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Lindsay S, Li Y, Joneja S, Hsu S. Experiences of racism and racial disparities in health care among children and youth with autism and their caregivers: a systematic review. Disabil Rehabil 2024:1-20. [PMID: 38864302 DOI: 10.1080/09638288.2024.2364823] [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: 11/15/2023] [Accepted: 06/02/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE Although the health benefits of early diagnosis and therapeutic approaches for children and youth with autism spectrum disorder (ASD), racial disparities persist. This systematic review explored the experiences of racism and racial disparities in health care among children and youth with ASD and their caregivers. METHODS We conducted a systematic review, drawing on six international databases. Two reviewers screened titles, abstracts, and full texts. Thirty-seven studies met our inclusion criteria and we applied a narrative synthesis to develop themes. RESULTS Four themes were identified: (1) experiences and aspects of racism and racial disparities (i.e., language and cultural barriers, poor quality health care interactions, stereotypes and discrimination, family and community stigma, and indirect barriers); (2) racial disparities in health care (i.e., screening and referral, diagnosis, health care services, and care coordination and medication); (3) facilitators to accessing health care services; and (4) recommendations from caregivers. CONCLUSIONS This review highlights the extensive racial disparities experienced by children with autism. More research is needed to explore youth's perspectives on racism in addition to exploring potential interventions to address racial disparities and improve health equity for youth with ASD.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Yiyan Li
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Simran Joneja
- Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Shaelynn Hsu
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Faculty of Science, York University, Toronto, Canada
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2
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Fannin DK, Williams EDG, Fuller M, Pearson JN, Boyd BA, Drame ER, Taylor J, Dickerson AS, Spinks-Franklin A, Coles-White DJ. Unpacking the prevalence: A warning against overstating the recently narrowed gap for Black autistic youth. Autism Res 2024; 17:1072-1082. [PMID: 38804591 DOI: 10.1002/aur.3168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Abstract
Recent findings from the Centers for Disease Control and Prevention's (CDC) Autism and Developmental Disabilities Monitoring (ADDM) Network's 2020 prevalence report indicate that disparities in autism diagnoses between Black and White youth have narrowed, reflecting improved screening, awareness, and access to services (Maenner et al., 2023. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002), 72, 1-14.). Claims of reducing disparities beyond prevalence rates, however, are not fully supported, as indicated by the reality that Black youth whose screenings indicate autistic traits are still not being referred for full evaluation or early intervention services at the same rate as their White peers (Major et al., 2020. Autism, 24, 1629-1638; Smith et al., 2020. Pediatrics, 145, S35-S46.). Black 8-year-olds identified as autistic still experience disparate educational placements (Waitoller et al., 2010. The Journal of Special Education. 44, 29-49.) where services may not be autism-specific or have Individual Education Plan goals only focused on "behavior problems" (Severini et al., 2018. Journal of Autism and Developmental Disorders, 48, 3261-3272.), are served in the most restrictive environments (Skiba et al., 2006. Exceptional Children, 72, 411-424.) and lack consistent augmentative and alternative communication support (Pope et al., 2022. American Journal of Speech-Language Pathology, 31, 2159-2174.). Additionally, ADMM researchers report consistent disparities in the identification of co-occurring intellectual disability where Black autistic children have significantly more co-occurrences than White autistic children. The purpose of this commentary is to first examine the assertion that the narrowed gap indicates, "…improved…access to services among historically underserved groups," (p. 9) (Maenner et al., 2023. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002), 72, 1-14.). We will then recommend strategies to address the ongoing disparities.
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Affiliation(s)
- Danai Kasambira Fannin
- Department of Communication Sciences and Disorders, North Carolina Central University, Durham, North Carolina, USA
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ed-Dee G Williams
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
| | - Marcus Fuller
- Department of Education, University of Maryland Eastern Shore, Princess Anne, Maryland, USA
| | - Jamie N Pearson
- Department of Teacher Education and Learning Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Brian A Boyd
- School of Education, University of North Carolina, Chapel Hill, North Carolina, USA
- Frank Porter Graham Child Development Institute, Chapel Hill, North Carolina, USA
| | - Elizabeth R Drame
- Department of Teaching and Learning, University of Wisconsin, Milwaukee, Wisconsin, USA
- Division of Diversity, Equity, and Inclusion, University of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jonte' Taylor
- Department of Educational Psychology, Counseling, and Special Education, Penn State University, University Park, Pennsylvania, USA
| | - Aisha S Dickerson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - D' Jaris Coles-White
- Department of Speech, Language, Hearing Science, Western Michigan University, Kalamazoo, Michigan, USA
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Benevides TW, Jaremski JE, Williams ED, Song W, Pham HH, Shea L. Racial and Ethnic Disparities in Community Mental Health Use Among Autistic Adolescents and Young Adults. J Adolesc Health 2024; 74:1208-1216. [PMID: 38493400 DOI: 10.1016/j.jadohealth.2024.01.036] [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: 06/28/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE The purpose of this cohort study was to evaluate differences in rate of co-occurring mental health (MH) conditions among transition-age autistic youth (TAYA) who are Black, indigenous, and other people of color, and to identify enabling variables associated with any community MH visit in this population. METHODS Medicare-Medicaid Linked Enrollees Analytic Data Source 2012 data were used for this study. TAYA 14-29 years old who received fee-for-service Medicare, Medicaid, or both were included. Predisposing, enabling, and need variables associated with both presence of MH conditions and any community MH visit were examined with general linear modeling. RESULTS N = 122,250 TAYA were included. Black, Asian/Pacific Islander, and Hispanic TAYA were significantly less likely than White TAYA to have a diagnosis of substance-use, depressive, anxiety, attention-deficit hyperactivity disorder, or post-traumatic stress disorders. These groups were also significantly less likely to have had a community MH visit in the past year after controlling for predisposing, enabling, and need variables. Enabling variables associated with greater use of at least one community MH visit included dual enrollment in both Medicare and Medicaid and 12+ months of enrollment in 1115 or 1915(C) Medicaid waivers. DISCUSSION Service delivery factors are an important area of future research, particularly dual enrollment and coverage disparities for Black, indigenous, and other people of color TAYA. Examining coverage of managed care enrollees, including differences by state, may offer additional insights on how these factors impact care.
