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Perry N, Boulton KA, Hodge A, Ong N, Phillips N, Howard K, Raghunandan R, Silove N, Guastella AJ. A psychometric investigation of health-related quality of life measures for paediatric neurodevelopment assessment: Reliability and concurrent validity of the PEDS-QL, CHU-9D, and the EQ-5D-Y. Autism Res 2024; 17:972-988. [PMID: 38597587 DOI: 10.1002/aur.3127] [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] [Received: 09/15/2023] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
There is a need for tools that can provide a brief assessment of functioning for children with neurodevelopmental conditions, including health-related quality of life (HR-QoL). This study evaluated the psychometric properties of three commonly used and well known HR-QoL measures in a cohort of children presenting to clinical developmental assessment services. The most common diagnoses received in these assessment services were autism spectrum disorders. Findings showed good internal consistency for the PedsQL and the CHU-9D, but not the EQ-5D-Y. This research also found that the CHU-9D, EQ-5D-Y, and PedsQL correlated with relevant functioning domains assessed by the VABS-III. Overall, the measures showed that children with neurodevelopmental conditions experienced poor HR-QoL. The majority of children (>86%) met cut-off criteria for significant health concerns on the PedsQL. On the EQ-5D-Y and CHU-9D, they showed reduced HR-QoL particularly on domains relating to school and homework, being able to join in activities, looking after self, and doing usual activities. This study supports the use of the CHU-9D and PedsQL in this population to assess and potentially track HR-QoL in a broad neurodevelopment paediatric population.
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Affiliation(s)
- N Perry
- Clinic for Autism and Neurodevelopment (CAN) Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - K A Boulton
- Clinic for Autism and Neurodevelopment (CAN) Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - A Hodge
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Child Development Unit, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - N Ong
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Child Development Unit, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - N Phillips
- Clinic for Autism and Neurodevelopment (CAN) Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - K Howard
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - R Raghunandan
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - N Silove
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Child Development Unit, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - A J Guastella
- Clinic for Autism and Neurodevelopment (CAN) Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
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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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Huang YC, Chen YC, Gau BS, Wang JK, Chang SH, Yang HL. Psychometric evaluation of the traditional chinese version of PedsQL ™ 3.0 cardiac module scale in adolescents with congenital heart disease: reliability, validity, measurement invariance, and adolescent-parent agreement. Health Qual Life Outcomes 2023; 21:39. [PMID: 37147623 PMCID: PMC10163758 DOI: 10.1186/s12955-023-02121-1] [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: 04/20/2022] [Accepted: 04/25/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND In recent decades, 95% of children with congenital heart disease (CHD) can survive to adolescence and adulthood. However, adolescents with CHD are prone to poorer health-related quality of life (HRQoL). It is imperative to develop a reliable and valid instrument for health professionals to monitor the HRQoL. This study aims to: (1) evaluate the psychometric properties of the traditional Chinese version of Pediatric Quality of Life™ 3.0 Cardiac Module (PedsQL-CM) and measurement invariance across adolescents with CHD and their parents; and (2) investigate the adolescent-parent agreement in HRQoL. METHODS A total of 162 adolescents and 162 parents were recruited. Internal consistency was examined using Cronbach's alpha and McDonald's Omega. The criterion-related validity was evaluated with intercorrelations between the PedsQL-CM and PedsQL™ 4.0 Generic Core (PedsQL-GC) Scale. The construct validity was examined by second-order confirmatory factor analysis (CFA). Measurement invariance was evaluated using the multi-group CFA. The adolescent-parent agreement was analyzed with the intraclass correlation (ICC), paired t-tests, and Bland-Altman plots. RESULTS PedsQL-CM showed acceptable internal consistency (self-reports 0.88, proxy-reports 0.91). The intercorrelations were medium to large effect size (self-reports 0.34-0.77, proxy-reports 0.46-0.68). The CFA supported the construct validity (CFI = 0.967, TLI = 0.963, RMSEA = 0.036, 90% CI = 0.026-0.046, SRMR = 0.065). The multi-group CFA proved scalar invariance between self and parent proxy-reports. Parents significantly underestimated their adolescents' HRQoL in cognitive problems (Cohen's d = 0.21) and communication (Cohen's d = 0.23) subscales, while there was a negligible difference in total HRQoL (Cohen's d = 0.16). ICCs were poor to moderate effect size with the highest and lowest agreement in heart problems and treatment subscale (ICC = 0.70) and communication subscale (ICC = 0.27), respectively. The Bland-Altman plots showed lesser variability in the heart problem and treatment subscale and the total scale. CONCLUSION The traditional Chinese version of PedsQL-CM has acceptable psychometric properties to measure disease-specific HRQoL in adolescents with CHD. Parents may be proxies for adolescents with CHD to rate total HRQoL. When the patient-reported score is the primary outcome, the proxy-reported score could serve as a secondary outcome for research and clinical evaluation.
