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Alhuzimi TE. Saudi parents' perspectives of the factors influencing the quality of life of their children with autism spectrum disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 152:104799. [PMID: 39002204 DOI: 10.1016/j.ridd.2024.104799] [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: 03/27/2024] [Revised: 07/03/2024] [Accepted: 07/09/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Research indicates that the deficits in social communication and the repetitive, restrictive behaviour of persons with Autistic Spectrum Disorder (ASD) can pose challenges to their functioning in different Quality of Life (QoL) domains, leading to lower levels of life satisfaction. Evidence also indicates that various social and family factors, such as the support received in the community/environment and the composition of the family, could impact the QoL of persons with ASD. AIM To study the factors influencing the QoL of children with ASD in the Kingdom of Saudi Arabia (KSA) by investigating the perspectives of their parents. METHOD Questionnaires were completed by 110 parents who had a child with ASD. The questionnaire included the 96-item KidsLife-ASD scale to capture parents' perspectives regarding the difficulties experienced by their child, the ASD support received by their families, and the QoL of the child. The data obtained from the questionnaire were statistically analysed using IBM SPSS software. RESULTS The difficulties experienced by children with ASD and aspects of the support (services and interventions, and challenges) they receive are factors that influence the QoL of children with ASD in the KSA. Moreover, the number of children in the family, the birth order of child with ASD, and the severity of ASD symptoms are factors that influence parents' perceptions of their children's difficulties, family ASD support, and the child's QoL. CONCLUSIONS Saudi parents who have one child with ASD believed that the QoL of their child was high and confirmed that the difficulties experienced by the child and the support received by the family were factors which influenced the QoL of a child with ASD.
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Affiliation(s)
- Talal E Alhuzimi
- Department of Special Education, College of Education, King Saud University, Riyadh, Saudi Arabia.
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Shyu HJ, Ryan Chen YW, Yih Ng D, Bundy A, Tseng MH, Cordier R. Does the PedsQL reflect the real-time quality of life in autistic adolescents? A comparison with the experience sampling methodology. Disabil Health J 2024:101690. [PMID: 39174385 DOI: 10.1016/j.dhjo.2024.101690] [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: 01/26/2024] [Revised: 07/20/2024] [Accepted: 08/19/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND The PedsQL is widely used to retrospectively evaluate quality of life (QoL) in autistic adolescents. However, concerns have arisen regarding its ability to reflect real-time QoL, considering their challenges in recollecting past experiences. OBJECTIVE We examined the overall and social QoLs of autistic adolescents compared to neurotypical peers using the PedsQL and the experience sampling method (ESM), an ecological momentary assessment of QoL in real-time. Additionally, we explored the relationship between these measures in each group. METHODS A total of 175 participants, including 117 autistic and 58 neurotypical adolescents aged 10-16, completed the PedsQL and an ESM protocol with a mobile device to record their real-time experiences seven times a day for seven days. We performed multiple linear regression and multilevel analyses to compare QoLs between groups and the association between the two measures. RESULTS Autistic adolescents scored significantly lower than neurotypical peers on PedsQL overall and social QoL but not on the real-time experiences collected with ESM. Among neurotypical adolescents, we found significant associations between the Social Functioning score of the PedsQL and various aspects of real-time social experiences recorded with ESM. For autistic adolescents, only the real-time experience of 'loneliness' during social engagement was associated with Social Functioning on the PedsQL. CONCLUSIONS The retrospective PedsQL does not entirely capture the real-time QoL via ESM. However, relying solely on ESM may overlook situations where participants opt out or could not complete surveys. Thus, using both retrospective and real-time assessments to examine QoL among autistic adolescents is recommended.
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Affiliation(s)
- Hui-Jen Shyu
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taiwan
| | - Yu-Wei Ryan Chen
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Daphne Yih Ng
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taiwan
| | - Anita Bundy
- College of Health and Human Sciences, Colorado State University, Fort Collins, USA
| | - Mei-Hui Tseng
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taiwan; Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taiwan.
| | - Reinie Cordier
- Department of Social Work, Education and Community Wellbeing, Faculty of Health & Life Sciences, Northumbria University, Newcastle, UK; Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, WA, Australia; Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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3
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Smits-Engelsman B, Denysschen M, Lust J, Coetzee D, Valtr L, Schoemaker M, Verbecque E. Which outcomes are key to the pre-intervention assessment profile of a child with developmental coordination disorder? A systematic review and meta-analysis. Biomed J 2024:100768. [PMID: 39032866 DOI: 10.1016/j.bj.2024.100768] [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: 03/07/2024] [Revised: 06/26/2024] [Accepted: 07/11/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Purpose of this study was to determine what key aspects of function should be incorporated to make up a pre-intervention assessment profile of a child with Developmental Coordination Disorder (DCD); more specifically, what aspects of functioning are implicated in DCD and what is their relative impact? METHODS A systematic review and meta-analysis were conducted, for which Pubmed, Web of Science, Scopus and Proquest were searched (last update: April 2023, PROSPERO: CRD42023461619). Case-control studies were included to determine point estimates for performances on field-based tests in different domains of functioning. Risk of bias was assessed, and level of evidence estimated. Random-effect meta-analyses were performed to calculate the pooled standardized mean differences for domains of functioning and subgrouping was done for clinically relevant subdomains. Heterogeneity was determined with I2. RESULTS 121 papers were included for analyses. Data of 5 923 children with DCD were included (59.8% boys) and 23 619 Typically Developing (TD) children (45.8% boys). The mean (SD) age of the DCD group was 10.3y (1.2) and 9.3y (1.3) for the TD children. Moderate evidence was found for motor performance, executive functions, sensory processing and perceptions, cognitive functions and sports and leisure activities to be affected in children with DCD. CONCLUSION Differences between the two groups varied per domain of functioning. This emphasizes the diversity present within children with DCD and provides a rationale for explaining the heterogeneity in this patient group. Yet, results highlight the potential involvement of all these domains and call for clinicians to be alert not only to examine motor skill difficulties but also other aspects of function. Results indicate the need to develop an individualized pre-intervention multi-dimensional assessment profile for each child with DCD. It also supports the important role that clinicians play in an interdisciplinary team to tackle the difficulties encountered by children with DCD.
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Affiliation(s)
- Bouwien Smits-Engelsman
- Physical Activity, Sport and Recreation, (PhASRec, focus area, Faculty Health Sciences, North-West University, Potchefstroom, South Africa; Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Marisja Denysschen
- Physical Activity, Sport and Recreation, (PhASRec, focus area, Faculty Health Sciences, North-West University, Potchefstroom, South Africa
| | - Jessica Lust
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Dané Coetzee
- Physical Activity, Sport and Recreation, (PhASRec, focus area, Faculty Health Sciences, North-West University, Potchefstroom, South Africa
| | - Ludvik Valtr
- Faculty of Physical Culture, Palacký University, Olomouc, Czechia
| | - Marina Schoemaker
- University of Groningen, University Medical Centre Groningen, Centre for Human Movement Sciences, Antonius Deusinglaan 1, 9713 AV Groningen, the Netherlands
| | - Evi Verbecque
- Rehabilitation Research Centre (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
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Berkalieva A, Kelly NR, Fisher A, Hohmann SF, Abul-Husn NS, Greally JM, Horowitz CR, Wasserstein MP, Kenny EE, Gelb BD, Ferket BS. Physician and informal care use explained by the Pediatric Quality of Life Inventory (PedsQL) in children with suspected genetic disorders. Qual Life Res 2024; 33:1997-2009. [PMID: 38743313 DOI: 10.1007/s11136-024-03677-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE To examine associations between Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales and PedsQL Infant Scales with formal health care resource utilization (HCRU) and informal caregiver burden. METHODS We studied a pediatric cohort of 837 patients (median age: 8.4 years) with suspected genetic disorders enrolled January 2019 through July 2021 in the NYCKidSeq program for diagnostic sequencing. Using linked ~ nine-month longitudinal survey and physician claims data collected through May 2022, we modeled the association between baseline PedsQL scores and post-baseline HCRU (median follow-up: 21.1 months) and informal care. We also assessed the longitudinal change in PedsQL scores with physician services using linear mixed-effects models. RESULTS Lower PedsQL total and physical health scores were independently associated with increases in 18-month physician services, encounters, and weekly informal care. Comparing low vs. median total scores, increases were 10.6 services (95% CI: 1.0-24.6), 3.3 encounters (95% CI: 0.5-6.8), and $668 (95% CI: $350-965), respectively. For the psychosocial domain, higher scores were associated with decreased informal care. Based on adjusted linear mixed-effects modeling, every additional ten physician services was associated with diminished improvement in longitudinal PedsQL total score trajectories by 1.1 point (95% confidence interval: 0.6-1.6) on average. Similar trends were observed in the physical and psychosocial domains. CONCLUSION PedsQL scores were independently associated with higher utilization of physician services and informal care. Moreover, longitudinal trajectories of PedsQL scores became less favorable with increased physician services. Adding PedsQL survey instruments to conventional measures for improved risk stratification should be evaluated in further research.
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Affiliation(s)
- Asem Berkalieva
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029-6574, USA
| | - Nicole R Kelly
- Division of Pediatric Genetic Medicine, Department of Pediatrics, Children's Hospital at Montefiore/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ashley Fisher
- Center for Advanced Analytics, Vizient, Chicago, IL, USA
| | | | - Noura S Abul-Husn
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- 23andMe Inc, Sunnyvale, CA, USA
- Division for Genomic Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John M Greally
- Division of Genomics, Department of Genetics, Children's Hospital at Montefiore/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Carol R Horowitz
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Melissa P Wasserstein
- Division of Pediatric Genetic Medicine, Department of Pediatrics, Children's Hospital at Montefiore/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eimear E Kenny
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division for Genomic Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bruce D Gelb
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, 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
| | - Bart S Ferket
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029-6574, USA.
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Brignell A, Williams KJ, Reilly S, Morgan AT. Language growth in verbal autistic children from 5 to 11 years. Autism Res 2024. [PMID: 38828606 DOI: 10.1002/aur.3171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 05/06/2024] [Indexed: 06/05/2024]
Abstract
To examine predictors and growth in language for verbal autistic and non-autistic children with/without low language from 4 to 11 years. Receptive and expressive language trajectories were compared in a community sample of 1026 children at ages 5, 7, and 11 years, across four groups: two autistic groups; one with and one without low language; and two non-autistic groups; one with and one without low language. Groups were delineated on baseline assessment at 4 years. Non-autistic and autistic children with low language had lower mean expressive language scores than the non-autistic typical language group (22.26 and 38.53 units lower, respectively, p < 0.001), yet demonstrated faster language growth across 5 to 11 years (p < 0.001 and p = 0.002, respectively). Both groups without low language had similar mean expressive language scores (p = 0.864) and a comparable rate of growth (p = 0.645). Language at 4 years was the only consistent predictor of language at 11 years for autistic children. Results were similar for receptive language in all analyses except there was no significant difference in rate of progress (slope) for the autistic with low language group compared with the typical language group (p = 0.272). Findings suggest early language ability, rather than a diagnosis of autism, is key to determining language growth and outcomes at 11 years in verbal children. Furthermore, children with low language showed developmental acceleration compared with same age peers.