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Affiliation(s)
- Teal W Benevides
- Institute of Public and Preventive Health, Augusta University, Augusta, Georgia.
| | - Jennifer E Jaremski
- Institute of Public and Preventive Health, Augusta University, Augusta, Georgia
| | - Ed-Dee Williams
- School of Social Work, Boston College, Chestnut Hill, Massachusetts
| | - Wei Song
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | | | - Lindsay Shea
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
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Girolamo T, Birmingham M, Patel K, Ghali S, Campos I, Greene-Pendelton K, Canale R, Larson C, Sterling A, Shogren KA. Self-determination in minoritized autistic adolescents and adults. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.02.24306799. [PMID: 38746405 PMCID: PMC11092698 DOI: 10.1101/2024.05.02.24306799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Self-determination plays an important role in outcomes in autism and shows intersectional disparities. Yet, little is known about the role of individual differences or social drivers of health in the development of self-determination. Understanding these factors is key for developing effective supports. This mixed-methods convergent study examined self-determination in racially and ethnically minoritized autistic individuals and caregivers. Participants ages 13 to 30 ( N = 73) varying widely in language and cognitive ability and caregivers ( n =52) completed the Self-Determination Inventory. Autism traits and sense of community predicted caregiver report of self-determination, and autism traits and language predicted self-report of self-determination, consistent with DisCrit and Diversity Science. Self-Determination Inventory interviews of a subset of participants ( n = 13) and caregivers ( n = 9) were analyzed using inductive thematic analysis. Themes pointed to the role of the intersection of race and disability in shaping self-determination. Altogether, findings point to the importance of these frameworks, environmental influences, and multi-informant perspectives in characterizing self-determination. Future work should focus on the impact of environmental factors in self-determination in minoritized autistic individuals during the transition to adulthood.
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Harrison AJ, Naqvi NC, Smit AK, Kumar PN, Muhammad NA, Saade S, Yu L, Cappe E, Low HM, Chan SJ, de Bildt A. Assessing Autism Knowledge Across the Global Landscape Using the ASK-Q. J Autism Dev Disord 2024; 54:1897-1911. [PMID: 36892718 DOI: 10.1007/s10803-023-05936-5] [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: 02/13/2023] [Indexed: 03/10/2023]
Abstract
Substantial variability exists with regard to autism service provision around the world. Service disparities observed in many low- and middle-income countries may be driven, in part, by limited autism knowledge; however, measurement limitations have made it difficult to quantify autism knowledge across countries. The current study uses the autism stigma and knowledge questionnaire (ASK-Q) to quantify autism knowledge and stigma between different countries and demographics. The current study compiled data from 6830 participants collected using adapted versions of the ASK-Q administered in 13 different countries, representing four different continents. Structural equation modeling was used to examine how autism knowledge varied across country and individual factors. Results reveal cross country variability with a large, 17-point difference between the countries with the highest knowledge (Canada) and the lowest knowledge (Lebanon). As expected, countries with higher economies had higher levels of knowledge. We also documented differences based on country worldview, participant occupation, gender, age, and education level. These results help to identify specific regions and populations that might most need greater information about autism.
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Affiliation(s)
- Ashley J Harrison
- Educational Psychology Department, University of Georgia, Athens, GA, 30606, USA.
- Department of Educational Psychology, University of Georgia, Aderhold Hall 110 Carlton Street, Athens, GA, 30602, USA.
| | - Nilofer C Naqvi
- Department of Psychology, Iona University, New Rochelle, NY, 10801, USA
| | - Anne K Smit
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Accare Child Study Center, Groningen, The Netherlands
| | - Prisha Nanda Kumar
- Educational Psychology Department, University of Georgia, Athens, GA, 30606, USA
| | - Noor Azimah Muhammad
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia. Jalan Yaacob Latiff, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Sabine Saade
- Psychology Department, American University of Beirut, Beirut, 1107 2020, Lebanon
| | - Luodi Yu
- Center for Autism Research, School of Education, Guangzhou University, Wenyi Bldg, Guangzhou, China
| | - Emilie Cappe
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, 92100, Boulogne-Billancourt, France
- Institut Universtaire de France (IUF), Paris, France
| | - Hui Min Low
- School of Education Studies, Universiti Sains Malaysia, Penang, Malaysia
| | - Sarah-Jane Chan
- Manggatal Health Clinic, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Annelies de Bildt
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Accare Child Study Center, Groningen, The Netherlands
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Del Bianco T, Lockwood Estrin G, Tillmann J, Oakley BF, Crawley D, San José Cáceres A, Hayward H, Potter M, Mackay W, Smit P, du Plessis C, Brink L, Springer P, Odendaal H, Charman T, Banaschewski T, Baron-Cohen S, Bölte S, Johnson M, Murphy D, Buitelaar J, Loth E, Jones EJ. Mapping the link between socio-economic factors, autistic traits and mental health across different settings. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1280-1296. [PMID: 37822256 DOI: 10.1177/13623613231200297] [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] [Indexed: 10/13/2023]
Abstract
LAY ABSTRACT Autistic individuals are more likely than non-autistic individuals to experience a mental health condition in their lifetime, and this includes externalising and internalising symptoms. We know very little about how different environments and family conditions impact these symptoms for autistic individuals. Improving our understanding of these relationships is important so that we can identify individuals who may be in greater need of support. In this article, we seek to improve our understanding of how environmental and family conditions impact externalising and internalising symptoms in autistic and non-autistic people. To do this, we conducted analyses with two cohorts in very different settings - in Europe and South Africa - to ensure our findings are globally representative. We used advanced statistical methods to establish environmental and family conditions that were similar to each other, and which could be combined into specific 'factors'. We found that four similar 'factors' could be identified in the two cohorts. These were distinguished by personal characteristics and environmental conditions of individuals, and were named Person Characteristics, Family System, Parental and Material Resources. Interestingly, just 'Family System' was associated with internalising and externalising symptoms, and this was the same in both cohorts. We also found that having high traits of autism impacted this relationship between Family System and mental health conditions with opposite directions in the two settings. These results show that characteristics in the Family System are associated with internalising and externalising symptoms, and autistic persons are particularly impacted, reinforcing the notion that family stressors are important to consider when implementing policy and practice related to improving the mental health of autistic people.