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Affiliation(s)
- Yong-Chen Huang
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, No. 17, Xu-Zhou Road, Taipei City, 100, Taiwan
| | - Yueh-Chih Chen
- School of Nursing, College of Medicine, National Taiwan University, No. 1 Jen-Ai Road, Section 1, Taipei City, 100, Taiwan
| | - Bih-Shya Gau
- School of Nursing, College of Medicine, National Taiwan University, No. 1 Jen-Ai Road, Section 1, Taipei City, 100, Taiwan
- Department of Nursing, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei City, 100, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei City, 100, Taiwan
| | - Shu-Hui Chang
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, No. 17, Xu-Zhou Road, Taipei City, 100, Taiwan
| | - Hsiao-Ling Yang
- School of Nursing, College of Medicine, National Taiwan University, No. 1 Jen-Ai Road, Section 1, Taipei City, 100, Taiwan.
- Department of Nursing, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei City, 100, Taiwan.
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Dekker LP, van der Vegt EJM, Louwerse A, Visser K, van der Ende J, Maras A, Verhulst FC, Greaves-Lord K. Complementing or Congruent? Desired Characteristics in a Friend and Romantic Partner in Autistic versus Typically Developing Male Adolescents. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1153-1167. [PMID: 36241943 PMCID: PMC10102130 DOI: 10.1007/s10508-022-02444-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 05/11/2023]
Abstract
Ideal friend and romantic partner characteristics related to self-perceived characteristics have been investigated in typically developing (TD) individuals, but not in individuals with autism spectrum disorder (ASD). Considering the autistic symptoms and challenges, investigating these concepts in autistic individuals is relevant. Given the lack of consensus, identity-first ("autistic person") and person-first ("person with autism") language are mixed throughout, to cover all preferences. This study explored (1) the association between self-perceived characteristics and desires in a friend/romantic partner, as well as (2) compare two groups (ASD and TD) in their desires for a friend/romantic partner. Two matched groups (ASD and TD) of 38 male adolescents (age 14-19 years) reported on the desire for nine characteristics (i.e., funny, popular, nice, cool, smart, trustworthy, good looking, similar interests, and being rich) in a friend/partner, and to what extent they felt they themselves possessed seven characteristics (i.e., funny, popular, nice, cool, smart, trustworthy, and good looking). Results showed both groups sought a friend and partner similar to themselves on intrinsic characteristics (e.g., trustworthiness), but less similar on extrinsic and social status characteristics (e.g., being less cool and popular). Particularly intrinsic characteristics, more than extrinsic and social status characteristics, were valued in both partners and friends, regardless of group. No significant differences were found between groups concerning to what extent characteristics were desired. Overall, adolescents with ASD desire similar characteristics as TD adolescents in their potential romantic partners and friends. There is some indication that the match between self-perception and desired characteristics is different.
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Affiliation(s)
- Linda P Dekker
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Burg. Oudlaan 50, Room T13-24, 3000 DR, Rotterdam, The Netherlands.
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University MC/Sophia Children's Hospital, Rotterdam, The Netherlands.