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Affiliation(s)
- Amanda Brignell
- Paediatrics, Monash University, Clayton, Victoria, Australia
- Speech and Language, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Developmental Paediatrics, Monash Children's Hospital, Clayton, Victoria, Australia
- Speech Pathology, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Katrina J Williams
- Paediatrics, Monash University, Clayton, Victoria, Australia
- Developmental Paediatrics, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Sheena Reilly
- Speech and Language, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Angela T Morgan
- Speech and Language, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Audiology and Speech Pathology, University of Melbourne, Carlton, Victoria, Australia
- Speech Pathology, Royal Children's Hospital, Parkville, Victoria, Australia
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Jacobs P, Power L, Davidson G, Devaney J, McCartan C, McCusker P, Jenkins R. A Scoping Review of Mental Health and Wellbeing Outcome Measures for Children and Young People: Implications for Children in Out-of-home Care. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2024; 17:159-185. [PMID: 38938951 PMCID: PMC11199430 DOI: 10.1007/s40653-023-00566-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 06/29/2024]
Abstract
Purpose One of the challenges for mental health research is the lack of an agreed set of outcome measures that are used routinely and consistently between disciplines and across studies in order to build a more robust evidence base for how to better understand young people's mental health and effectively address diverse needs. Methods This study involved a scoping review of reviews on consensus of the use of mental health and wellbeing measures with children and young people. We were particularly interested to identify if there are differences in measures that are recommended for children and young people with care experience including those with developmental disabilities. Findings We identified 41 reviews, of which two had a focus on child welfare settings, three on childhood trauma and 14 focused on children and young people with developmental disabilities. Overall, our review highlights a lack of consensus and a diversity of measures within the field. We identified 60 recommended measures, of which only nine were recommended by more than one review. Conclusions Our review highlights the need for greater agreement in the use of mental health outcome measures. While our review highlights that there is value in identifying measures that can be used with any child or young person, researchers need to take into account additional considerations when working with children and young people with care experience and those with developmental disabilities, to ensure measures are accessible and sensitive to their life experiences.
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Affiliation(s)
- Paula Jacobs
- Faculty of Social Sciences, Social Work, University of Stirling, Colin Bell Building, Stirling, UK
| | - Luke Power
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Gavin Davidson
- School of Social Sciences, Education and Social Work, Queen’s University Belfast, Belfast, UK
| | - John Devaney
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Claire McCartan
- School of Social Sciences, Education and Social Work, Queen’s University Belfast, Belfast, UK
| | - Pearse McCusker
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Ruth Jenkins
- Academic Support Librarian, University of Edinburgh, Edinburgh, UK
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Øverland E, Hauge ÅL, Orm S, Øie MG, Skogli EW, Pellicano E, Andersen PN. "I have to charge my social battery": Perspectives from autistic young adults on Quality of Life. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1369-1381. [PMID: 38629698 DOI: 10.1177/13623613241245578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
LAY ABSTRACT In this study we have asked a group of autistic young adults to describe what is important for their quality of life. The 14 participants (aged 21-29 years) were recruited from a 10-year follow-up study of autistic people. During interviews, our participants described the importance of having relationships with family, friends and pets. Having meaningful activities and being able to immerse themselves in particular interests was also reported to be important for a good quality of life. Interests had also guided their choice of what to study and what to do for work. They also spoke of how communication problems with professionals, bullying and sensory and emotional overload could have a negative impact on quality of life. Future interventions should focus on how professionals can help autistic people to connect to people/animals and meaningful activities, as the participants described this as important for having a good quality of life. These findings may be helpful in enhancing how passions and interests can be seen as opportunities for both academic and work careers for autistic people. Future research and interventions should also look at the communication barriers between autistic people and professionals, and how two-way understanding can be improved.
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Affiliation(s)
- Elisabeth Øverland
- Innlandet Hospital Trust, Norway
- Inland Norway University of Applied Sciences, Norway
| | | | - Stian Orm
- Innlandet Hospital Trust, Norway
- Inland Norway University of Applied Sciences, Norway
| | | | - Erik Winther Skogli
- Innlandet Hospital Trust, Norway
- Inland Norway University of Applied Sciences, Norway
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Paveenakiattikhun S, Likhitweerawong N, Sanguansermsri C. EEG findings and clinical severity and quality of life in non-epileptic patients with autism spectrum disorders. Child Neuropsychol 2024:1-11. [PMID: 38805362 DOI: 10.1080/09297049.2024.2360651] [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: 12/26/2023] [Accepted: 05/17/2024] [Indexed: 05/30/2024]
Abstract
Electroencephalogram (EEG) abnormalities could be seen in up to 60% of non-epileptic children with autism spectrum disorder (ASD). They have been used as biomarkers of ASD severity. The objective of our study is to identify EEG abnormalities in children with different degrees of ASD severity based on the Autism Treatment Evaluation Checklist (ATEC). We also want to assess the quality of life for children with ASD. All of the children underwent at least one hour of sleep-deprived EEG. Forty-five children were enrolled, of whom 42 were male. EEG abnormalities were found in 10 (22.2%) children, predominantly in the bilateral frontal areas. There were no differences in EEG findings among the mild, moderate, and severe ASD groups. The severity of ASD was associated with female sex (p-value = 0.013), ASD with attention deficit hyperactivity disorder (ADHD) (p-value = 0.032), ASD children taking medications (p-value = 0.048), and a lower Pediatric Quality of Life Inventory (PedsQL) (p-value <0.001). Social and emotional domains were the most problematic for health-related quality of life in ASD children, according to parent reports of PedsQL. Further studies with a larger sample size will help to clarify the potential associations between EEG abnormalities and the severity of ASD, as well as the impact on quality of life.
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Affiliation(s)
- Sirada Paveenakiattikhun
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University Hospital, Chiang Mai, Thailand
| | - Narueporn Likhitweerawong
- Child and Development Division, Department of Pediatrics, Faculty of Medicine, Chiang Mai University Hospital, Chiang Mai, Thailand
| | - Chinnuwat Sanguansermsri
- Neurology Division, Department of Pediatrics, Faculty of Medicine, Chiang Mai University Hospital, Chiang Mai, Thailand
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Menezes M, Soland J, Mazurek MO. Association Between Neighborhood Support and Family Resilience in Households with Autistic Children. J Autism Dev Disord 2024; 54:1765-1773. [PMID: 36928636 DOI: 10.1007/s10803-023-05951-6] [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: 02/27/2023] [Indexed: 03/18/2023]
Abstract
The capacity of families with autistic children to demonstrate resilience is a notable strength that has received little attention in the literature. A potential predictor of family resilience in households with autistic youth is neighborhood support. This study examined the relationship between neighborhood support and family resilience in households with autistic youth utilizing data from the National Survey of Children's Health. A structural equation model was constructed as neighborhood support and family resilience were latent variables. Findings demonstrated that neighborhood support significantly predicts family resilience. This study contributes to the literature as the first quantitative investigation of predictors of family resilience with this group. Strengths of autistic youth, their families, and their communities can be and should be leveraged to address challenges.
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Affiliation(s)
| | - Jim Soland
- University of Virginia, Charlottesville, VA, USA
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Eyuboglu D, Eyuboglu M, Yaylaci F, Guller B, Sahbudak B, Avunduk A, Dagli OO, Pala SC, Arslantas D. The Validity and Reliability of the Turkish Version of the Autism Family Experience Questionnaire (AFEQ). J Autism Dev Disord 2024:10.1007/s10803-024-06264-y. [PMID: 38459280 DOI: 10.1007/s10803-024-06264-y] [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: 01/22/2024] [Indexed: 03/10/2024]
Abstract
The aim of this study was to examine the reliability and validity of the Turkish version of the AFEQ for Turkish parents of children with ASD. The Turkish-translated version of the AFEQ was administered to 241 parents of children aged 2-12 years with ASD to examine the construct validity and internal consistencies. Parents completed the Autism Behavior Checklist (ABC), and Quality of Life in Autism Questionnaire Parent version, along with the AFEQ. The mean age of the children of 241 individuals in the study group was 7.63 ± 3.02 and 88.4% (n = 213) were male. Cronbach's alpha coefficient was 0.921 of the total variance. Cronbach alpha coefficients are 0.813 for the "Experience of being a parent" subscale, 0.768 for the "Family Life" subscale, 0.810 for the "Child Development, Understanding and Social Relationships" subscale, and 0.804 for the "Child Symptoms (Feelings and Behaviour)" subscale. In conclusion, the translated and culturally adapted AFEQ shows good reliability and validity to measure the priorities of autistic children and their families in Turkey. It can also be useful in monitoring the effectiveness of intervention programs and changes in the child.
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Affiliation(s)
- Damla Eyuboglu
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Eskisehir Osmangazi University, 26480, Eskisehir, Turkey.
| | - Murat Eyuboglu
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Eskisehir Osmangazi University, 26480, Eskisehir, Turkey
| | - Ferhat Yaylaci
- Department of Child and Adolescent Psychiatry, Bursa Dortcelik Children Hospital, Bursa, Turkey
| | - Baris Guller
- Department of Child and Adolescent Psychiatry, Bursa Dortcelik Children Hospital, Bursa, Turkey
| | - Begum Sahbudak
- Child and Adolescent Psychiatry, Manisa Mental Health and Diseases Hospital, Manisa, Turkey
| | - Aslihan Avunduk
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Eskisehir Osmangazi University, 26480, Eskisehir, Turkey
| | - Onur Oktay Dagli
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Eskisehir Osmangazi University, 26480, Eskisehir, Turkey
| | - Seval Caliskan Pala
- Department of Public Health, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
- Eskisehir Provincial Health Directorate, Odunpazari Health Directorate, Eskisehir, Turkey
| | - Didem Arslantas
- Department of Public Health, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
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11
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Nelson MA, Shaffer RC, Schmitt LM, Coffman MC, Horn PS, Reisinger DL, Erickson CA. Health Related Quality of Life in Autistic Youth and Their Families. J Autism Dev Disord 2023:10.1007/s10803-023-06054-y. [PMID: 37642877 DOI: 10.1007/s10803-023-06054-y] [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: 06/22/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE The construct Quality of Life (QoL) involves a range of factors related to one's well-being. Individuals on the autism spectrum have been previously reported to have lower QoL. The purpose of the present study is to examine QoL in autistic individuals and their families and to evaluate associations between QoL and measures of functioning using the PedsQL 4.0. METHOD Thirty-six autistic youth (ages 9-21 years) and their caregivers completed the PedsQL. Caregivers completed additional measures of their children's adaptive, social, behavioral, and emotional functioning. RESULTS Parents and youth generally agreed on the PedsQL, with the exception of the Social Functioning domain, which youth rated higher. The parent rated PedsQL did not correlate with most areas of caregiver-rated functioning; however, there were significant negative correlations between irritability and family functioning. CONCLUSION Limitations of this study included small sample size; broad range of intellectual functioning; lack of sample diversity; and likely recruiting bias for a drug treatment study. Despite limitations, HRQoL is an important feature that should be measured in addition to features of autism or symptoms of co-occurring symptoms.
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Affiliation(s)
- Meredith A Nelson
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA.
- Pediatrics, University of Cincinnati School of Medicine, Cincinnati, USA.
| | - Rebecca C Shaffer
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA
- Pediatrics, University of Cincinnati School of Medicine, Cincinnati, USA
| | - Lauren M Schmitt
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA
- Pediatrics, University of Cincinnati School of Medicine, Cincinnati, USA
| | | | - Paul S Horn
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA
- Pediatrics, University of Cincinnati School of Medicine, Cincinnati, USA
| | - Debra L Reisinger
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA
- Pediatrics, University of Cincinnati School of Medicine, Cincinnati, USA
| | - Craig A Erickson
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA
- Psychiatry, University of Cincinnati School of Medicine, Cincinnati, USA
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12
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Folostina R, Iacob CI, Syriopoulou-Delli CK. Physical activity, sedentary behaviour and quality of life in children with autism: insights from Romania and Greece. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2023; 69:432-441. [PMID: 37213593 PMCID: PMC10198000 DOI: 10.1080/20473869.2023.2204574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/15/2023] [Accepted: 04/15/2023] [Indexed: 05/23/2023]
Abstract
Background The COVID-19 pandemic has accentuated sedentarism in children, including those with autism. Given the importance of the topic for long-term health, this study aimed to explore the post-pandemic relationship between physical activity, sedentary behaviours and quality of life (QOL) in children with autism from Romania and Greece. Methods An online questionnaire collected information regarding physical activity levels in children and their parents, children's sedentary behaviours and QOL from 83 Romanian parents (m1age = 40.1; sd1age = 6.37) and 42 Greek parents (m2age = 39.5; sd2age = 5.45) between March and July 2022. Results Most Greek children (95%) had 2 or 3 weekly hours of physical education at school/kindergarten, while only 64% of Romanian children had the same level of physical education. Romanian parents reported being more active (χ2weekdays= 33.7, df = 3, p < .001; (χ2leisure= 41.8, df = 2, p < .001) than the Greek counterparts. Contrary to expectations, the parents' physical activity did not correlate with the child's physical activity. Sedentary behaviour time was significantly higher in Greek than Romanian children during working days and the weekends. Sedentary behaviour during weekdays predicted the child' QOL. Conclusions This exploratory study offers insight into Romanian and Greek children's patterns of physical and sedentary activities. The results stress the need to increase physical activity and decrease sedentary behaviours in children with autism from Romania and Greece. The practical implications and limits of this exploratory approach were further discussed.