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Affiliation(s)
| | | | - Julian Tillmann
- King's College London, UK
- F. Hoffmann-La Roche AG, Switzerland
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Davies J, Romualdez AM, Malyan D, Heasman B, Livesey A, Walker A, Pellicano E, Remington A. Autistic Adults' Priorities for Future Autism Employment Research: Perspectives from the United Kingdom. AUTISM IN ADULTHOOD 2024; 6:72-85. [PMID: 38435326 PMCID: PMC10902279 DOI: 10.1089/aut.2022.0087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Background A growing body of research has sought to understand autistic people's research priorities. Several of these studies have identified employment as a key research priority. Yet, there have been a few attempts to identify specific, actionable priorities within this area. Methods Using an online survey, we asked 197 autistic people in the United Kingdom about their priorities for future autism-employment research. Results Participants spoke of their challenges in gaining and sustaining meaningful employment and called for researchers to conduct research that results in direct improvements to employment experiences. Regarding their research priorities, participants indicated a need for research covering all aspects of the employment lifecycle from accessing employment to transitioning out of employment. Importantly, participants also discussed how such research should be conducted: with autistic people as co-researchers and ensuring a diverse range of autistic people are listened to. Conclusion While much existing autism-employment research appears to align with the priorities outlined in this study, seemingly minimal attention has been paid to later stages of the work lifecycle (e.g., progressing into more senior job roles or transitioning out of work). By identifying disparities between autistic people's priorities and the research being conducted, we can support autistic people to drive the research agenda and ensure autism-employment research positively impacts the community it aims to serve.
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Affiliation(s)
- Jade Davies
- UCL Centre for Research in Autism and Education (CRAE), University College London, London, United Kingdom
| | - Anna Melissa Romualdez
- UCL Centre for Research in Autism and Education (CRAE), University College London, London, United Kingdom
| | - Danae Malyan
- UCL Centre for Research in Autism and Education (CRAE), University College London, London, United Kingdom
| | - Brett Heasman
- School of Education, Language and Psychology, York St John University, York, United Kingdom
| | - Adam Livesey
- UCL Centre for Research in Autism and Education (CRAE), University College London, London, United Kingdom
| | - Amy Walker
- UCL Centre for Research in Autism and Education (CRAE), University College London, London, United Kingdom
- Neurodiversity Works, London, United Kingdom
| | - Elizabeth Pellicano
- Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- Macquarie School of Education, Macquarie University, Sydney, Australia
| | - Anna Remington
- UCL Centre for Research in Autism and Education (CRAE), University College London, London, United Kingdom
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Orsmond GI, Krishnan SG, Munsell EGS, Cohn ES, Coster WJ. Describing Outcomes in Autistic Young Adults One Year After High School Graduation. J Autism Dev Disord 2024:10.1007/s10803-023-06152-x. [PMID: 38285097 DOI: 10.1007/s10803-023-06152-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE Research documents poor outcomes for autistic adults in the domains of employment, independent living, and social relationships. Measurement and sample limitations in prior studies may have amplified past estimates of poor outcomes. The goal of the current study was to improve upon past approaches and to create and describe a measurement approach to capture adult outcomes that reflected the context of young adulthood and the perspectives of autistic individuals, pairing objective outcome indicators with subjective satisfaction indicators. METHODS Thirty-six autistic young adults (mean age 19.8 years) and a parent completed self-report surveys. Using these data, we defined an objective and subjective (i.e., satisfaction) outcome indicator in each of three domains: productivity (employment or post-secondary education), social well-being (frequency of contact with friends), and living situation (autonomy). RESULTS Three-quarters of young adults experienced at least 5 out of 6 positive outcomes. Over 90% were engaged in school, work, or a structured transition program, and an equal percentage were satisfied with their productivity activity. Over three-quarters of adults had a good amount of contact with friends and were satisfied with their social life. Most young adults had a moderate level of autonomy in their daily lives, and all were satisfied with their living situation. CONCLUSION Tailoring outcome measurement approaches specifically for autistic young adults provided a more optimistic portrayal of outcomes than previously noted in the literature. The approach used better reflects a neurodiversity approach and may be useful for evaluating the effectiveness of transition services or interventions.
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Affiliation(s)
- Gael I Orsmond
- Department of Occupational Therapy, Boston University, 635 Commonwealth Ave, Boston, MA, 02215, USA.
| | - Sharada G Krishnan
- Department of Occupational Therapy, Boston University, 635 Commonwealth Ave, Boston, MA, 02215, USA
| | | | - Ellen S Cohn
- Department of Occupational Therapy, Boston University, 635 Commonwealth Ave, Boston, MA, 02215, USA
| | - Wendy J Coster
- Department of Occupational Therapy, Boston University, 635 Commonwealth Ave, Boston, MA, 02215, USA
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Coulter KL, Moreno P, Barton M, Dumont-Mathieu T, Robins DL, Fein DA. Validity of the Toddler Autism Symptom Inventory in Non-Hispanic White and Black Toddlers. J Autism Dev Disord 2024; 54:339-352. [PMID: 36316523 PMCID: PMC10148924 DOI: 10.1007/s10803-022-05756-z] [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: 09/11/2022] [Indexed: 05/01/2023]
Abstract
Racial disparities exist in autism diagnosis, and yet, the development of most diagnostic tools has not explicitly examined measurement equity between racial and ethnic groups. We examined the validity of the Toddler Autism Symptom Inventory (TASI), a semi-structured interview developed for diagnosis of toddlers, in non-Hispanic Black/African American and non-Hispanic White children. After controlling for group differences in socio-economic status, no differences in diagnosis, age at diagnosis, mean developmental level, or autism severity were found. TASI ROC curves for both groups, in the overall sample, and in samples stratified by SES, showed high AUC values. Validity of two cutoff scores was acceptable. Lack of significant differences in TASI score or responses to individual items suggests similar symptomatology. These results provide early support for the use of the TASI in diagnostic evaluations of Black and White children.