- Yulius, Organization for Mental Health, Rotterdam, The Netherlands.
| | | | - Anneke Louwerse
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University MC/Sophia Children's Hospital, Rotterdam, The Netherlands
- Yulius, Organization for Mental Health, Rotterdam, The Netherlands
| | - Kirsten Visser
- Yulius, Organization for Mental Health, Rotterdam, The Netherlands
- Youz Child and Adolescent Psychiatry, Team Sarr Autism Expertise Centre, Rotterdam, The Netherlands
| | - Jan van der Ende
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University MC/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Athanasios Maras
- Yulius, Organization for Mental Health, Rotterdam, The Netherlands
| | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University MC/Sophia Children's Hospital, Rotterdam, The Netherlands
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kirstin Greaves-Lord
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University MC/Sophia Children's Hospital, Rotterdam, The Netherlands
- Yulius, Organization for Mental Health, Rotterdam, The Netherlands
- Autism Team Northern-Netherlands of Jonx, Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
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The amplitude of fNIRS hemodynamic response in the visual cortex unmasks autistic traits in typically developing children. Transl Psychiatry 2022; 12:53. [PMID: 35136021 PMCID: PMC8826368 DOI: 10.1038/s41398-022-01820-5] [Citation(s) in RCA: 2] [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: 08/03/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 12/21/2022] Open
Abstract
Autistic traits represent a continuum dimension across the population, with autism spectrum disorder (ASD) being the extreme end of the distribution. Accumulating evidence shows that neuroanatomical and neurofunctional profiles described in relatives of ASD individuals reflect an intermediate neurobiological pattern between the clinical population and healthy controls. This suggests that quantitative measures detecting autistic traits in the general population represent potential candidates for the development of biomarkers identifying early pathophysiological processes associated with ASD. Functional near-infrared spectroscopy (fNIRS) has been extensively employed to investigate neural development and function. In contrast, the potential of fNIRS to define reliable biomarkers of brain activity has been barely explored. Features of non-invasiveness, portability, ease of administration, and low-operating costs make fNIRS a suitable instrument to assess brain function for differential diagnosis, follow-up, analysis of treatment outcomes, and personalized medicine in several neurological conditions. Here, we introduce a novel standardized procedure with high entertaining value to measure hemodynamic responses (HDR) in the occipital cortex of adult subjects and children. We found that the variability of evoked HDR correlates with the autistic traits of children, assessed by the Autism-Spectrum Quotient. Interestingly, HDR amplitude was especially linked to social and communication features, representing the core symptoms of ASD. These findings establish a quick and easy strategy for measuring visually-evoked cortical activity with fNIRS that optimize the compliance of young subjects, setting the background for testing the diagnostic value of fNIRS visual measurements in the ASD clinical population.
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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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Bolbocean C, Andújar FN, McCormack M, Suter B, Holder JL. Health-Related Quality of Life in Pediatric Patients with Syndromic Autism and their Caregivers. J Autism Dev Disord 2021; 52:1334-1345. [PMID: 33937973 PMCID: PMC8854255 DOI: 10.1007/s10803-021-05030-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 11/06/2022]
Abstract
Children with autism have a significantly lower quality of life compared with their neurotypical peers. While multiple studies have quantified the impact of autism on health-related quality of life (HRQoL) through standardized surveys such as the PedsQL, none have specifically investigated the impact of syndromic autism. Here we evaluate HRQoL in children diagnosed with three genetic disorders that strongly predispose to syndromic autism: Phelan-McDermid syndrome (PMD), Rett syndrome (RTT), and SYNGAP1-related intellectual disability (SYNGAP1-ID). We find the most severely impacted dimension is physical functioning. Strikingly, syndromic autism results in worse quality of life than other chronic disorders including idiopathic autism. This study demonstrates the utility of caregiver surveys in prioritizing phenotypes, which may be targeted as clinical endpoints for genetically defined ASDs.
