- Habilitation & Health, Stockholm County Council, Stockholm, Sweden ,Department of Women’s and Children’s Health, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Pediatric Neuropsychiatry Unit, Karolinska Institutet, Stockholm, Sweden ,Center for Psychiatry Research, Region Stockholm, Stockholm, Sweden
| |
Collapse
|
16
|
Bottema-Beutel K, LaPoint SC, Kim SY, Mohiuddin S, Yu Q, McKinnon R. An evaluation of intervention research for transition-age autistic youth. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 27:890-904. [PMID: 36189778 DOI: 10.1177/13623613221128761] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT In this study, we assess the quality of intervention research that focuses on autistic youth who are 14-22 years old. We found 193 different studies on this topic, and carefully reviewed them. Most of these studies tested strategies that were behavioral. This means that they used procedures like prompting and rewards to change participants' behavior. We found that the majority of studies had problems that make it hard to determine whether or not the intervention worked. The problems related to how researchers designed their studies, and how they measured the study outcomes. We also found that researchers rarely tried to find out if the strategies they studied had unintended negative effects for participants. Because of these issues, we make suggestions for how researchers might design better studies that will let people know how well the strategies worked.
Collapse
|
17
|
Pellicano E, Fatima U, Hall G, Heyworth M, Lawson W, Lilley R, Mahony J, Stears M. A capabilities approach to understanding and supporting autistic adulthood. NATURE REVIEWS PSYCHOLOGY 2022; 1:624-639. [PMID: 36090460 PMCID: PMC9443657 DOI: 10.1038/s44159-022-00099-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 12/28/2022]
Abstract
There is little comprehensive research into autistic adulthood, and even less into the services and supports that are most likely to foster flourishing adult autistic lives. This limited research is partly because autism is largely conceived as a condition of childhood, but this focus of research has also resulted from the orthodox scientific approach to autism, which conceptualizes autistic experience almost entirely as a series of biologically derived functional deficits. Approaching autism in this way severely limits what is known about this neurodevelopmental difference, how research is conducted and the services and supports available. In this Review, we adopt an alternative research strategy: we apply Martha Nussbaum’s capabilities approach, which focuses on ten core elements of a thriving human life, to research on autistic adulthood. In doing so, we identify areas where autistic adults thrive and where they often struggle, and highlight issues to which researchers, clinicians and policymakers should respond. The resulting picture is far more complex than conventional accounts of autism imply. It also reveals the importance of engaging autistic adults directly in the research process to make progress towards genuinely knowing autism and supporting flourishing autistic lives. The focus on functional deficits in conventional autism research constrains understanding of autistic lives. In this Review, Pellicano et al. appraise research on autistic adulthood through a capabilities lens to identify areas where autistic adults thrive, and where more research and services are needed to enhance their quality of life.
Collapse
|
18
|
Song W, Salzer MS, Nonnemacher SL, Shea L. Lifespan service receipt and unmet needs among individuals on the autism spectrum. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:694-705. [PMID: 35320442 DOI: 10.1007/s10488-022-01192-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 01/18/2023]
Abstract
Timely data on service use and needs across the lifespan are essential to developing an effective and efficient service delivery system that is responsive to developmental issues. This study uses data from one of the largest statewide surveys conducted between 2017 and 2018 to compare service use and unmet needs among individuals on the autism spectrum across the lifespan. A statewide sample of 5792 caregivers of autistic children and adults were included in the study. Logistic regressions were conducted to compare service use and need among six age groups ranging from early childhood (0-5 years) to later adulthood (31+) while adjusting for sociodemographic characteristics. We found that the transition-age adult group (18-21 years) was less likely to receive services, including speech/language therapy, occupational therapy, one-on-one support, and social skill training, than adolescents. However, case management and mental health services increased with age. Young adults (22-30 years) were more likely to report unmet needs than both adolescents and transition-age adult groups. The use of services overall decrease and service needs increased compared to results from an earlier statewide survey that was conducting in 2009-2010. These results can be used to inform developmentally appropriate autism-related healthcare policies and service development and delivery. This study offers a more detailed look at differences between adult age subgroups that are novel. Further research is needed about the prevalence of ASD in adulthood, clinical trajectories, and outcomes in order to support autistic adults in getting the appropriate services and supports.