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Affiliation(s)
- Ruxandra Folostina
- Department of Special Education, University of Bucharest, Bucharest, Romania
| | - Claudia Iuliana Iacob
- Department of Applied Psychology and Psychotherapy, University of Bucharest, Bucharest, Romania
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13
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Pillai J, Dunn K, Efron D. Parent-reported factors associated with the emergency department presentation of children and adolescents with autism spectrum disorder and/or intellectual disability with behaviours of concern: a qualitative study. Arch Dis Child 2023; 108:264-270. [PMID: 36521861 DOI: 10.1136/archdischild-2022-325002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We aimed to examine the parent-reported factors contributing to the emergency department (ED) presentation of children and adolescents with autism spectrum disorder (autism) and/or intellectual disability (ID) with behaviours of concern (BOC). DESIGN Qualitative study using semistructured interviews. Data were analysed phenomenologically using inductive thematic analysis. SETTING The ED of the Royal Children's Hospital, Melbourne, Australia, a tertiary paediatric hospital. PARTICIPANTS 14 parents and/or carers of children and adolescents with autism and/or ID who presented to ED for management of BOC. RESULTS Three themes emerged from the data: (1) Parents and carers had difficulties navigating the healthcare system and accessing appropriate community supports prior to their child's ED presentation; (2) Families presented to ED due to an inability to manage risk and/or contain their child's behaviour, compounded by carer burn-out; (3) Presentation to ED was considered a last resort option for many families. The ED was generally unable to assist families in the ongoing management of their child's BOC, leading to a potential need to re-present in future. CONCLUSIONS This study highlights the need for families of children with autism and ID and associated BOC to have improved access to appropriately skilled community health professionals, allowing their BOC to be addressed as they emerge rather than at crisis point. The findings additionally highlight the need for changes to the delivery of acute care in the management of BOC, to minimise patient distress and maximise safe and satisfactory patient outcomes.
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Affiliation(s)
- Jasmine Pillai
- Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Karen Dunn
- Department of Emergency Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Daryl Efron
- Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Centre for Community Child Health, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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14
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Raju S, Hepsibah PEV, Niharika MK. Quality of life in parents of children with Autism spectrum disorder: Emphasizing challenges in the Indian context. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2023; 69:371-378. [PMID: 37213591 PMCID: PMC10198003 DOI: 10.1080/20473869.2023.2173832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 05/23/2023]
Abstract
Purpose: Research has raised concerns about the quality of life (QOL) of parents of children with Autism spectrum disorder (ASD). Parents in different cultures show different psychological functioning when caring for a child with ASD. Hence, we examined QOL in parents of children with ASD in India and its relationship with socio-demographic factors. Materials and methods: We used a self-reported questionnaire and WHOQOL-BREF instrument to collect data on socio-demographic details and QOL respectively. Data were collected from two groups of participants - parents of children with ASD and parents of typically developing children (N = 60). Results: Results revealed significant differences in QOL between the two groups. Further, we found a positive correlation between socio-demographic variables and QOL in parents of children with ASD. Conclusions: Findings emphasize the need for intervention approaches aimed at family functioning, improving support services, and assisting parents to develop healthy coping strategies.
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Affiliation(s)
- Suma Raju
- Department of Speech-Language Pathology, JSS Institute of Speech and Hearing, Mysuru, India
| | - P. E. V. Hepsibah
- Department of Speech-Language Pathology, JSS Institute of Speech and Hearing, Mysuru, India
| | - M. K. Niharika
- Department of Speech-Language Pathology, JSS Institute of Speech and Hearing, Mysuru, India
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15
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Salvador-Garcia C, Valverde-Esteve T, Chiva-Bartoll O, Maravé-Vivas M. Dynamic balance improvement in children with Autism Spectrum Disorder after an extracurricular Service-Learning Physical Education program. Dev Neurorehabil 2023; 26:18-26. [PMID: 36191252 DOI: 10.1080/17518423.2022.2131922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This study aimed to examine the acute changes in dynamic balance Postural Control experienced by children with Autism Spectrum Disorder (ASD) who undertook a 6-month extracurricular Service-Learning Physical Education (PE) program. The study used a quasi-experimental design with 23 participants divided into an experimental group and a control group. Limits of Stability protocol was used to measure the children's postural control. The results showed that the experimental group achieved statistically significant improvements. To conclude, this study provides substantial input about how extracurricular PE activities aimed at developing the general motor proficiency of ASD children can improve their dynamic balance.
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Affiliation(s)
- Celina Salvador-Garcia
- Department of Pedagogy and Didactics of the Social Sciences, Language and Literature, Universitat Jaume I, 12071 Castellón, Spain
| | - Teresa Valverde-Esteve
- Department of Didactics of Music, Visual and Body Expression, University of Valencia, 46022 Valencia, Spain
| | - Oscar Chiva-Bartoll
- Department of Education and Specific Didactics, Faculty of Humanities and Social Sciences, Universitat Jaume I, 12071 Castellón, Spain
| | - María Maravé-Vivas
- Department of Education and Specific Didactics, Faculty of Humanities and Social Sciences, Universitat Jaume I, 12071 Castellón, Spain
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16
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Evers K, Maljaars J, Schepens H, Vanaken GJ, Noens I. Conceptualization of quality of life in autistic individuals. Dev Med Child Neurol 2022; 64:950-956. [PMID: 35323990 DOI: 10.1111/dmcn.15205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/18/2022] [Accepted: 02/24/2022] [Indexed: 12/14/2022]
Abstract
The present study examines to what extent two core characteristics of the quality of life (QoL) construct were incorporated in the field of autism: (1) its subjective nature; and (2) its multidimensionality. Therefore, we reviewed 174 articles examining QoL in individuals with autism. The review showed parents reporting a lower QoL compared with autistic individuals themselves, especially on internal domains. This may suggest different expectations about what a good QoL may entail. Such an underestimation of QoL by others is commonly observed in individuals with disabilities (the so-called 'disability paradox'). For the multidimensionality of the QoL construct, our findings suggest that the narrower (and more unidimensional) construct of health-related QoL is often measured instead of QoL. Additionally, a substantial proportion of items did not measure QoL, but they evaluated characteristics that may or may not have an impact on QoL. Researchers and clinicians should be aware that QoL domains are selected and operationalized differently by different instruments. QoL may benefit from an exclusive focus on subjective aspects, which can be measured alongside more normative, objective characteristics of individuals or their environment.
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Affiliation(s)
- Kris Evers
- Parenting and Special Education Research Group, KU Leuven, Leuven, Belgium.,Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium.,Child and Adolescent Psychiatry, UPC-KU Leuven, Leuven, Belgium
| | - Jarymke Maljaars
- Parenting and Special Education Research Group, KU Leuven, Leuven, Belgium.,Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium.,Child and Adolescent Psychiatry, UPC-KU Leuven, Leuven, Belgium
| | - Hadewych Schepens
- Parenting and Special Education Research Group, KU Leuven, Leuven, Belgium
| | - Gert-Jan Vanaken
- Parenting and Special Education Research Group, KU Leuven, Leuven, Belgium.,Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium.,Child and Adolescent Psychiatry, UPC-KU Leuven, Leuven, Belgium.,Department of Philosophy, Centre for Ethics, University of Antwerp, Antwerp, Belgium
| | - Ilse Noens
- Parenting and Special Education Research Group, KU Leuven, Leuven, Belgium.,Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
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17
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Stiller A, Stiller C. Parental report of quality of life in autistic children and youths: the role of parents' (informal) social support, and children's active leisure time. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 70:354-364. [PMID: 38699505 PMCID: PMC11062282 DOI: 10.1080/20473869.2022.2092935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/17/2022] [Indexed: 05/05/2024]
Abstract
Research examining the quality of life (QoL) in children with autism in relation to leisure behavior is extremely rare. An online survey of parents (N = 282) was conducted to help to fill this gap. Using structural equation model (SEM), the association between the parents' (informal) social support and children's QoL (reported by parents) was examined. In this, parental behavior, children's active leisure time, children's TV consumption, as well as children's self-worth (reported by the parents) were integrated. Findings suggested that the parents' (informal) social support, children's active leisure, and self-worth have a positive effect on children's QoL. Implications of the results are discussed.
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Affiliation(s)
- Anja Stiller
- Der Kinderschutzbund Landesverband Niedersachsen e.V., Hanover, Germany
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18
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Song W, Nonnemacher SL, Miller KK, Anderson K, Shea LL. Living arrangements and satisfaction of current arrangement among autistic adults reported by autistic individuals or their caregivers. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:1174-1185. [DOI: 10.1111/jar.13003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 02/18/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Wei Song
- College of Public Health Temple University Philadelphia Pennsylvania USA
| | - Stacy L. Nonnemacher
- Pennsylvania Department of Human Services, Office of Developmental Programs Bureau of Supports for Autism and Special Populations Harrisburg Pennsylvania USA
| | - Kaitlin Koffer Miller
- A.J. Drexel Autism Institute, Policy and Analytics Center Drexel University Philadelphia Pennsylvania USA
| | - Kristy Anderson
- A.J. Drexel Autism Institute, Drexel University Philadelphia Pennsylvania USA
| | - Lindsay L. Shea
- A.J. Drexel Autism Institute, Drexel University Philadelphia Pennsylvania USA
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19
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Schneider S, Clément C, Goltzene MA, Meyer N, Gras-Vincendon A, Schröder CM, Coutelle R. Determinants of the evolutions of behaviours, school adjustment and quality of life in autistic children in an adapted school setting: an exploratory study with the International Classification of Functioning, disability and health (ICF). BMC Psychiatry 2022; 22:323. [PMID: 35524241 PMCID: PMC9074195 DOI: 10.1186/s12888-022-03924-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 04/07/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Previous studies about Quality of Life (QoL) in autistic children (ASD) have put forward the negative impact of factors such as Autism Spectrum Disorder (ASD) severity, psychiatric comorbidities and adaptive behaviour impairment. However, little is known about the relation of these factors to school adjustment, measured with the International Classification of Functions disability and health (ICF) framework (World Health Organization, 2001), and QoL evolutions. Thus, this study aimed at investigating the determinants of behaviours, school adjustment and QoL changes in 32 children in an ASD inclusion program over one academic year. METHODS Using Bayesian methods, we studied the impact of ASD severity, psychiatric comorbidities, adaptive behaviour level and a diagnosis of Pathological Demand Avoidance (PDA) on evolutions of behaviour, school adjustment (measured with the ICF) and QoL. RESULTS As predicted, adequate adaptive behaviour levels were associated with better progress of behaviours and school adjustment whereas psychiatric comorbidities were related to worse outcome of school adjustment. Contrary to our hypotheses, severe ASD was associated to better evolution of adjustment at school. PDA was not discriminant. We did not find any association between the studied factors and the evolution of QoL over the academic year. CONCLUSION Our results show that the assessment of adaptive behaviour levels, psychiatric comorbidities and ASD severity level may be useful predictors to discriminate of school adjustment evolution (assessed by teachers within the ICF model) over a one-year period in autistic children. The assessment of this time course of school adjustment was sensitive to change and adapted to differentiate evolutions in an inclusive education framework. The investigation of quality of school life of autistic children as well as its determinants may therefore be relevant to improving academic adaptation. However, further research in larger groups, over longer periods and in different personalized school settings for autistic children is needed.