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Affiliation(s)
- Corneliu Bolbocean
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,The Centre for Addiction and Mental Health, Toronto, ON, Canada.,Nuffield Department of Primary Care Health Sciences, Oxford University, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, USA
| | - Fabiola N Andújar
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, 1250 Moursund St. Suite 925, Houston, TX, 77030, USA.,Division of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Maria McCormack
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, 1250 Moursund St. Suite 925, Houston, TX, 77030, USA.,Division of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Bernhard Suter
- Division of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - J Lloyd Holder
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, 1250 Moursund St. Suite 925, Houston, TX, 77030, USA. .,Division of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
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Rodgers M, Marshall D, Simmonds M, Le Couteur A, Biswas M, Wright K, Rai D, Palmer S, Stewart L, Hodgson R. Interventions based on early intensive applied behaviour analysis for autistic children: a systematic review and cost-effectiveness analysis. Health Technol Assess 2020; 24:1-306. [PMID: 32686642 PMCID: PMC7397479 DOI: 10.3310/hta24350] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Early intensive applied behaviour analysis-based interventions are intensive interventions for autistic children that are often delivered on a one-to-one basis for 20-50 hours per week. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of early intensive applied behaviour analysis-based interventions for autistic children, based on current evidence. METHODS A systematic review and individual participant data meta-analysis were conducted to evaluate the clinical effectiveness of an early intensive applied behaviour analysis-based intervention for autistic children. An economic analysis included a review of existing analyses and the development of a new model. RESULTS Twenty studies were included in the clinical review. Individual participant data were retrieved from 15 of these studies. Results favoured the interventions when assessing adaptive behaviour after 2 years compared with treatment as usual/eclectic interventions (mean difference 7.00, 95% confidence interval 1.95 to 12.06). In analyses of cognitive ability (intelligence quotient), results favoured the interventions by approximately 10 points after 1 year (mean difference 9.16, 95% confidence interval 4.38 to 13.93) and 2 years (mean difference 14.13, 95% confidence interval 9.16 to 19.10). Evidence for other outcomes was limited and meta-analyses were generally inconclusive. There was no evidence that the effect of the interventions varied with characteristics of the children, but data were limited. Adopting a £30,000 per quality-adjusted life-year threshold, the results of the cost-effectiveness analysis indicate that early intensive applied behaviour analysis-based interventions would need to generate larger benefits or cost savings to be cost-effective. Adopting a public sector perspective and making pessimistic assumptions about long-term effects, the incremental cost-effectiveness ratio for early intensive applied behaviour analysis-based therapy compared with treatment as usual is £189,122 per quality-adjusted life-year. When optimistic assumptions are made, the incremental cost-effectiveness ratio is £46,768 per quality-adjusted life-year. Scenario analyses indicated that these interventions can potentially be cost-effective if long-term improvements persist into adulthood, or if they have significant impact on educational placement. Care should be taken when interpreting these scenarios owing to the limited data. LIMITATIONS All included studies were at risk of bias, there was substantial heterogeneity and effects varied considerably across studies. The effect of intervention on autism symptom severity, language development and school placement remains uncertain because of the limited data. The long-term effects are unclear owing to a lack of follow-up data. CONCLUSIONS This review found limited evidence that early intensive applied behaviour analysis-based interventions may improve cognitive ability and adaptive behaviour, but the long-term impact of the interventions remains unknown. The economic analysis is constrained by the limited effectiveness evidence, but suggests that these interventions are unlikely to be cost-effective unless clear long-term benefits, or a substantial change in which schools children attend, can be identified. FUTURE WORK Further studies into the effectiveness of early intensive applied behaviour analysis-based interventions may be warranted if they include well-defined, alternative interventions as comparators and collect relevant outcomes. Consideration should be given to future studies that not only address whether or not early intensive applied behaviour analysis-based interventions are clinically effective, but also aim to identify which components of early intensive applied behaviour analysis-based interventions might drive effectiveness. STUDY REGISTRATION This study is registered as PROSPERO CRD42017068303. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 35. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Mark Rodgers