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Affiliation(s)
- Kirsty L Coulter
- University of Connecticut, 406 Unit 1020, Babbidge Rd, 06269, Storrs, CT, USA.
| | - Paula Moreno
- University of Connecticut, 406 Unit 1020, Babbidge Rd, 06269, Storrs, CT, USA
| | - Marianne Barton
- University of Connecticut, 406 Unit 1020, Babbidge Rd, 06269, Storrs, CT, USA
| | - Thyde Dumont-Mathieu
- University of Connecticut School of Medicine, Connecticut Children's Medical Center, Farmington, CT, USA
| | | | - Deborah A Fein
- University of Connecticut, 406 Unit 1020, Babbidge Rd, 06269, Storrs, CT, USA
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White SW, Schall C, Santos JD, Maddox BB, Hillier A, Klinger L, Pugliese C. Promoting Quality of Life: Suggestions for Mental Health Care Providers Working with Young Autistic Adults. AUTISM IN ADULTHOOD 2023; 5:347-355. [PMID: 38116052 PMCID: PMC10726189 DOI: 10.1089/aut.2022.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
There is a growing population of autistic adults in need of supports from a service delivery system that, at present, fails to accommodate their needs adequately and equitably. Unfortunately, there is a shortage of trained behavioral health service providers to meet the needs of young autistic adults. Quality of life (QoL), or one's perception of, and satisfaction with, life in relation to held goals and expectations, has been identified as a key outcome of interest by autistic self-advocates. By supporting autistic clients to hone their strengths and interests, integrate various aspects of their identity, identify goals, and connect to appropriate resources, providers can promote clients' self-knowledge and self-determination, in the service of improving QoL. In this Perspectives article, we offer concrete recommendations to mental health providers, including those who do not specialize in autism, with the goal of supporting implementation of evidence-based strategies that improve QoL and promote self-determination among young autistic clients.
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Affiliation(s)
- Susan W. White
- Center for Youth Development and Intervention, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Carol Schall
- Autism Center for Education, Rehabilitation Research and Training Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jin Delos Santos
- Project REACH, College of Staten Island at the City University of New York, Staten Island, New York, USA
| | - Brenna B. Maddox
- TEACCH Autism Program, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ashleigh Hillier
- Department of Psychology, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Laura Klinger
- TEACCH Autism Program, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cara Pugliese
- Center for Autism Spectrum Disorders, Children's National Hospital, Washington, District of Columbia, USA
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11
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Ishler KJ, Berg KA, Olgac T, Obeid R, Biegel DE. Barriers to service and unmet need among autistic adolescents and young adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:1997-2010. [PMID: 36740742 DOI: 10.1177/13623613221150569] [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: 02/07/2023]
Abstract
LAY ABSTRACT Prior studies have described the roadblocks, or barriers, to needed services experienced by families with young autistic children, but less research has focused on those faced by autistic adolescents and young adults. In this study, we wished to understand the barriers to service experienced by autistic adolescents and young adults and their families. We surveyed 174 caregivers of autistic youth between 16 to 30 years old. We found that caregivers who felt more caregiving burden had more difficulty accessing services for their youth. Specifically, caregivers who felt more strongly that their daily lives had been disrupted, felt more financial strain, and worried more about their youth well-being experienced more roadblocks to getting services for the youth. Male caregivers also reported fewer difficulties related to service access. Importantly, the older the youth was when they had been diagnosed with autism, the more service barriers their caregivers reported. We did not see any differences in the level of barriers experienced by youth who lived in urban versus suburban settings, or between white and non-white families. However, when youth lived with their caregivers (rather than, for example, in a group home), fewer quality-related barriers to services were reported. Finally, greater access (but not quality) barriers were linked to youth having more unmet service needs. These findings can help to reduce the barriers to service experienced by autistic adolescents and young adults and their families.
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12
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Lai MC. Mental health challenges faced by autistic people. Nat Hum Behav 2023; 7:1620-1637. [PMID: 37864080 DOI: 10.1038/s41562-023-01718-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/07/2023] [Indexed: 10/22/2023]
Abstract
Mental health challenges impede the well-being of autistic people. This Review outlines contributing neurodevelopmental and physical health conditions, rates and developmental trajectories of mental health challenges experienced by autistic people, as well as unique clinical presentations. A framework is proposed to consider four contributing themes to aid personalized formulation: social-contextual determinants, adverse life experiences, autistic cognitive features, and shared genetic and early environmental predispositions. Current evidence-based and clinical-knowledge-informed intervention guidance and ongoing development of support are highlighted for specific mental health areas. Tailored mental health support for autistic people should be neurodivergence-informed, which is fundamentally humanistic and compatible with the prevailing bio-psycho-social frameworks. The personalized formulation should be holistic, considering physical health and transdiagnostic neurodevelopmental factors, intellectual and communication abilities, and contextual-experiential determinants and their interplay with autistic cognition and biology, alongside resilience. Supporting family well-being is integral. Mutual empathic understanding is fundamental to creating societies in which people across neurotypes are all empowered to thrive.