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Affiliation(s)
- Stéphanie Schneider
- grid.412220.70000 0001 2177 138XService de Psychiatrie de l’Enfant et de l’Adolescent, FHU NEUROGENΨCS, Fédération de Médecine Translationnelle de Strasbourg (FMTS), University Hospital and Medical School of Strasbourg, INSERM 1114, GIS Autisme et TND, Centre d’Excellence STRAS&ND, Strasbourg, France ,GIS Autisme et TND, Centre d’Excellence STRAS&ND, Strasbourg, France
| | - Céline Clément
- GIS Autisme et TND, Centre d’Excellence STRAS&ND, Strasbourg, France ,grid.11843.3f0000 0001 2157 9291LISEC, Laboratoire Interuniversitaire en Sciences de l’Education et de la Communication, UR 2310, Université de Strasbourg, Strasbourg, France
| | - Marc-André Goltzene
- grid.412220.70000 0001 2177 138XHôpitaux Universitaires de Strasbourg, Service de pathologie professionnelle et environnementale, 1 place de l’hôpital, 67000 Strasbourg, France
| | - Nicolas Meyer
- grid.412220.70000 0001 2177 138XDepartment of Public Health, University Hospitals of Strasbourg, Strasbourg, France ,grid.11843.3f0000 0001 2157 9291Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Agnès Gras-Vincendon
- grid.412220.70000 0001 2177 138XService de Psychiatrie de l’Enfant et de l’Adolescent, FHU NEUROGENΨCS, Fédération de Médecine Translationnelle de Strasbourg (FMTS), University Hospital and Medical School of Strasbourg, INSERM 1114, GIS Autisme et TND, Centre d’Excellence STRAS&ND, Strasbourg, France ,GIS Autisme et TND, Centre d’Excellence STRAS&ND, Strasbourg, France
| | - Carmen M. Schröder
- grid.412220.70000 0001 2177 138XService de Psychiatrie de l’Enfant et de l’Adolescent, FHU NEUROGENΨCS, Fédération de Médecine Translationnelle de Strasbourg (FMTS), University Hospital and Medical School of Strasbourg, INSERM 1114, GIS Autisme et TND, Centre d’Excellence STRAS&ND, Strasbourg, France ,GIS Autisme et TND, Centre d’Excellence STRAS&ND, Strasbourg, France ,grid.462184.d0000 0004 0367 4422CNRS UPR 3212, Equipe 9, “Lumière, Rythmes Circadiens, Homéostasie du Sommeil et Neuropsychiatrie”, Institut des Neurosciences Cellulaires et Intégratives (INCI), Strasbourg, France
| | - Romain Coutelle
- Service de Psychiatrie de l'Enfant et de l'Adolescent, FHU NEUROGENΨCS, Fédération de Médecine Translationnelle de Strasbourg (FMTS), University Hospital and Medical School of Strasbourg, INSERM 1114, GIS Autisme et TND, Centre d'Excellence STRAS&ND, Strasbourg, France. .,GIS Autisme et TND, Centre d'Excellence STRAS&ND, Strasbourg, France.
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20
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Ramey D, Healy O, McEnaney E. Defining and Measuring Indices of Happiness and Unhappiness in Children Diagnosed with Autism Spectrum Disorder. Behav Anal Pract 2022; 16:194-209. [PMID: 37006433 PMCID: PMC10050627 DOI: 10.1007/s40617-022-00710-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 11/25/2022] Open
Abstract
AbstractImproving quality of life (QoL) is the goal of behavior analytic services, but there can be barriers to assessing the QoL of autistic children due to characteristics inherent in the condition. Given that happiness is a fundamental element of QoL, previous research has relied on behavioral indicators of mood (e.g., smiling, crying) to evaluate the overall QoL of disabled individuals. However, the use of these traditional indices may not accurately reflect the emotional well-being of autistic individuals, who are known to engage in idiosyncratic mood indicators. The current study replicated selected procedures from Parsons et al. (2012) to identify and validate the unique mood indicators of young autistic children. The study showed that individualized indices of happiness and unhappiness could be operationally defined and reliably measured among these children. Key findings and limitations of this study are discussed, and the implications of these findings are presented.
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Affiliation(s)
- Devon Ramey
- School of Social Sciences, Education and Social Work, Queen’s University Belfast, Belfast, UK
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Olive Healy
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Emma McEnaney
- School of Psychology, Trinity College Dublin, Dublin, Ireland
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21
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Brown HM, Dwyer PSR, Gassner DL, Kapp SK, Ne′eman A, Ryan JG, Waisman TC, Williams ZJ. The Autism Intervention Research Network on Physical Health Autistic Researcher Review Board. Pediatrics 2022; 149:e2020049437F. [PMID: 35363294 PMCID: PMC9069212 DOI: 10.1542/peds.2020-049437f] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 01/29/2023] Open
Affiliation(s)
- Heather M. Brown
- Department of Educational Psychology, Faculty of Education, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick S. R. Dwyer
- Center for Mind and Brain, University of California Davis, Davis, California
- Department of Psychology, University of California Davis, Davis, California
| | - Dena L. Gassner
- School of Social Work, Adelphi University, Garden City, New York
- Department of Health Sciences, Towson University, Towson, Maryland
| | - Steven K. Kapp
- Department of Psychology, University of Portsmouth, Portsmouth, United Kingdom
| | - Ari Ne′eman
- Harvard University, Cambridge, Massachusetts
| | - Jacalyn G. Ryan
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - TC Waisman
- University of Calgary, Calgary, Alberta, Canada
| | - 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
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, Tennessee
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22
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Logrieco MG, Casula L, Ciuffreda GN, Novello RL, Spinelli M, Lionetti F, Nicolì I, Fasolo M, Giovanni V, Stefano V. Risk and protective factors of quality of life for children with autism spectrum disorder and their families during the COVID-19 lockdown. An Italian study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 120:104130. [PMID: 34826776 PMCID: PMC8602998 DOI: 10.1016/j.ridd.2021.104130] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/03/2021] [Accepted: 11/16/2021] [Indexed: 05/08/2023]
Abstract
BACKGROUND The lockdown due to the COVID-19 pandemic has been a difficult period for children with Autism Spectrum Disorder (ASD), and their families. AIMS The aim of this study was to investigate the predictors of the quality of life (QoL) of children with ASD and their parents throughout the first lockdown, providing a snapshot of the impact of the pandemic on these families life. METHOD AND PROCEDURES A cohort of 243 parents of children with ASD (2-15 years old) completed an original online survey regarding the modification of ASD cores symptoms during lockdown, the type of interventions they had done before and during lockdown and the activities performed by the child. Respondents filled the PedsQL for themselves and their children. OUTCOME AND RESULTS The data obtained show a worsening of specific ASD core symptoms during lockdown and their role in predicting parents and children's QoL. Furthermore, protective factors for a better children's QoL as the Telehealth intervention, and some activities done at home during the lockdown as physical activity and play with parents are identified. CONCLUSIONS This study identifies the QoL's risk and protective factors for children with ASD and their families. Furthermore, reveals the fundamental role of the parents as children's QoL protective factor, suggesting a higher collaboration between families and health care providers, whilst potentially improving families and children's QoL.
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Affiliation(s)
- Maria Grazia Logrieco
- University "G. d'Annunzio" Chieti-Pescara, Department of Neuroscience Imaging and Clinical Sciences, Via dei Vestini 33, 66100, Chieti, CH, Italy.
| | - Laura Casula
- Department of Neuroscience, IRCCS Children's Hospital Bambino Gesù, Piazza Sant' Onofrio, 4 00165, Rome, RM, Italy.
| | | | - Roberta Lucia Novello
- Department of Neuroscience, IRCCS Children's Hospital Bambino Gesù, Piazza Sant' Onofrio, 4 00165, Rome, RM, Italy.
| | - Maria Spinelli
- University "G. d'Annunzio" Chieti-Pescara, Department of Neuroscience Imaging and Clinical Sciences, Via dei Vestini 33, 66100, Chieti, CH, Italy.
| | - Francesca Lionetti
- University "G. d'Annunzio" Chieti-Pescara, Department of Neuroscience Imaging and Clinical Sciences, Via dei Vestini 33, 66100, Chieti, CH, Italy.
| | - Ilaria Nicolì
- University "G. d'Annunzio" Chieti-Pescara, Department of Neuroscience Imaging and Clinical Sciences, Via dei Vestini 33, 66100, Chieti, CH, Italy.
| | - Mirco Fasolo
- University "G. d'Annunzio" Chieti-Pescara, Department of Neuroscience Imagingand Clinical Sciences, Via dei Vestini 33, 66100, Chieti, CH, Italy.
| | - Valeri Giovanni
- Department of Neuroscience, IRCCS Children's Hospital Bambino Gesù, Piazza Sant' Onofrio, 4 00165, Rome, RM, Italy.
| | - Vicari Stefano
- Department of Neuroscience, IRCCS Children's Hospital Bambino Gesù, Piazza Sant' Onofrio, 4 00165 Rome, RM, Italy.
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23
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Adamou M, Jones SL, Wetherhill S. AAA screening in adults with ASD: a retrospective cohort study. ADVANCES IN AUTISM 2021. [DOI: 10.1108/aia-10-2020-0059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The Adult Asperger Assessment (AAA), comprising the Autism Questionnaire, the Empathy Quiotient and the Relatives Questionnaire is a commonly used screening tool designed to identify adults who may benefit from a further clinical assessment for autism spectrum disorder. The purpose of this paper is to investigate the usefulness of this screening measure in a clinical setting.
Design/methodology/approach
This retrospective cohort study comprised of 192 service users referred for diagnostic assessment of Autism by a specialist service of the National Health Service. The authors evaluated the diagnostic accuracy of the AAA by investigating if the Autism Questionnaire, the Empathy Quiotient and the Relatives Questionnaire were able to predict the diagnostic outcome of Autism in a clinical setting.
Findings
Scores from the Relatives Questionnaire can accurately predict diagnostic outcome. No evidence of accuracy for the Autism Questionnaire or the Empathy Quotient was apparent. Based on the findings, the authors recommend clinicians are cautious when interpreting results of the AAA.
Research limitations/implications
It should be acknowledged that the results may not be generalisable to whole populations. Also, the authors used the full item versions of the scales; therefore, the findings are most applicable to studies which did similar.
Originality/value
This study highlights the need for investigation into the lack of validation of commonly used screening measures in autistic populations.
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24
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Sundaresan A, Penchina B, Cheong S, Grace V, Valero-Cabré A, Martel A. Evaluating deep learning EEG-based mental stress classification in adolescents with autism for breathing entrainment BCI. Brain Inform 2021; 8:13. [PMID: 34255197 PMCID: PMC8276906 DOI: 10.1186/s40708-021-00133-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/31/2021] [Indexed: 12/16/2022] Open
Abstract
Mental stress is a major individual and societal burden and one of the main contributing factors that lead to pathologies such as depression, anxiety disorders, heart attacks, and strokes. Given that anxiety disorders are one of the most common comorbidities in youth with autism spectrum disorder (ASD), this population is particularly vulnerable to mental stress, severely limiting overall quality of life. To prevent this, early stress quantification with machine learning (ML) and effective anxiety mitigation with non-pharmacological interventions are essential. This study aims to investigate the feasibility of exploiting electroencephalography (EEG) signals for stress assessment by comparing several ML classifiers, namely support vector machine (SVM) and deep learning methods. We trained a total of eleven subject-dependent models-four with conventional brain-computer interface (BCI) methods and seven with deep learning approaches-on the EEG of neurotypical (n=5) and ASD (n=8) participants performing alternating blocks of mental arithmetic stress induction, guided and unguided breathing. Our results show that a multiclass two-layer LSTM RNN deep learning classifier is capable of identifying mental stress from ongoing EEG with an overall accuracy of 93.27%. Our study is the first to successfully apply an LSTM RNN classifier to identify stress states from EEG in both ASD and neurotypical adolescents, and offers promise for an EEG-based BCI for the real-time assessment and mitigation of mental stress through a closed-loop adaptation of respiration entrainment.