- Centre for Reviews and Dissemination, University of York, York, UK
| | - David Marshall
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Mark Simmonds
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Ann Le Couteur
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mousumi Biswas
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Dheeraj Rai
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
| | - Lesley Stewart
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Robert Hodgson
- Centre for Reviews and Dissemination, University of York, York, UK
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Dekker LP, Visser K, van der Vegt EJM, Maras A, van der Ende J, Tick NT, Verhulst FC, Greaves-Lord K. Insight into Informant Discrepancies Regarding Psychosexual Functioning of Adolescents with and without Autism Spectrum Disorder. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2020; 30:487-501. [PMID: 31802571 DOI: 10.1111/jora.12539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The private nature of psychosexual functioning leads adolescents and their parents to have different perspectives, which highlights studying parent-child informant discrepancies in this domain. We investigated informant discrepancy in psychosexual functioning, using the self-report and parent report versions of the Teen Transition Inventory (TTI), of adolescents with autism spectrum disorder (ASD; 136 parent-child dyads) compared to adolescents from the general population (GP; 70 parent-child dyads). Significantly larger informant discrepancies exist in ASD dyads than GP dyads in most domains of psychosexual functioning, except for Body image, Sexual behavior, and Confidence in the future. It is important to use and pay attention to both informants, as discrepancies are relevant for both research and clinical practice regarding psychosexual functioning.
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Affiliation(s)
| | - Kirsten Visser
- Erasmus MC-Sophia
- Yulius, Organization for Mental Health
- Youz Child & Adolescent Psychiatry, Team Sarr Autism Expertise Centre
| | | | | | | | - Nouchka T Tick
- Yulius, Organization for Mental Health
- University Utrecht
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Graham Holmes L, Zampella CJ, Clements C, McCleery JP, Maddox BB, Parish-Morris J, Udhnani MD, Schultz RT, Miller JS. A Lifespan Approach to Patient-Reported Outcomes and Quality of Life for People on the Autism Spectrum. Autism Res 2020; 13:970-987. [PMID: 32154664 DOI: 10.1002/aur.2275] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/11/2020] [Accepted: 01/23/2020] [Indexed: 12/16/2022]
Abstract
Autistic self-advocates, family members, and community organizations have called for greater emphasis on enhancing quality of life (QoL) for people with autism. Doing this is critical to understand how QoL unfolds across the life course and to clarify whether gender affects QoL, health, and functioning for people with autism. The purpose of this study was to curate and test a lifespan QoL measurement tool using freely available and well-constructed National Institutes of Health Parent-Reported Outcomes Measurement Information System (PROMIS). To develop the PROMIS Autism Battery-Lifespan (PAB-L), we identified PROMIS scales relevant for autism, reviewed each item, consulted with a panel of autism experts, and elicited feedback from autistic people and family members. This battery provides a comprehensive portrait of QoL for children ages 5-13 (through parent proxy), teens 14-17 (parent proxy and self-report), and adults 18-65 (self-report) with autism compared to the general population. Participants and parent informants (N = 912) recruited through a children's hospital and nationwide U.S. autism research registry completed the PAB-L online. Results indicate that compared to general population norms, people with autism of all ages (or their proxies) reported less desirable outcomes and lower QoL across all domains. Women and girls experienced greater challenges in some areas compared to men and boys with autism. The PAB-L appears to be a feasible and acceptable method for assessing patient-reported outcomes and QoL for autistic people across the life course. Autism Res 2020, 13: 970-987. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: We developed a survey to measure the quality of life of children, teens, and adults with autism using free National Institutes of Health PROMIS questionnaires. People with autism and family members rated the PROMIS Autism Battery-Lifespan as useful and important. Some reported a good quality of life, while many reported that their lives were not going as well as they wanted. Women and girls reported more challenges in some areas of life than men and boys.