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Affiliation(s)
- Meng-Chuan Lai
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health and Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychology, Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
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Li Y, Ragunathan S, Fuentes K, Hsu S, Lindsay S. Exploring the experiences of ableism among Asian children and youth with disabilities and their families: a systematic review of qualitative studies. Disabil Rehabil 2023:1-20. [PMID: 37737152 DOI: 10.1080/09638288.2023.2258792] [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: 02/28/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE Asian children and youth with disabilities often experience multiple barriers, stigmas and discrimination within and outside their families; yet less is understood about their lived experiences. This systematic review explored the experiences of ableism among Asian children and youth with disabilities and their families. METHODS We conducted a systematic review of qualitative studies and a qualitative meta-synthesis. We searched six databases including Ovid Medline, Embase, PsychInfo, Healthstar, Web of Science, and Scopus. RESULTS Forty-two articles met our inclusion criteria involving 17 countries and regions over a 22-year period. The findings were synthesized into four themes: (1) individual- and family-level ableism (i.e., stigma, fears, concerns, stress and anxieties, physical abuse, bullying, reduced engagement in community activities); (2) institutional-level ableism (i.e., barriers to accessing and navigating supports, ableist attitudes among service providers, unavailable services); (3) societal-level ableism (i.e., cultural and religious stigma, social rejection, discrimination, environmental and policy barriers); and (4) coping strategies (i.e., self-care activities, supports from family, friends and people with similar conditions, religious beliefs). CONCLUSIONS Our results highlight the ableist experiences that Asian children and youth with disabilities and their caregivers often encounter and the strong need for further supports to address ableism using culturally responsive strategies.
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Affiliation(s)
- Yiyan Li
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Sharmigaa Ragunathan
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Kristina Fuentes
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Shaelynn Hsu
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Faculty of Science, York University, Toronto, Canada
| | - Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
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14
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Bahry S, Gerhardt PF, Weiss MJ, Leaf JB, Putnam RF, Bondy A. The Ethics of Actually Helping People: Targeting Skill Acquisition Goals That Promote Meaningful Outcomes for Individuals with Autism Spectrum Disorder. Behav Anal Pract 2023; 16:672-695. [PMID: 37680332 PMCID: PMC10480108 DOI: 10.1007/s40617-022-00757-x] [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: 10/28/2022] [Indexed: 12/14/2022] Open
Abstract
As a field that predominately supports individuals with autism spectrum disorder (ASD), we have an ethical duty as behavior analysts to ensure that the goals we write and interventions we prescribe promote best outcomes across the lifespan. This is critical, given that as it stands now, outcomes in adulthood for individuals with ASD are poor in every area assessed. The Ethics Code for Behavior Analysts can be interpreted to provide support for teaching the right goals, the right way, with respect to inherent rights of those we serve, in order to help affect positive changes in these outcomes. The present article highlights ethical themes that are relevant in order to affect these changes that are supported by the Code, as well as actionable steps to take next. The aim is to provide a resource for practitioners to use in clinical practice and in making ethical decisions that will help to improve outcomes for individuals with autism in adulthood. In addition, recommendations are made about integrating these values and approaches in terms of training, supervision, advocacy, and research.
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Affiliation(s)
- Shanna Bahry
- Endicott College, Beverly, MA USA
- Meaningful HOPE, East Providence, RI USA
| | | | | | - Justin B. Leaf
- Endicott College, Beverly, MA USA
- Autism Partnership Foundation, Seal Beach, CA USA
| | - Robert F. Putnam
- Endicott College, Beverly, MA USA
- May Institute, Randolph, MA USA
| | - Andy Bondy
- Pyramid Educational Consultants, New Castle, DE USA
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15
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Wehman P, Schall C, Avellone L, McDonough J, Whittenburg H, Dubois T, Broda M. Effects of a 9-Month Military-Base Internship on the Competitive Integrated Employment of Military Dependent and Connected Youth with ASD. J Autism Dev Disord 2023; 53:3525-3541. [PMID: 35737193 PMCID: PMC9218705 DOI: 10.1007/s10803-022-05634-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 12/02/2022]
Abstract
This waitlist-controlled cluster randomized clinical trial presents the results of PS + ASD for military dependent and connected youth with ASD. Following earlier findings regarding PS + ASD, this study expands upon that previous work by including a new population, military dependent and connected transition aged youth with ASD. Findings indicate that military dependent and connected youth who participated in PS + ASD gained competitive integrated employment at 60% despite the impact of the COVID-19 pandemic and economic downturn. In addition, these youth worked a mean of 24.42 h weekly and earned an average hourly wage of $9.38 at one year post baseline while the waitlist control group participants did not gain CIE. In addition, by 18 months, 58.3% of participants gained positions in federal employment. Implications of the study are discussed.
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Affiliation(s)
- Paul Wehman
- Rehabilitation Research and Training Center, Virginia Commonwealth University, 1314 West Main Street, Richmond, VA, 23284-2011, USA
| | - Carol Schall
- Rehabilitation Research and Training Center, Virginia Commonwealth University, 1314 West Main Street, Richmond, VA, 23284-2011, USA.
| | - Lauren Avellone
- Rehabilitation Research and Training Center, Virginia Commonwealth University, 1314 West Main Street, Richmond, VA, 23284-2011, USA
| | - Jennifer McDonough
- Rehabilitation Research and Training Center, Virginia Commonwealth University, 1314 West Main Street, Richmond, VA, 23284-2011, USA
| | - Holly Whittenburg
- Department of Teaching & Learning, Washington State University, Pullman, WA, USA
| | - Thomas Dubois
- Rehabilitation Research and Training Center, Virginia Commonwealth University, 1314 West Main Street, Richmond, VA, 23284-2011, USA
| | - Michael Broda
- School of Education, Virginia Commonwealth University, Richmond, VA, USA
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16
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Friedman NR, Watkins L, Barnard-Brak L, Barber A, White SW. De-implementation of Low-Value Practices for Autism Spectrum Disorder. Clin Child Fam Psychol Rev 2023; 26:690-705. [PMID: 37452164 DOI: 10.1007/s10567-023-00447-2] [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: 07/04/2023] [Indexed: 07/18/2023]
Abstract
Due to a variety of factors, Autism Spectrum Disorder (ASD) has long been tethered to use of low-value practice (LVP), arguably moreso than any other psychiatric or neurodevelopmental condition. Although dissemination of empirically supported treatments (EST) for autistic individuals has expanded markedly over the past decade, there has not been concomitant reduction in the use of LVP. It is critical that clinicians and scientists not only promote the implementation of EST, but also facilitate the de-implementation (abandonment and/or divestment) of ineffective or harmful practices. In this review, we describe a data-driven approach that can be used to identify LVP, drawing from established criteria for identification of evidence-based treatments (e.g., APA Division 12, National Clearinghouse on Autism Evidence and Practice; SAMHSA), as well as broader considerations such as social validity, cost, and parsimony. Herein, a data-based approach to LVP identification is proposed with a goal of improving quality of service access. Within an implementation science framework, we identify specific facilitators that sustain LVP use, and recommendations for subsequent de-implementation strategies are offered.