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Affiliation(s)
- Avirath Sundaresan
- The Nueva School, San Mateo, CA, 94033, USA.,Causal Brain Dynamics, Plasticity and Rehabilitation Team, Frontlab, Brain and Spine Institute, ICM, CNRS UMR, Paris, 7225, France
| | - Brian Penchina
- The Nueva School, San Mateo, CA, 94033, USA.,Causal Brain Dynamics, Plasticity and Rehabilitation Team, Frontlab, Brain and Spine Institute, ICM, CNRS UMR, Paris, 7225, France
| | - Sean Cheong
- The Nueva School, San Mateo, CA, 94033, USA.,Causal Brain Dynamics, Plasticity and Rehabilitation Team, Frontlab, Brain and Spine Institute, ICM, CNRS UMR, Paris, 7225, France
| | - Victoria Grace
- Muvik Labs, LLC, Locust Valley, NY, 11560, USA.,Center for Computer Research in Music and Acoustics, Stanford University, Stanford, CA, 94305, USA.,Causal Brain Dynamics, Plasticity and Rehabilitation Team, Frontlab, Brain and Spine Institute, ICM, CNRS UMR, Paris, 7225, France
| | - Antoni Valero-Cabré
- Center for Computer Research in Music and Acoustics, Stanford University, Stanford, CA, 94305, USA.,Department of Anatomy and Neurobiology, Laboratory of Cerebral Dynamics, Boston University School of Medicine, Boston, MA, 02118, USA.,Cognitive Neuroscience and Information Technology Research Program, Open University of Catalonia (UOC), Barcelona, Spain.,Causal Brain Dynamics, Plasticity and Rehabilitation Team, Frontlab, Brain and Spine Institute, ICM, CNRS UMR, Paris, 7225, France
| | - Adrien Martel
- Cognitive Neuroscience and Information Technology Research Program, Open University of Catalonia (UOC), Barcelona, Spain. .,Causal Brain Dynamics, Plasticity and Rehabilitation Team, Frontlab, Brain and Spine Institute, ICM, CNRS UMR, Paris, 7225, France.
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25
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Searching for What Really Matters: A Thematic Analysis of Quality of Life among Preschool Children on the Autism Spectrum. J Autism Dev Disord 2021; 52:2098-2111. [PMID: 34060000 DOI: 10.1007/s10803-021-05097-3] [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: 05/16/2021] [Indexed: 10/21/2022]
Abstract
Quality of life (QoL) is an essential measure when assessing health interventions. Most early interventions for preschool children on the spectrum evaluate the effects on autism symptoms. However, researchers increasingly believe that good interventions should also improve the QoL of these children. Domains of QoL among preschool children on the autism spectrum have not previously been researched. We interviewed adults on the spectrum to explore early childhood experiences that made their lives satisfying. Our data revealed four major themes: interests, environmental regularity, sensory differences and social interactions. This study provides the first insights on aspects of life important to pre-schoolers on the spectrum. Findings will contribute to developing items for a measure of QoL among this population.
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Chezan LC, Liu J, Cholewicki JM, Drasgow E, Ding R, Warman A. A Psychometric Evaluation of the Quality of Life for Children with Autism Spectrum Disorder Scale. J Autism Dev Disord 2021; 52:1536-1552. [PMID: 33961179 DOI: 10.1007/s10803-021-05048-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2021] [Indexed: 11/26/2022]
Abstract
Our purpose in this study was to validate the Quality of Life for Children with Autism Spectrum Disorder scale. We first conducted an exploratory factor analysis to examine the factor structure. Results suggested that a three-factor model (Interpersonal Relationships, Self-Determination, and Emotional Well-Being) should be retained. Next, we conducted a confirmatory factor analysis to compare a higher-order factor model and additional models. Results showed acceptable model fit for the higher-order factor model. The scale had excellent reliability (α = .90) for the overall scale and for the three subscales (Interpersonal Relationships, α = .87; Self-Determination, α = .81; and Emotional Well-Being, α = .66). The 16-item scale showed convergent and divergent validity. Implications for future research and practice are discussed.
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Affiliation(s)
- Laura C Chezan
- Old Dominion University, 4501 Hampton Blvd., Child Study Center 122, Norfolk, VA, 23529, USA.
| | - Jin Liu
- University of South Carolina, 820 Main Street, Columbia, SC, 29208, USA
| | | | - Erik Drasgow
- University of South Carolina, 820 Main Street, Columbia, SC, 29208, USA
| | - Ruyi Ding
- Tsinghua Shenzhen International Graduate School, University Town of Shenzhen, Nanshan District, Shenzhen, 518055, People's Republic of China
| | - Adam Warman
- The Faison Center, 1701 Byrd Avenue, Richmond, VA, 23230, USA
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27
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Health-Related Quality of Life in Children with Developmental Disorders. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2021. [DOI: 10.1007/s40474-021-00235-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Abstract
Purpose of Review
(1) To give an overview of what is currently known about health-related quality of life (HRQoL) in three common and co-occurring developmental disorders: attention deficit hyperactivity disorder (ADHD), autism spectrum disorders (ASD), and developmental coordination disorder (DCD), and (2) to provide directions for future research.
Recent Findings
HRQoL is compromised in all three developmental disorders, affecting various domains of HRQoL. However, some domains are more affected than others depending on the nature of the core deficits of the disorder. Overall, parents’ rate HRQoL of their children lower than the children themselves. Children with ASD and ADHD with co-occurring disorders have lower HRQoL compared to those with singular disorders. Future studies in DCD are needed to investigate the effect of co-occurring disorder in this population.
Summary
Children with developmental disorders have lower HRQoL than typically developing children. Future research should focus on the effects of co-occurring disorders on HRQoL and on protective factors that may increase HRQoL. HRQoL should be a part of clinical assessment, as it reveals the areas in life children are struggling with that could be targeted during intervention.
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Menezes M, Mazurek MO. Associations between domains of health-related quality of life and comorbid emotional and behavioral problems in youth with autism spectrum disorder. RESEARCH IN AUTISM SPECTRUM DISORDERS 2021; 82:101740. [PMID: 33603826 PMCID: PMC7886261 DOI: 10.1016/j.rasd.2021.101740] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Health-related quality of life (HRQoL) can be used as a measure of the impact of a particular disorder on one's daily functioning. Previous studies have found that comorbid psychiatric disorders in children and adolescents with autism spectrum disorder (ASD) are associated with poorer HRQoL than ASD alone. Less is known about potential associations between specific symptoms of comorbid psychopathology (i.e., emotional and behavioral problems) and domains of functioning or HRQoL in youth with ASD. METHOD Participants were 470 children with ASD 2-14 years old recruited from one of three sites. Hierarchical multiple regressions were conducted with Pediatric Quality of Life Inventory 4.0 (PedsQL; Varni et al., 2001) HRQoL domains of physical functioning, emotional functioning, school functioning, and social functioning as the dependent variables. Covariates were entered at step 1, followed by the independent variables of interest at step 2: irritability, social withdrawal, stereotypic behavior, hyperactivity/noncompliance, and inappropriate speech. RESULTS The study found that increased irritability was associated with poorer emotional and physical functioning and that greater social withdrawal was associated with worse social functioning. Furthermore, findings showed that more hyperactivity/noncompliance was associated with worse school functioning. CONCLUSIONS Results demonstrated that certain emotional and behavioral symptoms are differentially associated with domains of HRQoL. This indicates that comorbid emotional and behavioral problems should be considered when measuring HRQoL in children with ASD. It also suggests that treating comorbid emotional/behavioral problems could improve HRQoL and functioning in certain domains for this population.
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Pecor KW, Barbayannis G, Yang M, Johnson J, Materasso S, Borda M, Garcia D, Garla V, Ming X. Quality of Life Changes during the COVID-19 Pandemic for Caregivers of Children with ADHD and/or ASD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3667. [PMID: 33915884 PMCID: PMC8037979 DOI: 10.3390/ijerph18073667] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 12/21/2022]
Abstract
The COVID-19 pandemic has presented many challenges to caregivers of children. Families with children with attention-deficit/hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD) are an understudied but potentially vulnerable population to changes during the outbreak. As such, the aim of this study was to contrast quality of life for caregivers of children with ADHD and/or ASD, before and during the pandemic, compared to caregivers of neurotypical (NT) children. Total, Parent Health-Related Quality of Life, and Family Functioning Summary Scores from the Family Impact Module of the Pediatric Quality of Life InventoryTM were contrasted among caregivers of children with ADHD, ASD, comorbid ADHD and ASD, and NT development. For all scores, caregivers of ADHD and/or ASD children reported lower quality of life, both before and during the pandemic, in comparison to caregivers of NT children. For all diagnoses, quality of life decreased during the pandemic, but caregivers of children with ADHD and/or ASD reported a greater decrease in quality of life than caregivers for NT children. There are limitations to this study in terms of the composition of the sample and the survey methodology, but we are able to conclude that caregivers of children with ADHD and/or ASD have been disproportionately affected by the pandemic, and it is imperative that these families receive additional resources and support to improve their quality of life.
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Affiliation(s)
- Keith W. Pecor
- Department of Biology, The College of New Jersey, Ewing, NJ 08628, USA;
| | - Georgia Barbayannis
- Department of Neurology, Rutgers University-New Jersey Medical School, Newark, NJ 07103, USA; (G.B.); (J.J.); (D.G.)
| | - Max Yang
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA; (M.Y.); (S.M.)
| | - Jacklyn Johnson
- Department of Neurology, Rutgers University-New Jersey Medical School, Newark, NJ 07103, USA; (G.B.); (J.J.); (D.G.)
| | - Sarah Materasso
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA; (M.Y.); (S.M.)
| | - Mauricio Borda
- Department of Neurology, Montefiore Medical Center, Bronx, NY 10467, USA;
| | - Disleidy Garcia
- Department of Neurology, Rutgers University-New Jersey Medical School, Newark, NJ 07103, USA; (G.B.); (J.J.); (D.G.)
| | - Varsha Garla
- College of Arts and Sciences, Vanderbilt University, Nashville, TN 37212, USA;
| | - Xue Ming
- Department of Neurology, Rutgers University-New Jersey Medical School, Newark, NJ 07103, USA; (G.B.); (J.J.); (D.G.)
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30
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Güeita-Rodríguez J, Ogonowska-Slodownik A, Morgulec-Adamowicz N, Martín-Prades ML, Cuenca-Zaldívar JN, Palacios-Ceña D. Effects of Aquatic Therapy for Children with Autism Spectrum Disorder on Social Competence and Quality of Life: A Mixed Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063126. [PMID: 33803581 PMCID: PMC8002945 DOI: 10.3390/ijerph18063126] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 01/02/2023]
Abstract
Autism Spectrum Disorder (ASD) is a constellation of social deficits and repetitive sensory-motor behaviours. Aquatic therapy (AT) may be effective in improving the social interactions and behaviours in children with ASD. The objective of this study was to evaluate the effects of an AT program on social competence and quality of life and to understand participant’s experiences related to the intervention by obtaining qualitative data. A mixed methods intervention study was conducted among 6 children with ASD and their parents, with two research phases in a concurrent embedded design (an aquatic intervention as the quantitative design and a qualitative design in second step). The intervention and qualitative design followed international guidelines and were integrated into the method and reporting subheadings. Significant improvement was observed in the physical competence (p = 0.026) and important improvements in school functioning and aquatic skills, with no adverse events. Qualitative findings described: the meaning of AT intervention, patterns of behaviour and activities changes, social communication and social interaction. The aquatic intervention showed positive results for the social and physical competence, with elements of discordance, expansion, and confirmation between quantitative and qualitative results.
