Service Use Among Transition-Age Youth with Autism Spectrum Disorder

"Glimmers of hope and good things": Positive aspects of caregiving to autistic adolescents and young adults

LAY ABSTRACT

We wanted to explore the positive, or rewarding, experiences of caregivers who were caring for older adolescents or young autistic adults. We surveyed 174 caregivers, asking questions about how they dealt with stressors, the support they had from people in their lives, and the different behaviors of the autistic youth they care for. Using an existing measure, as well as an open-ended question, we asked caregivers about the most rewarding aspects of caring for their youth. When examining survey responses, we found that caregivers who reported receiving more help and support from their autistic youth also reported more positive aspects related to caregiving. In response to our study's open-ended question, caregivers talked about the reward of seeing their youth grow and progress (e.g. learning new skills, reaching new milestones), described positive aspects of the relationship with their youth (e.g. sharing a special bond), and reflected on their own learning and personal growth as caregivers and people. Our findings highlight the positive, or rewarding, aspects of caregiving for autistic adolescents and young adults. This work will inform future work studying positive aspects of caring for autistic individuals and how this may impact caregivers' psychological well-being.

Family Experiences with Supplemental Social Security Income and Legal Guardianship for Autistic Adults: A Mixed-Methods Study

Background

Family interactions with the Supplemental Social Security Income (SSI) program and the decision to pursue legal guardianship are poorly understood in services research for autistic adults.

Methods

We conducted a mixed-methods study and incorporated quantitative survey data from 122 autistic adults in an existing longitudinal cohort with qualitative interviews with 12 autistic adults and/or legal guardians. We explored associations between sociodemographic, developmental, and behavioral features with the likelihood of having SSI and a legal guardian at 25 years old. Spoken interviews were transcribed verbatim, and interviews were analyzed using a rapid qualitative analytic approach.

Results

There were quantitative differences in whether families were able to obtain SSI and guardianship based on intelligence quotient (IQ) scores, adaptive behavior, and autistic characteristics, but not by race, ethnicity, or maternal education. Qualitative data analysis revealed six themes that highlighted the challenges associated with obtaining and maintaining SSI, along with the complex, nuanced decisions associated with legal guardianship. Families noted many challenges in navigating these procedures and some potential benefits for each unique circumstance.

Conclusions

These findings offer new perspectives on experiences associated with pursuing SSI benefits and legal guardianship for autistic adults, including similarities and key differences in these procedures. Findings also provide suggestions for future research to improve coordination and supports for families throughout adulthood.

Mental health care use of autistic adults: Identifying longitudinal patterns using sequence analysis

LAY ABSTRACT

Many autistic adults experience co-occurring mental health problems, which have a negative effect on their well-being and result in increased use of mental health services. To improve mental healthcare for autistic adults, a better understanding is needed of what type of support they use in real life. Clinical guidelines recommend three kinds of mental health interventions: therapy, counseling, and medication. We investigated the use of these types of interventions in a sample of 445 autistic adults (aged 18-87 years) across a 5-to-7-year period. We found evidence for four different patterns of intervention use, or so-called subgroups: (1) least intervention use, (2) mostly counseling, (3) mostly medication, and (4) mixed intervention use. The group with mixed intervention use consisted of relatively more females and individuals with co-occurring psychiatric conditions, especially compared to the subgroup with the least intervention use. It appeared that many, but not all, autistic individuals used mental health services for an extended period. However, there was considerable variability in the type, combination, and duration of intervention use. This means that determining the optimal support for autistic adults is often a complex task, which requires collaboration of clinical experts and autistic individuals themselves, to make informed decisions.

Exploring Racial Discrimination, Disability Discrimination, and Perception of the Future Among Black-Identifying Emerging Adults with and without Autism in the United States: A Mixed-Methods Descriptive Study

Discrimination experienced by Black emerging adults with autism is rarely studied nor have their experiences been juxtaposed to Black emerging adults without autism. A mixed methods descriptive approach was used to describe responses to open-ended questions collected as part of a larger study of discrimination experienced by Black emerging adults with autism (n = 14) and Black emerging adults without autism (n = 20). Questions focused around racial discrimination, disability discrimination, and perception of the future. Qualitative and quantitative content analysis were applied. Qualitatively- a manifest approach was used, and quantitatively- frequency counts and ratios were identified within themes and subthemes. Four main themes and twelve subthemes were identified. Racial discrimination had two themes: 1) Impact on mental health, and 2) Societal threats, with five subthemes, each reported at higher rates by people without autism (Theme 1 = 5:7, Theme 2 = 3:11). Disability discrimination was only reported on by those with autism, and had one main theme of neurodiverse/autism bias, and three subthemes. Perception of the future contained the theme of emerging life hopes, with four subthemes. Subthemes relating to work/career/family and future unknown were reported more highly by those without autism than with autism (1:8 and 4:7 respectively), while subthemes describing diverse or unique priorities for fulfillment and mental wellness were reported only by those with autism (6:0 and 4:0 respectively). Study findings suggest unique experiences and needs among Black emerging adults with autism, as well as the consequences of anti-blackness and anti-ableism/neurobigotry which can have double impact in their lives, spanning different ages and stages. Results have implications for building resiliency among Black persons with autism and without autism as they transition to adulthood.