Collapse
Affiliation(s)
- Wei Song
- College of Public Health, Temple University, 1700 N. Broad St., Suite 313, 19122, Philadelphia, PA, USA.
| | - Mark S Salzer
- Temple University Collaborative on Community Inclusion of Individuals with, Psychiatric Disabilities, 1700 N. Broad St., Suite 304, 19122, Philadelphia, PA, USA
| | - Stacy L Nonnemacher
- Bureau of Supports for Autism and Special Populations, Department of Human Services, 801 Market St, 19107, Philadelphia, Pennsylvania, PA, USA
| | - Lindsay Shea
- Policy and Analytics Center, A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, 19104, Philadelphia, PA, USA
| |
Collapse
|
19
|
Schendel D, Roux AM, McGhee Hassrick E, Lyall K, Shea L, Vivanti G, Wieckowski AT, Newschaffer C, Robins DL. Applying a public health approach to autism research: A framework for action. Autism Res 2022; 15:592-601. [PMID: 35199493 DOI: 10.1002/aur.2689] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/20/2021] [Accepted: 02/08/2022] [Indexed: 12/26/2022]
Abstract
Most published autism research, and the funding that supports it, remains focused on basic and clinical science. However, the public health impact of autism drives a compelling argument for utilizing a public health approach to autism research. Fundamental to the public health perspective is a focus on health determinants to improve quality of life and to reduce the potential for adverse outcomes across the general population, including in vulnerable subgroups. While the public health research process can be conceptualized as a linear, 3-stage path consisting of discovery - testing - translation/dissemination/implementation, in this paper we propose an integrated, cyclical research framework to advance autism public health objectives in a more comprehensive manner. This involves discovery of primary, secondary and tertiary determinants of health in autism; and use of this evidence base to develop and test detection, intervention, and dissemination strategies and the means to implement them in 'real world' settings. The proposed framework serves to facilitate identification of knowledge gaps, translational barriers, and shortfalls in implementation; guides an iterative research cycle; facilitates purposeful integration of stakeholders and interdisciplinary researchers; and may yield more efficient achievement of improved health and well-being among persons on the autism spectrum at the population-level. LAY SUMMARY: Scientists need better ways to identify and address gaps in autism research, conduct research with stakeholders, and use findings to improve the lives of autistic people. We recommend an approach, based in public health science, to guide research in ways that might impact lives more quickly.
Collapse
Affiliation(s)
- Diana Schendel
- A.J. Drexel Autism Institute, Drexel University, University Park, Pennsylvania, Pennsylvania, USA
| | - Anne M Roux
- A.J. Drexel Autism Institute, Drexel University, University Park, Pennsylvania, Pennsylvania, USA
| | | | - Kristen Lyall
- A.J. Drexel Autism Institute, Drexel University, University Park, Pennsylvania, Pennsylvania, USA
| | - Lindsay Shea
- A.J. Drexel Autism Institute, Drexel University, University Park, Pennsylvania, Pennsylvania, USA
| | - Giacomo Vivanti
- A.J. Drexel Autism Institute, Drexel University, University Park, Pennsylvania, Pennsylvania, USA
| | | | - Craig Newschaffer
- College of Health and Human Development, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Diana L Robins
- A.J. Drexel Autism Institute, Drexel University, University Park, Pennsylvania, Pennsylvania, USA
| |
Collapse
|
20
|
Ferreira ML, Loyacono N. Rationale of an Advanced Integrative Approach Applied to Autism Spectrum Disorder: Review, Discussion and Proposal. J Pers Med 2021; 11:jpm11060514. [PMID: 34199906 PMCID: PMC8230111 DOI: 10.3390/jpm11060514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 05/22/2021] [Accepted: 05/27/2021] [Indexed: 12/14/2022] Open
Abstract
The rationale of an Advanced Integrative Model and an Advanced Integrative Approach is presented. In the context of Allopathic Medicine, this model introduces the evaluation, clinical exploration, diagnosis, and treatment of concomitant medical problems to the diagnosis of Autism Spectrum Disorder. These may be outside or inside the brain. The concepts of static or chronic, dynamic encephalopathy and condition for Autism Spectrum Disorder are defined in this model, which looks at the response to the treatments of concomitant medical problemsto the diagnosis of Autism Spectrum Disorder. (1) Background: Antecedents and rationale of an Advanced Integrative Model and of an Advanced Integrative Approach are presented; (2) Methods: Concomitant medical problems to the diagnosis of Autism Spectrum Disorder and a discussion of the known responses of their treatments are presented; (3) Results: Groups in Autism are defined and explained, related to the responses of the treatments of the concomitant medical problems to ASD and (4) Conclusions: The analysis in the framework of an Advanced Integrative Model of three groups including the concepts of static encephalopathy; chronic, dynamic encephalopathy and condition for Autism Spectrum Disorder explains findings in the field, previously not understood.
Collapse
Affiliation(s)
| | - Nicolás Loyacono
- TEA-Enfoque Integrador Group, Bahía Blanca 8000, Argentina;
- SANyTA (Sociedad Argentina de Neurodesarrollo y Trastornos Asociados), Migueletes 681, Piso 2, Departamento 2, BUE-Ciudad Autónoma de Buenos Aires C1426, Argentina
- Correspondence: ; Tel.: +54-911-5825-5209
| |
Collapse
|