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Affiliation(s)
- Javier Güeita-Rodríguez
- Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Madrid, Spain;
- Correspondence: ; Tel.: +34-914-888-600
| | - Anna Ogonowska-Slodownik
- Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, 00-968 Warsaw, Poland; (A.O.-S.); (N.M.-A.)
| | - Natalia Morgulec-Adamowicz
- Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, 00-968 Warsaw, Poland; (A.O.-S.); (N.M.-A.)
| | | | - Juan Nicolás Cuenca-Zaldívar
- Rehabilitation Unit, Hospital de Guadarrama, 28440 Madrid, Spain;
- Department of Physical Therapy, Universidad Francisco de Vitoria, 28223 Madrid, Spain
| | - Domingo Palacios-Ceña
- Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Madrid, Spain;
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Ozboke C, Yanardag M, Yilmaz I. Exploring the relationships between motor proficiency, independence and quality of life in adolescents with autism spectrum disorder. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2021; 68:850-857. [PMID: 36568624 PMCID: PMC9788684 DOI: 10.1080/20473869.2021.1900506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 05/30/2023]
Abstract
The aim of this study was to explore the relationships between autism severity, motor performance, independence in daily living skills and quality of life in adolescents with autism spectrum disorder (ASD). The study included 31 participants, aged 13-18 years. Evaluations were made with the Gilliam Autistic Disorders Rating Scale-2 (GARS-2), Bruininks-Oseretsky Test of Motor Proficiency-2 Short Form (BOT-2-SF), Functional Independence Measure (WeeFIM II), and Pediatric Quality of Life Inventory (PedsQL). Motor performance of the participants was determined as below average according to the norms of BOT-2 SF, and were negatively correlated with GARS-2 at a moderate level (r = -0.61, p < 0.001), and a moderate negative correlation was determined between GARS-2 and WeeFIM II (r = -0.65, p < 0.001) and PedsQL (r = -0.61, p < 0.001). Independence in daily living skills (DLS) and autism severity were found to be significant predictors of PedsQL (R2 = 0.463, p < 0.05). Motor impairment still appears to be a missing piece of the puzzle for this age group. Promoting motor skill acquisition and independence could be a key factor in preventing the deterioration of physical health and improving quality of life in adolescents with ASD.
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Affiliation(s)
- Caner Ozboke
- Faculty of Sport Sciences, Eskisehir Technical University, Eskisehir, Turkey
| | - Mehmet Yanardag
- Research Institute for Individuals with Disability, Anadolu University, Eskisehir, Turkey
| | - Ilker Yilmaz
- Faculty of Sport Sciences, Eskisehir Technical University, Eskisehir, Turkey
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32
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Lopez-Espejo MA, Nuñez AC, Moscoso OC, Escobar RG. Brief Report: Health-Related Quality of Life in Preschoolers with Autism Spectrum Disorder is Related to Diagnostic Age and Autistic Symptom Severity. J Autism Dev Disord 2021; 51:4704-4710. [PMID: 33569707 DOI: 10.1007/s10803-021-04909-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
We conducted a cross-sectional study to explore whether clinical characteristics and autism diagnostic-traits severity are associated with caregiver-reported impairment of health-related quality of life (Pediatric Quality of Life Inventory Generic Core Scales, Fourth Edition) in 93 Chilean toddlers (age: 2-4 years) with autism spectrum disorder. Median total scale, physical health, and psychosocial health scores were 76 (IQR 70-81), 88 (IQR 81-94), and 71 (IQR 62-79), respectively. In multiple-regression analysis, diagnostic age (β = 0.219; p 0.021) and Calibrated Severity Score of Autism Diagnostic Observation Schedule, second edition (β = - 0.434; p < 0.001) were independently correlated to the total scale score. Lower age and higher autistic traits severity at diagnosis are correlated with worse well-being perception by caregivers.
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Affiliation(s)
- Mauricio A Lopez-Espejo
- Unit of Neurology, Division of Pediatrics, School of Medicine, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Chile.
| | - Alicia C Nuñez
- Unit of Neurology, Division of Pediatrics, School of Medicine, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Chile
| | - Odalie C Moscoso
- Unit of Neurology, Division of Pediatrics, School of Medicine, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Chile
| | - Raul G Escobar
- Unit of Neurology, Division of Pediatrics, School of Medicine, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Chile
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33
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Gómez LE, Morán ML, Alcedo MÁ, Arias VB, Verdugo MÁ. Addressing Quality of Life of Children With Autism Spectrum Disorder and Intellectual Disability. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 58:393-408. [PMID: 33032321 DOI: 10.1352/1934-9556-58.5.393] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/29/2019] [Indexed: 06/11/2023]
Abstract
Despite the advances on the assessment of quality of life, this concept is barely studied and is riddled with important limitations for those with autism spectrum disorder (ASD). This article is aimed at validating a questionnaire to assess quality of life of children with ASD and intellectual disability (ID). Based on the KidsLife Scale, geared toward people with ID, the most reliable items for those with ASD were selected. Study participants were 420 persons, from 4 to 21 years old. Results indicated that the KidsLife-ASD Scale measured eight intercorrelated domains, had good reliability, and exhibited adequate evidences of validity. KidsLife-ASD emerges as a helpful tool to guide person-centered planning addressed at improving quality of life.
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Affiliation(s)
- Laura E Gómez
- Laura E. Gómez, M. Lucía Morán, and M. Ángeles Alcedo, Universidad de Oviedo, Oviedo, Asturias, 33003, Spain
| | - M Lucía Morán
- Laura E. Gómez, M. Lucía Morán, and M. Ángeles Alcedo, Universidad de Oviedo, Oviedo, Asturias, 33003, Spain
| | - M Ángeles Alcedo
- Laura E. Gómez, M. Lucía Morán, and M. Ángeles Alcedo, Universidad de Oviedo, Oviedo, Asturias, 33003, Spain
| | - Víctor B Arias
- Víctor B. Arias and Miguel-Ángel Verdugo, INICO, Universidad de Salamanca, Salamanca, 37005, Spain
| | - Miguel-Ángel Verdugo
- Víctor B. Arias and Miguel-Ángel Verdugo, INICO, Universidad de Salamanca, Salamanca, 37005, Spain
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Viljoen M, Mahdi S, Shelly J, de Vries PJ. Parental perspectives of functioning in their children with autism spectrum disorder: A global scoping review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 25:176-198. [PMID: 32862674 DOI: 10.1177/1362361320950055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT No paper to date has summarized parents' views on the functional challenges and/or strengths of their children with autism spectrum disorder. In this review we set out to perform a scoping review aiming to (a) find and compare existing research from around the globe on parental perception of functioning and (b) summarize results from these papers using the International Classification of Functioning Disability and Health-Child and Youth version framework. Since we know that the place and circumstances we live in can have a significant influence on our functioning in daily life, we were specifically interested in comparing perceptions from high-income countries and low-/middle-income countries. Two researchers conducted a comprehensive search of English studies published between 1990 and June 2016. Papers were summarized and key findings were linked to International Classification of Functioning Disability and Health-Child and Youth categories. Thirty-three studies were identified, of which most were conducted in high-income countries (n = 25/33, 76%) with only six studies in low/middle-income countries (n = 6/33, 18%). Two studies compared views from low/middle-income and high-income countries (n = 2/33, 6%). Functional themes from high-income countries included a range across the International Classification of Functioning Disability and Health-Child and Youth framework while functional themes from low-/middle-income countries were mostly focused on environmental factors. It was difficult to directly compare studies from low/middle-income and high-income countries because they investigated and discussed such different parts of functioning. We suggest that future research should use an approach that will allow researchers to directly compare functional categories in order to get a more accurate impression of the impact of context on functioning.
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Affiliation(s)
| | | | - James Shelly
- Eastern Health Child & Youth Mental Health Service, Australia
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35
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Azad GF, Dillon E, Feuerstein J, Kalb L, Neely J, Landa R. Quality of Life in School-Aged Youth Referred to an Autism Specialty Clinic: A Latent Profile Analysis. J Autism Dev Disord 2020; 50:1269-1280. [PMID: 31901118 DOI: 10.1007/s10803-019-04353-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We examined whether different profiles of quality of life (QoL) existed among youth referred to an autism spectrum disorder (ASD) specialty clinic and, if present, determined if these groups were associated with different characteristics. Data were from parental report of 5-17 year-old youth (N = 476) who were scheduled to receive an evaluation at an ASD clinic. Parents completed questionnaires, including the Pediatric Quality of Life Inventory, assessing child and family functioning; providers reported diagnostic impressions. A latent profile analysis found five distinct groups: Low Risk, School Problems, Only Social Emotional Problems, and two Physical/Social Emotional Problems. The groups differed on clinical characteristics and family functioning. These findings have implications for more efficient and effective evaluations in service delivery systems serving complex patients.
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Affiliation(s)
- Gazi F Azad
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA. .,Kennedy Krieger Institute's Center for Autism and Related Disorders, 3901 Greenspring Avenue, Baltimore, MD, 21211, USA.
| | - Emily Dillon
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 733 North Broadway, Baltimore, MD, 21205, USA.,Kennedy Krieger Institute's Center for Autism and Related Disorders, 3901 Greenspring Avenue, Baltimore, MD, 21211, USA
| | - Julie Feuerstein
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 733 North Broadway, Baltimore, MD, 21205, USA.,Kennedy Krieger Institute's Center for Autism and Related Disorders, 3901 Greenspring Avenue, Baltimore, MD, 21211, USA
| | - Luke Kalb
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.,Kennedy Krieger Institute's Center for Autism and Related Disorders, 3901 Greenspring Avenue, Baltimore, MD, 21211, USA
| | - Jason Neely
- May Institute, 41 Pacella Park Drive, Randolph, MA, 02368, USA.,Kennedy Krieger Institute's Center for Autism and Related Disorders, 3901 Greenspring Avenue, Baltimore, MD, 21211, USA
| | - Rebecca Landa
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 733 North Broadway, Baltimore, MD, 21205, USA.,Kennedy Krieger Institute's Center for Autism and Related Disorders, 3901 Greenspring Avenue, Baltimore, MD, 21211, USA
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36
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McCauley JB, Pickles A, Huerta M, Lord C. Defining Positive Outcomes in More and Less Cognitively Able Autistic Adults. Autism Res 2020; 13:1548-1560. [PMID: 32851813 DOI: 10.1002/aur.2359] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/19/2020] [Accepted: 06/27/2020] [Indexed: 02/03/2023]
Abstract
Identifying positive outcomes for a wide range of intellectual abilities in autism spectrum disorder (ASD) remains a challenge. Several past studies of autistic adults have used outcome definitions that do not reflect the experiences of less cognitively able adults. The aim of the current study was to (1) define three domains of outcomes: autonomy, social relationships, and purpose, and (2) examine how these outcomes relate to concurrent aspects of adult functioning. Using data from a longitudinal sample of 126 adults (85% diagnosed with ASD at some point), mean age 26, who first entered the study in early childhood, we generated distinct outcomes for less (daily living skills above an 8-year-old level, having regular activities outside the home, and social contacts outside the family) and more cognitively able adults (living independently, having paid employment, and at least one true friend). Verbal IQ, assessed in adulthood, was a significant predictor of more outcomes achieved for individuals within more and less cognitively able groups. For less cognitively able adults, having ever received a formal ASD diagnosis (in contrast to current Autism Diagnostic Observation Schedule [ADOS] CSS scores) was associated with lower odds of positive outcomes. For more cognitively able adults, living skills and happiness measures were positively associated with number of outcomes met; higher ADOS CSS, internalizing and externalizing symptoms, being racially diverse, and having caregiver education below college graduation were all negatively associated with the number of positive outcomes. Tailoring outcomes to ability levels may lead to better identification of goals and service needs. LAY SUMMARY: This article describes the outcomes of autistic adults who are more and less cognitively able. For less cognitively able individuals, an earlier autism diagnosis was negatively related to outcomes. Several factors that were associated with positive outcomes for more cognitively able individuals, including daily living skills, fewer mental health problems, family demographics, and subjective measures of happiness. Our study identifies several important factors for families, individuals, and service providers to consider and discuss when planning the transition to adulthood. Autism Res 2020, 13: 1548-1560. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- James B McCauley
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, California, USA
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Marisela Huerta
- Centre for Autism and the Developing Brain, Weill Cornell Medicine, New York City, New York, USA
| | - Catherine Lord
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, California, USA
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Sandercock RK, Lamarche EM, Klinger MR, Klinger LG. Assessing the convergence of self-report and informant measures for adults with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:2256-2268. [PMID: 32744068 PMCID: PMC7541713 DOI: 10.1177/1362361320942981] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Self-report measures are widely used for research and clinical assessment of adults with autism spectrum disorder. However, there has been little research examining the convergence of self- and informant-report in this population. This study examined agreement between 40 pairs of adults with autism spectrum disorder and their caregivers on measures of symptom severity, daily living skills, quality of life, and unmet service needs. In addition, this study examined the predictive value of each reporter for objective independent living and employment outcomes. Caregiver and self-report scores were significantly positively correlated on all measures (all r’s >0.50). Results indicated that there were significant differences between reporter ratings of daily living skills, quality of life, and unmet service needs, but no significant differences between ratings of symptom severity. Combining caregiver-report and self-report measures provided significantly higher predictive value of objective outcomes than measures from a single reporter. These findings indicate that both informants provide valuable information and adults with autism spectrum disorder should be included in reporting on their own symptoms and experiences. Given that two reporters together were more predictive of objective outcomes; however, a multi-informant assessment may be the most comprehensive approach for evaluating current functioning and identifying service needs in this population.