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Affiliation(s)
- Nicole R Friedman
- Center for Youth Development and Intervention, University of Alabama, 101 McMillan Bldg, Box 870348, Tuscaloosa, AL, 35487, USA
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Laci Watkins
- Department of Special Education, University of Alabama, Tuscaloosa, AL, USA
- Department of Educational Psychology, Texas A&M University, College Station, TX, USA
| | - Lucy Barnard-Brak
- Department of Special Education, University of Alabama, Tuscaloosa, AL, USA
| | - Angela Barber
- Department of Communication Sciences and Disorders, Samford University, Birmingham, AL, USA
| | - Susan W White
- Center for Youth Development and Intervention, University of Alabama, 101 McMillan Bldg, Box 870348, Tuscaloosa, AL, 35487, USA.
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA.
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17
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Fountain C, Winter AS, Cheslack-Postava K, Bearman PS. Developmental Trajectories of Autism. Pediatrics 2023; 152:e2022058674. [PMID: 37615073 PMCID: PMC10551845 DOI: 10.1542/peds.2022-058674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVES The goal of this study was to describe the typical, longitudinal, developmental trajectories of communication and social functioning in individuals with autism spectrum disorder from childhood through adulthood and to determine the correlates of these trajectories. METHODS Children with autism spectrum disorder who were born in California from 1992 through 2016 and enrolled with the California Department of Developmental Services were identified. Subjects with <4 evaluations in the database were excluded, resulting in a sample of 71 285 individuals. Score sequences were constructed based on evaluative items for communication and social functioning. Typical trajectories were identified using group-based latent trajectory modeling, and logistic regression was used to determine the odds of classification into a social adolescent decline trajectory by individual-, family-, and zip code-level factors. RESULTS Six typical patterns of communication functioning and 7 typical patterns of social functioning were identified. Whereas the majority of autistic individuals exhibit improved communication functioning as they age, the majority of individuals exhibit steady social functioning. A small group of individuals (5.0%) exhibits high social functioning in childhood that declines in adolescence. Membership in this adolescent decline group is associated with maternal non-Hispanic white race and ethnicity, female sex, moderate levels of maternal education, lower zip code-level median home values and population density, and higher zip code-level inequality. CONCLUSIONS Most autistic individuals show improved communication and social functioning as they age, but not all do. Trajectory group membership is correlated with socioeconomic status. Future research should investigate what drives these correlations.
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Affiliation(s)
- Christine Fountain
- Department of Anthropology & Sociology, Fordham
University, New York, NY
| | - Alix S. Winter
- Interdisciplinary Center for Innovative Theory and
Empirics, Columbia University, New York, NY
| | | | - Peter S. Bearman
- Interdisciplinary Center for Innovative Theory and
Empirics, Columbia University, New York, NY
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18
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Goldblum JE, McFayden TC, Bristol S, Putnam OC, Wylie A, Harrop C. Autism Prevalence and the Intersectionality of Assigned Sex at Birth, Race, and Ethnicity on Age of Diagnosis. J Autism Dev Disord 2023:10.1007/s10803-023-06104-5. [PMID: 37584770 PMCID: PMC10869641 DOI: 10.1007/s10803-023-06104-5] [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: 08/08/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE An official autism diagnosis is required to access timely intervention and is associated with better long-term wellbeing and mental health. Certain demographic characteristics, such as being female or a racially or ethnically minoritized youth, have been associated with significant diagnostic lag. However, it remains unclear how assigned sex, race, and ethnicity interact with each other in predicting the prevalence and age of autism diagnosis. METHODS To examine the interactions between assigned sex, race, and ethnicity, we used data from the National Survey of Children's Health (NSCH; 2016 > 2021). RESULTS One in 38 children had an autism diagnosis and 3.8 males were diagnosed per 1 female. Hierarchical linear regressions yielded diagnostic delays in some females, particularly those who were non-Hispanic white, Black, and Asian. Ethnic and racial minority children had significantly earlier diagnoses than white and non-Hispanic children when not accounting for sex. CONCLUSION This study demonstrates slight increases in reported autism prevalence, a diagnostic lag in some autistic females that was strongly associated with ethnicity, and earlier diagnoses in racial and ethnic minority youth, a finding that may be explained by factors associated with phenotypic differences. This study has important implications for the diagnosis of minority autistic youth, particularly females and females who are non-Hispanic, who may experience a greater propensity for diagnostic delays.
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Affiliation(s)
- Jessica E Goldblum
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, 325 E. Cameron Avenue, Chapel Hill, NC, 27599-327, USA.
| | - Tyler C McFayden
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Stephanie Bristol
- Division of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Orla C Putnam
- Division of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Amanda Wylie
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, 325 E. Cameron Avenue, Chapel Hill, NC, 27599-327, USA
| | - Clare Harrop
- Division of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, USA
- TEACCH Autism Program, University of North Carolina at Chapel Hill, Chapel Hill, USA
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19
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Malow BA, Qian Y, Ames JL, Alexeeff S, Croen LA. Health conditions in autism: Defining the trajectory from adolescence to early adulthood. Autism Res 2023; 16:1437-1449. [PMID: 37377040 PMCID: PMC10524876 DOI: 10.1002/aur.2960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/01/2023] [Indexed: 06/29/2023]
Abstract
Autistic adults, as compared to non-autistic adults, have increased rates of nearly all medical and psychiatric conditions. Many of these conditions begin in childhood, although few longitudinal studies have been conducted to examine prevalence rates of these conditions from adolescence into early adulthood. In this study, we analyze the longitudinal trajectory of health conditions in autistic youth, compared to age and sex-matched non-autistic youth, transitioning from adolescence into early adulthood in a large integrated health care delivery system. The percent and modeled prevalence of common medical and psychiatric conditions increased from age 14 to 22 years, with autistic youth having a higher prevalence of most conditions than non-autistic youth. The most prevalent conditions in autistic youth at all ages were obesity, neurological disorders, anxiety, and ADHD. The prevalence of obesity and dyslipidemia rose at a faster rate in autistic youth compared to non-autistic youth. By age 22, autistic females showed a higher prevalence of all medical and psychiatric conditions compared to autistic males. Our findings emphasize the importance of screening for medical and psychiatric conditions in autistic youth, coupled with health education targeted at this population, to mitigate the development of adverse health outcomes in autistic adults.