Health care transition quadruple aim outcomes for IDD: Scoping review

Purpose

Structured HCT models addressing planning, transfer, and integration into adult care for adolescents and young adults with childhood-acquired chronic conditions are becoming more prevalent. However, consensus on outcome measures to assess health care transition (HCT) interventions particularly for intellectual and developmental disabilities (IDD) population is lacking. This scoping review identified potential HCT outcome measures for young adults (aged 18-26) with IDD using the Quadruple Aim Framework.

Methods

On August 6, 2021 and April 27, 2023, Medline Ovid, Embase, Web of Science, PsycINFO, and Cochrane databases were searched using the terms "young adult," "intellectual disability," "developmental disability, "cognitive dysfunction," "autism," "cerebral palsy," "spina bifida," and "transition to adult care." Searches were limited to publications in English and published from 2000 to present. Observational and experimental (qualitative or quantitative) studies were included if participants were young adults (median/mean ages 18-26) with IDD (Autism, cerebral palsy, Down syndrome, spina bifida, or other IDD-related conditions) and study outcomes addressed one of the Quadruple Aim domains (population health, patient/family experience, cost/utilization, and healthcare provider/caregiver experience). Studies were excluded if participants had attention deficit/hyperactivity disorder or learning disability only, if outcomes were primarily educational or vocational, or if publications were reviews, abstracts, or not in English.

Results

One hundred and three articles were included data extraction. Articles were categorized under the Quadruple Aim domains: Population Health (43), Patient/Caregiver Healthcare Experience included (23), Cost/Utilization (24), and Healthcare Provider/Caregiver Experience (15). Most articles were observational and utilized a variety of assessments or internally developed questions as measures.

Conclusions

While studies describing HCT outcomes for the IDD population are limited and measures are inconsistent, studies pertaining to Quadruple Aim outcomes identified in this review can further direct efforts towards consensus and standardization of HCT outcome measures to address the needs of individuals with IDD, their families, and caregivers/providers.

The Prevalence and Characteristics of Children With Profound Autism, 15 Sites, United States, 2000-2016

OBJECTIVES

Autism spectrum disorder (autism) is a heterogeneous condition that poses challenges in describing the needs of individuals with autism and making prognoses about future outcomes. We applied a newly proposed definition of profound autism to surveillance data to estimate the percentage of children with autism who have profound autism and describe their sociodemographic and clinical characteristics.

METHODS

We analyzed population-based surveillance data from the Autism and Developmental Disabilities Monitoring Network for 20 135 children aged 8 years with autism during 2000-2016. Children were classified as having profound autism if they were nonverbal, were minimally verbal, or had an intelligence quotient <50.

RESULTS

The percentage of 8-year-old children with profound autism among those with autism was 26.7%. Compared with children with non-profound autism, children with profound autism were more likely to be female, from racial and ethnic minority groups, of low socioeconomic status, born preterm or with low birth weight; have self-injurious behaviors; have seizure disorders; and have lower adaptive scores. In 2016, the prevalence of profound autism was 4.6 per 1000 8-year-olds. The prevalence ratio (PR) of profound autism was higher among non-Hispanic Asian/Native Hawaiian/Other Pacific Islander (PR = 1.55; 95 CI, 1.38-1.73), non-Hispanic Black (PR = 1.76; 95% CI, 1.67-1.86), and Hispanic (PR = 1.50; 95% CI, 0.88-1.26) children than among non-Hispanic White children.

CONCLUSIONS

As the population of children with autism continues to change, describing and quantifying the population with profound autism is important for planning. Policies and programs could consider the needs of people with profound autism across the life span to ensure their needs are met.