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38
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Diao H, Wang H, Yang L, Li T. The impacts of multiple obesity-related interventions on quality of life in children and adolescents: a randomized controlled trial. Health Qual Life Outcomes 2020; 18:213. [PMID: 32631401 PMCID: PMC7336614 DOI: 10.1186/s12955-020-01459-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 06/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE Obesity has become a serious public health problem and family- and school-based interventions including physical exercise and diet control have been widely applied to attempt to combat this issue. The purpose of our study was to verify the effectiveness of an obesity-related comprehensive intervention model aimed at improving quality of life (QoL) among adolescents. METHODS A cluster randomized controlled trial (RCT) was conducted involving 948 subjects who were divided into an intervention group (n = 518) and a control group (n = 430). The intervention group received 1 year of obesity-related health education, physical exercise, and diet control. Their baseline body mass index (BMI) was calculated, and their QoL and basic information were assessed both before and after the intervention period using a self-designed Adolescent Quality of Life Scale and a basic information questionnaire. RESULTS After the intervention, significant differences in the psychological, social, and pubertal dimensions, and in total QoL (P < 0.05) were observed in the intervention group relative to the control group. Improved psychological QoL in the intervention group was our most robust study finding, with increases in psychological (B = 1.883, SE = 0.646, P = 0.004), pubertal (B = 0.853, SE = 0.296, P = 0.004) and total (B = 3.024, SE = 1.214, P = 0.013) QoL all being higher in this group. This intervention effect was found to be more substantial in boys than in girls. CONCLUSIONS Family-individual-school-based interventions combining obesity-related health education, physical exercise, and diet control can improve psychological, pubertal, and total QoL in children, with these effects being most pronounced in boys. TRIAL REGISTRATION retrospectively registered NCT02343588 .
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Affiliation(s)
- Hua Diao
- School of Public Health and Management, Chongqing Medical University, Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing, China
| | - Hong Wang
- School of Public Health and Management, Chongqing Medical University, Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing, China.
| | - Lianjian Yang
- School of Public Health and Management, Chongqing Medical University, Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing, China
| | - Ting Li
- School of Public Health and Management, Chongqing Medical University, Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing, China
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39
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Mierau JO, Kann-Weedage D, Hoekstra PJ, Spiegelaar L, Jansen DEMC, Vermeulen KM, Reijneveld SA, van den Hoofdakker BJ, Buskens E, van den Akker-van Marle ME, Dirksen CD, Groenman AP. Assessing quality of life in psychosocial and mental health disorders in children: a comprehensive overview and appraisal of generic health related quality of life measures. BMC Pediatr 2020; 20:329. [PMID: 32620157 PMCID: PMC7333319 DOI: 10.1186/s12887-020-02220-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/22/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Mental health problems often arise in childhood and adolescence and can have detrimental effects on people's quality of life (QoL). Therefore, it is of great importance for clinicians, policymakers and researchers to adequately measure QoL in children. With this review, we aim to provide an overview of existing generic measures of QoL suitable for economic evaluations in children with mental health problems. METHODS First, we undertook a meta-review of QoL instruments in which we identified all relevant instruments. Next, we performed a systematic review of the psychometric properties of the identified instruments. Lastly, the results were summarized in a decision tree. RESULTS This review provides an overview of these 22 generic instruments available to measure QoL in children with psychosocial and or mental health problems and their psychometric properties. A systematic search into the psychometric quality of these instruments found 195 suitable papers, of which 30 assessed psychometric quality in child and adolescent mental health. CONCLUSIONS We found that none of the instruments was perfect for use in economic evaluation of child and adolescent mental health care as all instruments had disadvantages, ranging from lack of psychometric research, no proxy version, not being suitable for young children, no age-specific value set for children under 18, to insufficient focus on relevant domains (e.g. social and emotional domains).
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Affiliation(s)
- Jochen O Mierau
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
- Aletta Jacobs School of Public Health, Groningen, The Netherlands
| | | | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lisan Spiegelaar
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Danielle E M C Jansen
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Barbara J van den Hoofdakker
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erik Buskens
- University Medical Center Groningen and Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - M Elske van den Akker-van Marle
- Department of Biomedical Data Sciences, section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Carmen D Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Annabeth P Groenman
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, freepostnumber 176, 9700VB, Groningen, The Netherlands.
- Department of Psychology, Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands.
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Bent S, Wahlberg J, Chen Y, Widjaja F, McDonald MG, Hendren RL. Quality of Life Among School-Age Children With Autism: The Oak Hill School Outcomes Study. Semin Pediatr Neurol 2020; 34:100808. [PMID: 32446439 DOI: 10.1016/j.spen.2020.100808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Prior studies have documented a lower quality of life (QOL) in children with autism spectrum disorder (ASD) compared to typically developing peers, but few studies have examined the trajectory of QOL over time in the same population. We conducted a 2-year cohort study in 29 children attending a specialized school for ASD with quarterly measures of parent-rated QOL as well as parent and teacher measures of behavior and social skills to determine the trajectory of change in QOL and predictors of change. The average change in QOL was constant (no change over time), but there was substantial variation with some students showing significant gains and others showing declines. Exploratory analyses revealed that improvements in behavior and social skills were greater (nonsignificantly) among children with improvements in QOL. Children with improved QOL were also younger and had a lower initial symptom burden. This study suggests that early intervention programs that provide social skills and behavioral management strategies may improve QOL in children with ASD. The study also highlights the need to develop and study novel, qualitative measures of QOL in this population.
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Affiliation(s)
- Stephen Bent
- Department of Psychiatry, University of California, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA.
| | - Jessica Wahlberg
- Department of Psychiatry, University of California, San Francisco, CA
| | - Yingtong Chen
- Department of Psychiatry, University of California, San Francisco, CA
| | - Felicia Widjaja
- Department of Psychiatry, University of California, San Francisco, CA
| | | | - Robert L Hendren
- Department of Psychiatry, University of California, San Francisco, CA
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Fitzpatrick SE, Schmitt LM, Adams R, Pedapati EV, Wink LK, Shaffer RC, Sage J, Weber JD, Dominick KC, Erickson CA. Pediatric Quality of Life Inventory (PedsQL) in Fragile X Syndrome. J Autism Dev Disord 2020; 50:1056-1063. [PMID: 31728808 DOI: 10.1007/s10803-019-04292-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To date, health related quality of life (QoL) has not been systematically evaluated in youth with fragile X syndrome (FXS), the most common single gene cause of autism and the most common inherited form of developmental disability. We describe QoL data gathered using the Pediatric Quality of Life Inventory (PedsQL) completed online by 364 parents of youth with FXS. Parents consistently reported across all gender and age groups that their children experienced the highest QoL in Physical functioning and the lowest QoL in Cognitive functioning. Overall, older children with FXS had increase QoL ratings in the domains of School and Cognitive function.
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Affiliation(s)
- Sarah E Fitzpatrick
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA
| | - Lauren M Schmitt
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA
| | - Ryan Adams
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ernest V Pedapati
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Logan K Wink
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rebecca C Shaffer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jessica Sage
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA
| | | | - Kelli C Dominick
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Craig A Erickson
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA. .,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Katsiana A, Strimpakos N, Ioannis V, Kapreli E, Sofologi M, Bonti E, Stiliani K, Stalikas A. Health-related Quality of Life in Children with Autism Spectrum Disorder and Children with Down Syndrome. Mater Sociomed 2020; 32:93-98. [PMID: 32843854 PMCID: PMC7428921 DOI: 10.5455/msm.2020.32.93-98] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/26/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Measuring health- related quality of life (HRQoL) is very important for children with developmental disorders such as autism spectrum disorder (ASD) and Down syndrome (DS). However, no HRQoL studies found in the literature for the differences between children with ASD and children with DS. AIM The aim of this study was to examine HRQoL in children with ASD and children with DS. METHODS The participants consisted of 206 children with ASD (61), DS (55) and typical development (TD) (90), aged 5-10 years old, after administering anonymous questionnaires to their parents-caregivers. The Pediatric Quality of Life Inventory ™ 4.0- Parent Report (PedsQL) was used to measure HRQoL. One-way analysis of variance and χ2 were applied for comparisons among groups. RESULTS TD group scored higher than ASD and DS in all comparisons. Post-hoc (Tukey) comparisons revealed that the statistically univariate effect was due to differences between the TD group and the other two groups, ASD and DS (p<0.01). The ASD group achieved significantly lower scores than DS in the emotional functioning scale. Post-hoc analysis did not reveal any significant differences between the DS and the ASD group in the physical health, psychosocial health and the total PedsQL summary scores. CONCLUSIONS Children with ASD and DS had significantly lower HRQoL compared to a TD population, and this finding was not affected by age. Children with ASD demonstrated a significantly lower score in the emotional functioning scale than children with DS but are similar in the physical health scale. It is thus considered necessary to take the physical health scale into account when assessing and designing treatment for children with ASD. Future research studies should focus on HRQoL indicators that could serve as a standard diagnostic tool for the development of therapies and outcomes of assessment findings in ASD and DS.
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Affiliation(s)
- Aikaterini Katsiana
- Department of Psychology, Panteion University of Social and Political Sciences, Athens, Greece
- Department of Occupational Therapy, University of Western Macedonia, KEPTSE, Ptolemaida, Greece
| | | | - Ventoulis Ioannis
- Department of Occupational Therapy, University of Western Macedonia, KEPTSE, Ptolemaida, Greece
| | - Eleni Kapreli
- Department of Physiotherapy, University of Thessaly, Lamia, Greece
| | - Maria Sofologi
- Department of Psychology, Aristotle University of Thessaloniki, Greece
| | - Eleni Bonti
- 1st Psychiatric Clinic, Medical School, Aristotle University of Thessaloniki, “Papageorgiou” General Hospital of Thessaloniki
| | | | - Anastasios Stalikas
- Department of Psychology, Panteion University of Social and Political Sciences, Athens, Greece
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Anixt JS, Murray DS, Coury DL, Kuhlthau KA, Eskra D, Seide J, Kelly A, Hess A, Lipkin PH, Law JK, Fedele A, Lannon C. Improving Behavior Challenges and Quality of Life in the Autism Learning Health Network. Pediatrics 2020; 145:S20-S29. [PMID: 32238528 DOI: 10.1542/peds.2019-1895e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To summarize baseline data and lessons learned from the Autism Learning Health Network, designed to improve care and outcomes for children with autism spectrum disorder (ASD). We describe challenging behaviors, co-occurring medical conditions, quality of life (QoL), receipt of recommended health services, and next steps. METHODS A cross-sectional study of children 3 to 12 years old with ASD receiving care at 13 sites. Parent-reported characteristics of children with ASD were collected as outcome measures aligned with our network's aims of reducing rates of challenging behaviors, improving QoL, and ensuring receipt of recommended health services. Parents completed a survey about behavioral challenges, co-occurring conditions, health services, and the Patient-Reported Outcomes Measurement Information System Global Health Measure and the Aberrant Behavior Checklist to assess QoL and behavior symptoms, respectively. RESULTS Analysis included 530 children. Challenging behaviors were reported by the majority of parents (93%), frequently noting attention-deficit/hyperactivity disorder symptoms, irritability, and anxiety. Mean (SD) scores on the Aberrant Behavior Checklist hyperactivity and irritability subscales were 17.9 (10.5) and 13.5 (9.2), respectively. The Patient-Reported Outcomes Measurement Information System Global Health Measure total score of 23.6 (3.7) was lower than scores reported in a general pediatric population. Most children had received recommended well-child (94%) and dental (85%) care in the past 12 months. CONCLUSIONS This baseline data (1) affirmed the focus on addressing challenging behaviors; (2) prioritized 3 behavior domains, that of attention-deficit/hyperactivity disorder, irritability, and anxiety; and (3) identified targets for reducing severity of behaviors and strategies to improve data collection.