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Affiliation(s)
- Beth A. Malow
- Sleep Disorders Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yinge Qian
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jennifer L. Ames
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Stacey Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Lisa A. Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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20
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Williams EDG, Smith MJ. Virtual Interview Training Among BIPOC Autistic Transition-Age Youth: A Secondary Analysis of an Initial Effectiveness RCT. J Autism Dev Disord 2023:10.1007/s10803-023-06022-6. [PMID: 37269499 PMCID: PMC10759921 DOI: 10.1007/s10803-023-06022-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/05/2023]
Abstract
Black, Indigenous, and Persons of Color (BIPOC) autistic transition-aged youth (TAY) report lower rates of competitive employment compared to White autistic TAY and even greater deficits with social skills associated with positive job interviewing. A virtual job interviewing program was adapted to support and improve the job interviewing skills of autistic TAY. The current study evaluates the effectiveness of an efficacious virtual interview training program on the job interview skills, interview anxiety, and likeliness to be hired, for a subsample of 32 BIPOC autistic TAY, ages 17-26 years old from a previous randomized control trial of the program. Bivariate analyses were used to evaluate between-group differences at pre-test related to background characteristics, and whether Virtual Interview Training for Transition-Age Youth (VIT-TAY) was associated with changes between pre-test and post-test measures of job interview skills. Additionally, a Firth logistic regression was conducted to examine the relationship between VIT-TAY and competitive integrative employment at 6 months, covarying for fluid cognition, having ever had a job interview, and baseline employment status. Participants receiving pre-employment services (Pre-ETS) and virtual interview training had better job interview skills (F = 12.7, [Formula: see text] < .01; [Formula: see text] = .32), lower job interview anxiety (F = .3.96, [Formula: see text] < .05; [Formula: see text] = .12), and a higher likeliness of receiving employment (F = 4.34, [Formula: see text] < .05; [Formula: see text] = .13 at the 6-month follow up compared to participants that only had Pre-ETS. Findings from this study suggest that virtual interview training for TAY is effective for BIPOC autistic TAY in improving their interview skills to gain competitive employment and lower their job interview anxiety.
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Affiliation(s)
- Ed-Dee G Williams
- School of Social Work, University of Michigan, 1080 S. University Ave., Ann Arbor, MI, 48109, USA.
- Boston College School of Social Work, Chestnut Hill, MA, USA.
| | - Matthew J Smith
- School of Social Work, University of Michigan, 1080 S. University Ave., Ann Arbor, MI, 48109, USA
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21
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Elias R, Conner CM, White SW. Brief Report: Creation of a Transition Readiness Scale for Adolescents with ASD. J Autism Dev Disord 2023; 53:1279-1284. [PMID: 35138556 PMCID: PMC10423634 DOI: 10.1007/s10803-022-05449-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 11/27/2022]
Abstract
The transition to postsecondary education is characterized by many changes for adolescents with autism spectrum disorder (ASD). A data-based understanding of a student's readiness for postsecondary education could help students, and their parents, better prepare for this life transition. The Transition Readiness Scale (TRS) was created to address this need. The TRS is a self/other-report questionnaire used to assess postsecondary readiness across behavioral, cognitive, and emotional domains among adolescents 15-18 years of age. The present study details measure development and provides preliminary psychometric properties in a sample of transition-aged youth with ASD. Results indicate strong internal consistency, adequate item-level analyses, and discriminant and concurrent validity. Future validation of the TRS in large-scale field testing is merited to inform clinical interpretation.
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Affiliation(s)
- Rebecca Elias
- University of Southern California Keck School of Medicine, 4650 Sunset Blvd. Mailstop #146, Los Angeles, CA, 90027, USA.
- Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Caitlin M Conner
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Susan W White
- Center for Youth Development and Intervention, University of Alabama, Tuscaloosa, AL, USA
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22
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Lee D, Ramírez M, Castruita-Rios Y, Chen X, Tansey T. Effective Secondary Services in Transition-Age Youth With Disabilities: A Systematic Review of the Literature. REHABILITATION RESEARCH, POLICY, AND EDUCATION 2023. [DOI: 10.1891/re-22-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
Background:Youth with disabilities who have at least one paid work experience during high school are more than twice as likely to be employed after high school. However, barriers exist that limit work opportunities for youth with disabilities and subsequent entry to work as part of their adult lives.Objective:The study identified secondary education services that have been found to be scientifically valid and effective in improving transition to work of youth with disabilities.Methods:A scoping review was conducted of secondary services provided to transition-age youth with disabilities associated with employment outcomes. The final full-text review consisted of 30 articles.Findings:Findings describe five major themes related to secondary education services associated with employment. These themes are work experience, independence and autonomy, IEP and transition planning process, student characteristics, and medical restoration services.Conclusions:These findings suggest that secondary education services are effective in improving the transition to work for transition-age youth with disabilities. Recommendations are made for educators, rehabilitation professionals, and school administrators to enhance the rates of youth with disabilities in finding and maintaining meaningful employment.