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Affiliation(s)
- Laura Graham Holmes
- Children's Hospital of Philadelphia Center for Autism Research, Philadelphia, Pennsylvania.,A. J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Casey J Zampella
- Children's Hospital of Philadelphia Center for Autism Research, Philadelphia, Pennsylvania
| | - Caitlin Clements
- Children's Hospital of Philadelphia Center for Autism Research, Philadelphia, Pennsylvania.,Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph P McCleery
- Children's Hospital of Philadelphia Center for Autism Research, Philadelphia, Pennsylvania.,Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Psychology and Kinney Center for Autism Education and Support, Saint Joseph's University, Philadelphia, Pennsylvania
| | - Brenna B Maddox
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia Parish-Morris
- Children's Hospital of Philadelphia Center for Autism Research, Philadelphia, Pennsylvania.,Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Manisha D Udhnani
- Children's Hospital of Philadelphia Center for Autism Research, Philadelphia, Pennsylvania
| | - Robert T Schultz
- Children's Hospital of Philadelphia Center for Autism Research, Philadelphia, Pennsylvania.,Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Judith S Miller
- Children's Hospital of Philadelphia Center for Autism Research, Philadelphia, Pennsylvania.,Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
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11
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Jozefiak T, Greger HK, Koot HM, Klöckner CA, Wallander JL. The role of family functioning and self-esteem in the quality of life of adolescents referred for psychiatric services: a 3-year follow-up. Qual Life Res 2019; 28:2443-2452. [PMID: 31077032 DOI: 10.1007/s11136-019-02197-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate, in adolescents referred for psychiatric services, the associations of initial self-esteem and family functioning with level and change of quality of life (QoL) over a 3-year period, over and above the effect of their emotional problems. METHODS Of 1648 eligible 13-18 years old patients attending the child and adolescent psychiatric clinic (CAP) at least once, 717 (54.8% females) were enrolled at baseline (a response rate of 43.5%). Self- and parent reports on the McMaster Family Assessment Device were obtained. Adolescents reported self-esteem on the Rosenberg Scale, and emotional problems on the Symptom Check List-5. Adolescents completed the Inventory of Life Quality in Children and Adolescents (ILC). After 3 years, 570 adolescents again completed the ILC, and for 418 adolescents parent information was available. The longitudinal analysis sample of 418 adolescents was representative of the baseline sample for age, gender, emotional problems, and QoL. We used modified growth-model analysis, adjusted for SES, age, gender and time of contact with CAP, where residual variances for ILC at baseline and follow-up were fixed to 0. RESULTS A poorer family functioning at baseline, reported by parents, was significantly associated with worsening QoL during the 3 years follow-up period (p = 0.001). CONCLUSIONS Parents have important knowledge about their families that may reflect long-term influences on QoL development in adolescent psychiatric patients. Health care providers and policy makers should optimize treatment outcomes by addressing family functioning in adolescents with emotional problems.
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Affiliation(s)
- Thomas Jozefiak
- Regional Center for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, MTFS, Pb. 8905, 7491, Trondheim, Norway.
| | - Hanne K Greger
- Regional Center for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, MTFS, Pb. 8905, 7491, Trondheim, Norway.,Department of Child and Adolescent Psychiatry, St. Olavs Hospital, Elgeseter, Postboks 6810, 7433, Trondheim, Norway
| | - Hans M Koot
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Christian A Klöckner
- Department of Psychology, University of Science and Technology, Trondheim, Norway
| | - Jan L Wallander
- Regional Center for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, MTFS, Pb. 8905, 7491, Trondheim, Norway.,Psychological Sciences and Health Sciences Research Institute, University of California, Merced, 5200, North Lake Rd, Merced, CA, 95343, USA
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12
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Adams D, Clark M, Simpson K. The Relationship Between Child Anxiety and the Quality of Life of Children, and Parents of Children, on the Autism Spectrum. J Autism Dev Disord 2019; 50:1756-1769. [DOI: 10.1007/s10803-019-03932-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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13
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Knüppel A, Telléus GK, Jakobsen H, Lauritsen MB. Quality of life in adolescents and adults with autism spectrum disorder: Results from a nationwide Danish survey using self-reports and parental proxy-reports. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 83:247-259. [PMID: 30312897 DOI: 10.1016/j.ridd.2018.09.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 09/16/2018] [Accepted: 09/20/2018] [Indexed: 05/21/2023]
