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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 Race and reported symptoms on the Withdrawn/Depressed and Social Problems syndrome scales did not relate to screening status.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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Barger B, Salmon A, Moore Q. Medical Home, Developmental Monitoring/Screening, and Early Autism Identification. J Autism Dev Disord 2024; 54:3242-3261. [PMID: 37477840 DOI: 10.1007/s10803-023-06044-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/22/2023]
Abstract
Developmental monitoring/screening predict early identified autism spectrum disorders (ASD), but studies have not yet robustly controlled for a key health care service impacting early identification: medical home. National Surveys of Children's Health (NSCH; 2016-2020) were used to determine the relationship between medical home, developmental monitoring/screening, and identified ASD. NSCH overall medical home variable had a minimal relationship with ASD (under 5 years of age, under 5 identified in last year, under 5 identified over a year prior). Usual source of care was positively, and care coordination negatively, associated with ASD identified in last year, suggesting the overall medical home variable may mask variance from subscales. Research is needed to determine how medical home relates to identification in applied settings.
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Affiliation(s)
- Brian Barger
- Center for Leadership in Disability, School of Public Health, Georgia State University, 75 Piedmont Rd., Atlanta, GA, 30303, USA.
- Population Health Sciences, School of Public Health, Georgia State University, Atlanta, USA.
| | - Ashley Salmon
- Center for Leadership in Disability, School of Public Health, Georgia State University, 75 Piedmont Rd., Atlanta, GA, 30303, USA
| | - Quentin Moore
- Center for Leadership in Disability, School of Public Health, Georgia State University, 75 Piedmont Rd., Atlanta, GA, 30303, USA
- Population Health Sciences, School of Public Health, Georgia State University, Atlanta, USA
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Weitlauf AS, Foster T, Slaughter JC, Fleck M, Harris J, Coffield C, Simcoe K, Baggett J, Stainbrook A, Warren ZE. Screening Options in Autism Telediagnosis: Examination of TAP, M-CHAT-R, and DCI Concordance and Predictive Value in a Telediagnostic Model. J Autism Dev Disord 2024:10.1007/s10803-024-06427-x. [PMID: 38833028 DOI: 10.1007/s10803-024-06427-x] [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: 05/28/2024] [Indexed: 06/06/2024]
Abstract
Tele-assessment of autism in early childhood has increased. However, it is unclear how autism screening tools (M-CHAT-R, DCI) function as part of tele-assessment and relate to a commonly used tele-assessment instrument, the TAP. 361 families from a clinically referred sample of children (mean age: 27.63 months, sd = 4.86 months) completed the M-CHAT-R and DCI prior to a tele-assessment visit utilizing the TAP. Data was collected on demographic background, measure scores, and diagnostic outcome. No significant differences in measure scores or diagnostic findings emerged in age at referral, age group, age at diagnosis, or child sex, ethnicity, or racial background. The M-CHAT-R and DCI correlated strongly and positively. Older age was associated with lower risk scores on screening instruments. Children with autism had significantly higher scores on all screener and subdomain scores, with the exception of DCI Behavior. Subdomains of the DCI emerged as the strongest predictor of diagnostic outcome. Both the DCI total score and the M-CHAT-R significantly related to diagnostic outcome and TAP score in this tele-assessment model, regardless of child age or sex. Findings also support use of the DCI for children under 24 months of age.
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Affiliation(s)
- Amy S Weitlauf
- Department of Pediatrics, Vanderbilt University Medical Center, 230 Appleton Place, PMB 74, Nashville, Tennessee, 37203, USA.