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Affiliation(s)
- Julia S Anixt
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; .,Division of Developmental and Behavioral Pediatrics and.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Donna S Murray
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Division of Developmental and Behavioral Pediatrics and.,Autism Speaks, New York, New York
| | - Daniel L Coury
- Division of Developmental and Behavioral Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Karen A Kuhlthau
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children and Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Diane Eskra
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Janet Seide
- Division of Developmental and Behavioral Pediatrics and.,Curry School of Education and Human Development, University of Virginia, Charlottesville, Virginia
| | - Amy Kelly
- Devereux Advanced Behavioral Health and Family Partners Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Amy Hess
- Division of Developmental and Behavioral Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Paul H Lipkin
- Kennedy Krieger Institute, Baltimore, Maryland; and.,Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - J Kiely Law
- Kennedy Krieger Institute, Baltimore, Maryland; and.,Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Carole Lannon
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Ioannou C, Seernani D, Stefanou ME, Riedel A, Tebartz van Elst L, Smyrnis N, Fleischhaker C, Biscaldi-Schaefer M, Boccignone G, Klein C. Comorbidity Matters: Social Visual Attention in a Comparative Study of Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder and Their Comorbidity. Front Psychiatry 2020; 11:545567. [PMID: 33192661 PMCID: PMC7555692 DOI: 10.3389/fpsyt.2020.545567] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/19/2020] [Indexed: 12/20/2022] Open
Abstract
Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) represent two common neurodevelopmental disorders with considerable co-occurrence. Their comorbidity (ASD + ADHD) has been included in the latest diagnostic guidelines (DSM-V, 2013). The present study focuses on social visual attention that i) is a main aspect of social attention reflecting social cognition and ii) its atypicalities have been suggested as a potential biomarker for ASD. Considering the possible shared background of both disorders and their comorbidity, it is important to compare such traits directly. Here, 73 children and adolescents paired for age and IQ diagnosed with ASD (N = 12), ADHD (N = 21), comorbid ASD + ADHD (N = 15), and "typically developing" (TD) controls (N = 25), were shown static real-life social scenes while their gaze movements were recorded with eye-tracking. Scenes with two levels of social complexity were presented: low complexity (one person depicted) and high (four interacting individuals). Gaze fixation variables were investigated. Fixation duration on faces was significantly reduced only in ASD + ADHD which also required longer time to fixate all faces at least once. Fixation duration on faces in ASD was reduced, compared to TD, only when looking at scenes with high versus low social complexity. ADHD individuals did not differ from TD. Concluding, the observed alterations of social visual attention support the existence of possible dysfunctional particularities differentiating ASD, ADHD, and ASD + ADHD, which can be revealed with the new method of eye-tracking technique. The objective gaze measurements provided contribute to the development of biomarkers enabling early diagnosis, amelioration of care and further interventions specified for each group.
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Affiliation(s)
- Chara Ioannou
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Divya Seernani
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Maria Elena Stefanou
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Freiburg, Freiburg, Germany.,School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Andreas Riedel
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Nikolaos Smyrnis
- Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - Christian Fleischhaker
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Monica Biscaldi-Schaefer
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Freiburg, Freiburg, Germany
| | | | - Christoph Klein
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Freiburg, Freiburg, Germany.,Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece.,Department of Child and Adolescent Psychiatry, University Hospital Cologne, Cologne, Germany
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Penchina B, Sundaresan A, Cheong S, Martel A. Deep LSTM Recurrent Neural Network for Anxiety Classification from EEG in Adolescents with Autism. Brain Inform 2020. [DOI: 10.1007/978-3-030-59277-6_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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46
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Shaltout E, Al-Dewik N, Samara M, Morsi H, Khattab A. Psychological Comorbidities in Autism Spectrum Disorder. ADVANCES IN NEUROBIOLOGY 2020; 24:163-191. [PMID: 32006360 DOI: 10.1007/978-3-030-30402-7_6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Autism spectrum disorder (ASD) is characterized by impairment in behavior, communication, and social interaction. Thus, accurate identification, regular behavioral and other nonmedical interventions would improve the diagnosis, management, and treatment of this condition.In this chapter, we investigate the importance of diagnosing and identifying comorbid psychiatric disorders that occur with ASD as these conditions can often complicate treatment, and failure to recognize them can result in deficits that can persist into adolescence and adulthood. In addition, we explore the impact of comprehensive psychological intervention in ASD patients with comorbid psychiatric disorders with the ultimate goal of improving overall quality of life.
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Affiliation(s)
- Eman Shaltout
- Medical Research Center, Hamad Medical Corporation (HMC), Doha, Qatar.,Department of Psychology, Kingston University London, Kingston upon Thames, UK
| | - Nader Al-Dewik
- Clinical and Metabolic Genetics, Pediatrics Department, Hamad General Hospital (HGH), Hamad Medical Corporation (HMC), Doha, Qatar.,College of Health and Life Sciences, Hamad Bin Khalifa University (HBKU), Doha, Qatar
| | - Muthanna Samara
- Department of Psychology, Kingston University London, Kingston upon Thames, UK.
| | - Hisham Morsi
- Department of Psychology, Kingston University London, Kingston upon Thames, UK.,Quality of Life Unit, National Center for Cancer Care and Research, (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Azhar Khattab
- Qatar Rehabilitation Institute, Pediatric Rehabilitation, Hamad Medical Corporation (HMC), Doha, Qatar
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Health- and oral health-related quality of life among preschool children with autism spectrum disorders. Eur Arch Paediatr Dent 2019; 21:363-371. [DOI: 10.1007/s40368-019-00500-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
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MORÁN SUÁREZ ML, GÓMEZ SÁNCHEZ LE, ALCEDO RODRÍGUEZ MÁ. Inclusión social y autodeterminación: los retos en la calidad de vida de los jóvenes con autismo y discapacidad intelectual. ACTA ACUST UNITED AC 2019. [DOI: 10.14201/scero20195032946] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Adams D, Clark M, Keen D. Using self‐report to explore the relationship between anxiety and quality of life in children on the autism spectrum. Autism Res 2019; 12:1505-1515. [DOI: 10.1002/aur.2155] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/27/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Dawn Adams
- Autism Centre of Excellence, School of Education and Professional StudiesGriffith University Brisbane Australia
- Griffith Institute of Educational Research, Griffith University Brisbane Australia
- Cooperative Research Centre for Living with Autism (Autism CRC) Brisbane Australia
| | - Megan Clark
- Autism Centre of Excellence, School of Education and Professional StudiesGriffith University Brisbane Australia
- Griffith Institute of Educational Research, Griffith University Brisbane Australia
- Cooperative Research Centre for Living with Autism (Autism CRC) Brisbane Australia
| | - Deb Keen
- Autism Centre of Excellence, School of Education and Professional StudiesGriffith University Brisbane Australia
- Griffith Institute of Educational Research, Griffith University Brisbane Australia
- Cooperative Research Centre for Living with Autism (Autism CRC) Brisbane Australia
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Hilton CL, Ratcliff K, Collins DM, Flanagan J, Hong I. Flourishing in children with autism spectrum disorders. Autism Res 2019; 12:952-966. [PMID: 30912315 PMCID: PMC6684035 DOI: 10.1002/aur.2097] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 03/01/2019] [Accepted: 03/06/2019] [Indexed: 01/01/2023]
Abstract
Flourishing is an indicator of positive mental health and is important for children's development and well-being. We used variables from the National Survey of Children's Health 2016 as indicators of flourishing (difficulty making friends, is bullied, bullies others, shares ideas with family, argues, finishes tasks, does all homework, shows curiosity, stays calm, and cares about doing well in school) to compare differences in parent perceptions of their children with and without autism spectrum disorder (ASD). We anticipate that these findings will help identify intervention targets to support the well-being of individuals with ASD. Children between 6 and 17 years of age, without intellectual disability, brain injury, cerebral palsy, or Down syndrome were included. Total participants were 34,171 controls (male/female = 17,116/17,155) and 812 with ASD (male/female = 668/144). Factor analysis resulted in three-factor structures (social competence, behavioral control, and school motivation) with good model fit (root mean square error of approximation = 0.08, comparative fit index = 0.92, Tucker-Lewis index = 0.89). The multivariate regression model and propensity score with inverse probability of treatment weighting (PS-IPTW) method revealed that children with ASD had lower scores in the social competence and behavioral control factors compared to the control group (all P < 0.05). However, no significant differences were found in the school motivation factor between the two groups (P > 0.05) in both multivariate regression model and PS-IPTW method. Findings suggest that social competence and behavioral control are indicators of flourishing and are important intervention targets to increase flourishing among children with ASD. Autism Res 2019, 12: 952-966. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Flourishing is an indicator of positive mental health and is important for children's development and well-being. We used variables from The National Survey of Children's Health 2016 to examine differences in parent perceptions of the indicators of flourishing (difficulty making friends, is bullied, bullies others, shares ideas with family, argues, finishes tasks, does all homework, shows curiosity, stays calm, and cares about doing well in school) between children with and without autism spectrum disorders (ASD). We anticipate that this information will help to identify therapeutic targets to support the well-being of individuals with ASD. Children between 6 and 17 years old, without intellectual disability (ID), brain injury (BI), cerebral palsy (CP), or Down syndrome (DS) were included. From the total (N = 50,212), we excluded children under age 6 (n = 14,494), those who once, but do not currently have ASD (n = 81), and those with ID (n = 432), BI (n = 170), CP (n = 35), and DS (n = 17), resulting in 34,983 records used. Total participants, age 6-17 years, were 34,171 controls (male/female = 17,116/17,155) and 812 with ASD (male/female = 668/144). Factor analysis resulted in the identification of three flourishing categories among the indicator variables (social competence, behavioral control, and school motivation). Children with ASD had lower scores in the social competence and behavioral control factors compared to the control group. However, there were no significant differences in the school motivation factor between the two groups. Findings suggest that social competence and behavioral control are indicators of flourishing and are important intervention targets to increase flourishing among children with ASD.
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Affiliation(s)
- Claudia L Hilton
- Occupational Therapy Department, University of Texas Medical Branch, School of Health Professions, 301 University Boulevard, Galveston, Texas, 77555-1142
| | - Karen Ratcliff
- Occupational Therapy Department, University of Texas Medical Branch, School of Health Professions, 301 University Boulevard, Galveston, Texas, 77555-1142
| | - Diane M Collins
- Occupational Therapy Department, University of Texas Medical Branch, School of Health Professions, 301 University Boulevard, Galveston, Texas, 77555-1142
| | - Joanne Flanagan
- Occupational Therapy Department, University of Texas Medical Branch, School of Health Professions, 301 University Boulevard, Galveston, Texas, 77555-1142
| | - Ickpyo Hong
- Occupational Therapy Department, University of Texas Medical Branch, School of Health Professions, 301 University Boulevard, Galveston, Texas, 77555-1142
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