Barriers to service and unmet need among autistic adolescents and young adults

LAY ABSTRACT

Prior studies have described the roadblocks, or barriers, to needed services experienced by families with young autistic children, but less research has focused on those faced by autistic adolescents and young adults. In this study, we wished to understand the barriers to service experienced by autistic adolescents and young adults and their families. We surveyed 174 caregivers of autistic youth between 16 to 30 years old. We found that caregivers who felt more caregiving burden had more difficulty accessing services for their youth. Specifically, caregivers who felt more strongly that their daily lives had been disrupted, felt more financial strain, and worried more about their youth well-being experienced more roadblocks to getting services for the youth. Male caregivers also reported fewer difficulties related to service access. Importantly, the older the youth was when they had been diagnosed with autism, the more service barriers their caregivers reported. We did not see any differences in the level of barriers experienced by youth who lived in urban versus suburban settings, or between white and non-white families. However, when youth lived with their caregivers (rather than, for example, in a group home), fewer quality-related barriers to services were reported. Finally, greater access (but not quality) barriers were linked to youth having more unmet service needs. These findings can help to reduce the barriers to service experienced by autistic adolescents and young adults and their families.

A cross-sectional examination of service complexity in youths with co-occurring autism spectrum disorder and psychiatric or medical diagnoses across service sectors

Introduction

Autism spectrum disorder (ASD) is a heterogeneous, life-long, and complex condition. Youth diagnosed with ASD require several supports addressing core symptoms associated with the disorder, but also those resulting from co-occurring mental and physical health conditions. As a result, their care is overseen by numerous professionals spanning various service sectors, but communication between sectors is hindered due to the absence of a standardized assessment system to identify and triage youth to services. A paucity of information surrounding this population's service use lingers and a siloed delivery system persists.

Methods

Using archival data collected from 1,020 youth between 12 and 18 years of age, this study explored service complexity among autistic youth with and without psychiatric and medical co-occurring conditions in Ontario, Canada. In doing so, a negative binomial regression was utilized to investigate which predisposing, enabling, and need variables were associated with service complexity.

Results

Results revealed that experiencing financial difficulties was not associated with service complexity. However, age, sex, caregiver distress, comorbidity, intellectual disability, and evaluated health status were significant predictors. More specifically, female youth and youth with distressed caregivers had greater mental health service complexity scores. Additionally, youth diagnosed with two or more conditions in addition to ASD who required longer durations of programming, controlling for other predictors, had greater mental health service complexity scores. Yet, youth with an intellectual disability had lower service complexity scores.

Discussion

Clinical implications of this study are discussed to inform future investments into mental health efforts for autistic youth.

"Don't Promise Something You can't Deliver:" Caregivers' Advice for Improving Services to Adolescents and Young Adults with Autism

Approximately 50,000 youths with autism spectrum disorders (ASD) exit U.S. high schools yearly to enter adult systems of care, many of whom remain dependent on family for day-to-day care and service system navigation. As part of a larger study, 174 family caregivers for adolescents or young adults with ASD were asked what advice they would give service providers about how to improve services for youth with ASD. Reflexive thematic analysis identified a framework of five directives: (1) provide a roadmap to services; (2) improve service access; (3) fill gaps to address unmet needs; (4) educate themselves, their families, and society about autism; and (5) operate from a relationship-building paradigm with families. Education, health, and social service providers, as well as policymakers, can use these directives to better assist youth with ASD and their families in the transition to adulthood.

Elevating the employment outcomes of transition-age youth with disabilities: Four decades of intervention research

BACKGROUND: Preparing students with disabilities for future employment is a primary purpose of special education and secondary transition services. OBJECTIVE: Knowing which interventions lead to subsequent employment is essential for establishing a strong evidence base that can guide the field. METHODS: We systematically reviewed available experimental and quasi-experimental studies that evaluated interventions addressing employment outcomes for transition-age youth with disabilities (ages 14–22). RESULTS: These 25 studies were of varied methodological quality, and most interventions improved employment status for youth. Collectively, these findings emphasize the importance and impact of connecting youth with disabilities to career development experiences while they are still receiving transition supports. CONCLUSION: We offer recommendations for future research focused on unpacking the key features of these multi-component interventions as well as guidance on assessing meaningful employment outcomes for youth with disabilities.

Self-reported COVID-19 vaccination acceptance and hesitancy among autistic adults

Identifying factors associated with COVID-19 vaccination acceptance among vulnerable groups, including autistic individuals, can increase vaccination rates and support public health. The purpose of this study was to determine differences among autistic adults who reported COVID-19 vaccination acceptance from those who did not. In this study we describe COVID-19 vaccination status and self-reported preferences among autistic adults and identify related factors. Vaccine accepters were more likely to report increased loneliness during COVID-19, lived in more populous counties (p = 0.02), and lived in counties won by President Biden in the 2020 US presidential election (p < 0.001). Positive correlations were found between desire to protect others, concern about contracting COVID-19, and trusting vaccine safety (p < 0.001). Concern about vaccine safety was common among the vaccine hesitant, while lack of concern about COVID-19 overall was not. Identifying health promotion strategies based on self-reported, lived experiences about COVID-19 among vulnerable groups is key for public health impact.