| | - Tori Foster
- Department of Pediatrics, Vanderbilt University Medical Center, 230 Appleton Place, PMB 74, Nashville, Tennessee, 37203, USA
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mary Fleck
- Department of Pediatrics, Vanderbilt University Medical Center, 230 Appleton Place, PMB 74, Nashville, Tennessee, 37203, USA
| | - Jill Harris
- Department of Pediatrics, Children's Specialized Hospital, New Brunswick, New Jersey, USA
| | - Caroline Coffield
- Department of Pediatrics, Robert Wood Johnson Medical School at Rutgers University, New Brunswick, New Jersey, USA
| | - Kathleen Simcoe
- Department of Pediatrics, Vanderbilt University Medical Center, 230 Appleton Place, PMB 74, Nashville, Tennessee, 37203, USA
| | - Jenny Baggett
- Department of Pediatrics, Vanderbilt University Medical Center, 230 Appleton Place, PMB 74, Nashville, Tennessee, 37203, USA
| | - Alacia Stainbrook
- Department of Pediatrics, Vanderbilt University Medical Center, 230 Appleton Place, PMB 74, Nashville, Tennessee, 37203, USA
| | - Zachary E Warren
- Department of Pediatrics, Vanderbilt University Medical Center, 230 Appleton Place, PMB 74, Nashville, Tennessee, 37203, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Special Education, Vanderbilt University, Nashville, Tennessee, USA
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Wallis KE, Guthrie W. Screening for Autism: A Review of the Current State, Ongoing Challenges, and Novel Approaches on the Horizon. Pediatr Clin North Am 2024; 71:127-155. [PMID: 38423713 DOI: 10.1016/j.pcl.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Screening for autism is recommended in pediatric primary care. However, the median age of autism spectrum disorder (ASD) diagnosis is substantially higher than the age at which autism can reliably be identified, suggesting room for improvements in autism recognition at young ages, especially for children from minoritized racial and ethnic groups, low-income families, and families who prefer a language other than English. Novel approaches are being developed to utilize new technologies in aiding in autism recognition. However, attention to equity is needed to minimize bias. Additional research on the benefits and potential harms of universal autism screening is needed. The authors provide suggestions for pediatricians who are considering implementing autism-screening programs.
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Affiliation(s)
- Kate E Wallis
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Whitney Guthrie
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Honda H, Sasayama D, Niimi T, Shimizu A, Toibana Y, Kuge R, Takagi H, Nakajima A, Sakatsume R, Takahashi M, Heda T, Nitto Y, Tsukada S, Nishigaki A. Awareness of children's developmental problems and sharing of concerns with parents by preschool teachers and childcare workers: The Japanese context. Child Care Health Dev 2024; 50:e13153. [PMID: 37460209 DOI: 10.1111/cch.13153] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND This study aims to determine the extent to which preschool teachers and childcare workers are aware of the presence of developmental problems among children and to what extent they share information with parents about their concerns regarding a child's development or diagnosis of neurodevelopmental disorders (NDDs). METHODS We wrote to all 924 preschools and childcare centres in Japan's Nagano and Yamanashi prefectures to request participants. We then sent survey forms to the preschools and childcare centres that agreed to cooperate for three grades comprising 3-, 4- and 5-year-olds in the school year 2020. We asked the staff member in charge of each child to complete the survey. The survey included questions about the teacher's concerns regarding the possibility of an NDD and whether the matter had been shared with the children's parents. RESULTS We obtained data for 10 354 children from 206 preschools and childcare centres (response rate = 22.3%). Among these children, 457 (4.4%) had an NDD diagnosis that their parents shared with the teachers. However, the teachers of 1274 children (12.3%) had concerns regarding their development but were not informed by the parents about the diagnosis, if any. These 1274 children included 775 (60.8%) cases where the teachers failed to share their concerns with parents because (1) the teachers could not communicate with parents (n = 119), (2) the teachers were not sure if there was a neurodevelopmental problem (n = 360) and (3) the parents were not aware of the problem (n = 296). CONCLUSIONS Preschool teachers and childcare workers had concerns about the development of a substantial proportion of children in their charge. However, teachers and childcare workers did not share their concerns regarding many children's developmental problems with their parents. The findings suggest that there are challenges in information-sharing between teachers/childcare workers and parents.