Abstract
BACKGROUND Quality of life (QoL) in individuals with autism spectrum disorder (ASD) is essential to investigate with regard to knowledge about factors of importance for QoL and concordance between self-reported and parental proxy-reported QoL. AIMS This study investigated QoL in adolescents and adults with ASD using both self-reports and parental proxy-reports. METHODS From a nationwide survey, 1738 individuals diagnosed with ASD in childhood, were included for this study. The individuals themselves and/or their parents completed the INICO-FEAPS scale. Concordance between self-reports and proxy-reports were examined, and factors associated with QoL were explored via linear regression models. RESULTS Compared to proxy-reported QoL scores, self-reported QoL scores were significantly but only slightly higher and not in every QoL domain. Independent of respondent type it was found that psychiatric comorbidity, sleeping difficulty, intellectual disability, maladaptive behavior, adaptive functioning, autism symptomatology, main daytime activity and residence were associated with QoL. CONCLUSION Proxy-reported QoL is different from self-reported QoL and should be considered as an alternative source of information. QoL might be enhanced when factors associated with QoL are improved. However, large variations in QoL were found for most factors, suggesting the need to involve the individuals with ASD and/or their families when improving their QoL.
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Affiliation(s)
- Ane Knüppel
- Aalborg University Hospital, Psychiatry, Mølleparkvej 10, 9000 Aalborg, Denmark.
| | - Gry Kjaersdam Telléus
- Aalborg University Hospital, Psychiatry, Mølleparkvej 10, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Helle Jakobsen
- Aalborg University Hospital, Psychiatry, Mølleparkvej 10, 9000 Aalborg, Denmark
| | - Marlene Briciet Lauritsen
- Aalborg University Hospital, Psychiatry, Mølleparkvej 10, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
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14
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Roberts CA, Smith KC, Sherman AK. Comparison of Online and Face-to-Face Parent Education for Children with Autism and Sleep Problems. J Autism Dev Disord 2018; 49:1410-1422. [DOI: 10.1007/s10803-018-3832-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Grove R, Hoekstra RA, Wierda M, Begeer S. Special interests and subjective wellbeing in autistic adults. Autism Res 2018; 11:766-775. [PMID: 29427546 DOI: 10.1002/aur.1931] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 12/01/2017] [Accepted: 01/05/2018] [Indexed: 01/07/2023]
Abstract
Special interests form part of the core features of autism. However, to date there has been limited research focusing on the role of special interests in the lives of autistic adults. This study surveyed autistic adults on their special interest topics, intensity, and motivation. It also assessed the relationship between special interests and a range of quality of life measures including subjective wellbeing and domain specific life satisfaction. About two thirds of the sample reported having a special interest, with relatively more males reporting a special interest than females. Special interest topics included computers, autism, music, nature and gardening. Most autistic adults engaged in more than one special interest, highlighting that these interests may not be as narrow as previously described. There were no differences in subjective wellbeing between autistic adults with and without special interests. However, for autistic adults who did have special interests, motivation for engaging in special interests was associated with increased subjective wellbeing. This indicates that motivation may play an important role in our understanding of special interests in autism. Special interests had a positive impact on autistic adults and were associated with higher subjective wellbeing and satisfaction across specific life domains including social contact and leisure. However, a very high intensity of engagement with special interests was negatively related to wellbeing. Combined, these findings have important implications for the role of special interests in the lives of autistic adults. Autism Res 2018, 11: 766-775. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY Autistic adults reported having special interests in a range of topics, including computers, music, autism, nature and gardening. Special interests were associated with a number of positive outcomes for autistic adults. They were also related to subjective wellbeing and satisfaction across specific life domains including social contact and leisure. Very high intensity of engagement with special interests was related to lower levels of wellbeing. This highlights the important role that special interests play in the lives of autistic adults.
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Affiliation(s)
| | - Rosa A Hoekstra
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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