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Affiliation(s)
- Hideo Honda
- Department of Child and Adolescent Developmental Psychiatry, Shinshu University School of Medicine, Nagano, Japan
- Mental Health Clinic for Children, Shinshu University Hospital, Nagano, Japan
| | - Daimei Sasayama
- Department of Child and Adolescent Developmental Psychiatry, Shinshu University School of Medicine, Nagano, Japan
- Mental Health Clinic for Children, Shinshu University Hospital, Nagano, Japan
- Department of Psychiatry, Shinshu University School of Medicine, Nagano, Japan
| | - Taemi Niimi
- Department of Child and Adolescent Developmental Psychiatry, Shinshu University School of Medicine, Nagano, Japan
| | - Ayako Shimizu
- Department of Child and Adolescent Developmental Psychiatry, Shinshu University School of Medicine, Nagano, Japan
| | - Yuki Toibana
- Department of Child and Adolescent Developmental Psychiatry, Shinshu University School of Medicine, Nagano, Japan
| | - Rie Kuge
- Department of Child and Adolescent Developmental Psychiatry, Shinshu University School of Medicine, Nagano, Japan
- Mental Health Clinic for Children, Shinshu University Hospital, Nagano, Japan
| | - Hidetoshi Takagi
- Department of Psychiatry, Shinshu University School of Medicine, Nagano, Japan
| | - Aya Nakajima
- Department of Child and Adolescent Developmental Psychiatry, Shinshu University School of Medicine, Nagano, Japan
- Social Welfare Corporation Kosodachi Hattatsu No Sato, Nest Yamanashi Mental Support, Yamanashi, Japan
| | | | | | - Takuma Heda
- Social Welfare Group Kosui Fukushikai, Nagano, Japan
| | - Yukari Nitto
- Department of Human Psychology, Sagami Women's University, Sagamihara, Japan
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Zerman N, Zotti F, Chirumbolo S, Zangani A, Mauro G, Zoccante L. Insights on dental care management and prevention in children with autism spectrum disorder (ASD). What is new? FRONTIERS IN ORAL HEALTH 2022; 3:998831. [PMID: 36238091 PMCID: PMC9551997 DOI: 10.3389/froh.2022.998831] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/09/2022] [Indexed: 11/26/2022] Open
Abstract
Autistic subjects represent a severe concern to dentistry due to the considerable difficulty in managing their oral health, maintaining routine toothbrushing, and preventing dental and periodontal problems. The social and economic burden of managing dental care in autism spectrum disorder (ASD) children is particularly cumbersome for families and public and private health expenditure, especially when children reach the dentist following a late diagnosis with evident oral health problems. An early diagnosis of ASD helps dentists better address these children's oral health. Unfortunately, insufficient attention is paid to the training and education of general pediatricians, dentists, and dental hygienists, allowing them to get to approach the different clinical aspects of ASD. Usually, children diagnosed with ASD are scheduled for dental appointments like their neurotypical peers, whereas their needs are typically complex and personalized. Scant attention is also devoted to these patients by commercial manufacturers of dental products and devices for oral hygiene and prevention of caries and periodontal diseases, leaving parents without the support and often failing when they address the oral health of autistic children. The difficulties of oral care do not derive simply from the behavior of ASD patients, as is commonly assumed, and therefore cannot be overcome solely by the patience and attention of parents and dentists. Genetics, dietary habits, sensory impairments, and cognition disorders are other causes contributing in various degrees to the impact on the mood and psychological reactions of autistic children towards dentists. How can we prevent teeth caries, periodontal disorders, and other oral health impairments by properly managing ASD children? This manuscript gives an up-to-date overview of these problems and helps to provide good remarks.
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Affiliation(s)
- Nicoletta Zerman
- Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Verona, Italy
| | - Francesca Zotti
- Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Verona, Italy
| | - Salvatore Chirumbolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alessandro Zangani
- Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Verona, Italy
| | | | - Leonardo Zoccante
- Autism Veneto Region Center, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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