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23
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Gray WN, Partain L, Benekos E, Grant K, Kennedy M, Dorriz P, Carpinelli A, Chavez K, Yun C, Torno L, Shrey D, Daniels M, Weiss M. Integrating transition readiness assessment into clinical practice: Adaptation of the UNC TRXANSITION index into the cerner electronic medical record. J Pediatr Nurs 2022:S0882-5963(22)00313-X. [PMID: 36528455 DOI: 10.1016/j.pedn.2022.11.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To describe the process of developing, and evaluating the feasibility and acceptability of, an EMR-based transition readiness assessment. DESIGN AND METHODS A Cerner-based version of the UNC TRxANSITION Index was implemented across four pediatric subspecialty clinics: epilepsy, inflammatory bowel disease; type 1 diabetes, oncology survivorship. The feasibility was assessed by each's clinic's ability to meet form completion goals and their assessment rate. Acceptability was assessed via family refusal rate, a staff-completed feedback questionnaire, and whether the form was adopted into routine clinical care after completion of the pilot study. RESULTS All clinics met form completion goals (N = 10/clinic). The assessment rate ranged from 66 to 100% across clinics. No families refused completion of the form. Most staff (70%) reported completing the form in <10 min. Staff reported on challenges experienced and provided recommendations to streamline administration and enhance clinical care. All staff reported the form helped them identify knowledge gaps in their patients. Two clinics continued using the form following completion of the pilot study. CONCLUSIONS Implementation was most feasible in clinics that were well-staffed and had lengthier patient visits, however, time and staff resources were the biggest challenges to implementation across clinics. Based on staff feedback to improve efficiency and developmentally-tailor assessment, the form will be divided into Beginner Skills and Advanced Skills. PRACTICAL IMPLICATIONS Integrating transition readiness assessment into the EMR has the potential to improve clinical care by facilitating staff's ability to efficiently identify knowledge gaps in their transition-aged patients and intervene.
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Affiliation(s)
- Wendy N Gray
- Children's Health of Orange County, Orange, CA, USA.
| | | | - Erin Benekos
- Children's Health of Orange County, Orange, CA, USA
| | | | | | | | | | | | | | | | - Daniel Shrey
- Children's Health of Orange County, Orange, CA, USA
| | - Mark Daniels
- Children's Health of Orange County, Orange, CA, USA
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24
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Kirjava SA, Witham K. Practical and ethical considerations for neurodiversity inclusion in audiology education and practice. Trends Neurosci Educ 2022; 29:100185. [PMID: 36470615 DOI: 10.1016/j.tine.2022.100185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/16/2022] [Accepted: 08/30/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND . An increasing number of people who are neurodiverse (people who have conditions such as autism, ADHD, and dyslexia) are pursuing higher education, including education and employment in the field of audiology METHODS: . This conceptual article was written by neurodivergent professionals to promote a cultural shift of inclusion for students, clinicians, researchers, and professors who identify as neurodivergent. FINDINGS . People with these conditions thrive with supportive accommodations in higher education and workplaces but little has been reported in the literature on neurodiversity accommodations in audiology education and practice CONCLUSIONS: . This article reviews the current literature on neurodiversity as it relates to audiology and discusses the practical and ethical considerations for neurodiversity inclusivity in the discipline of audiology.
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Affiliation(s)
- Shade Avery Kirjava
- University of California, Program in Public Health, 8421 Palo Verde Rd, Irvine, CA 92617, United States of America.
| | - Kate Witham
- Gallaudet University, United States of America
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25
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Malone KM, Pearson JN, Palazzo KN, Manns LD, Rivera AQ, Mason Martin DL. The Scholarly Neglect of Black Autistic Adults in Autism Research. AUTISM IN ADULTHOOD 2022; 4:271-280. [PMID: 36777371 PMCID: PMC9908289 DOI: 10.1089/aut.2021.0086] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Black autistic individuals, regardless of age, have not been centered in autism research. Instead, they often exist on the margins-on the periphery of autism research. In fact, Black autistic adults are largely absent from the literature. Most participants in autism research are majority-white autistic individuals and families. In this conceptual article, we use intersectionality and Dis/ability Studies and Critical Race Theory theories to contextualize Black autistic adults' experiences. Second, we argue that systemic disparities and methodological concerns are two contributors to the scholarly neglect of Black autistic adults in autism research. Third, we provide guidelines to support researchers in moving from neglect to inclusive research with Black autistic adults.
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Affiliation(s)
- Kayla M. Malone
- Applied Developmental Science and Special Education, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jamie N. Pearson
- Special Education, North Carolina State University, Raleigh, North Carolina, USA
| | - Kayla N. Palazzo
- Applied Developmental Science and Special Education, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Special Education, North Carolina State University, Raleigh, North Carolina, USA
- Educational equity, North Carolina State University, Raleigh, North Carolina, USA
| | - Lonnie D. Manns
- Special Education, North Carolina State University, Raleigh, North Carolina, USA
- Educational equity, North Carolina State University, Raleigh, North Carolina, USA
| | - Amelia Q. Rivera
- Special Education, North Carolina State University, Raleigh, North Carolina, USA
- Educational equity, North Carolina State University, Raleigh, North Carolina, USA
| | - DeVoshia L. Mason Martin
- Special Education, North Carolina State University, Raleigh, North Carolina, USA
- Educational equity, North Carolina State University, Raleigh, North Carolina, USA
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26
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Cox M, Urban JB, Lich KH, Wells R, Lawrence CN, Kwaja N. A Multi-Stakeholder Perspective on Factors Affecting Successful Transition to Adulthood for Youth with Severe Emotional Disturbances. CHILD & ADOLESCENT SOCIAL WORK JOURNAL : C & A 2022; 40:1-19. [PMID: 36407677 PMCID: PMC9665016 DOI: 10.1007/s10560-022-00898-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
This study elicited the perspectives of youth, caregivers, service providers and researchers to explore how communities can best support the transition to adulthood for youth ages 16-21 with mental health and functional impairments, who are at risk of disconnecting from health and human services. Framed by Relational Systems Evaluation (RSE) and Positive Youth Development (PYD), our study demonstrates the importance of engagement with youth experts. Group Concept Mapping (GCM), a collaborative multiphase mixed-methods approach, was used as a systematic process for participants to make meaning of qualitative data using multidimensional scaling and hierarchical cluster analysis (Kane and Trochim in Concept mapping for planning and evaluation, Sage Publications Inc., Thousand Oaks, 2007). Across all participant groups, Life Skills were perceived as highly important and highly feasible for a successful transition to adulthood. However, Positive Social Support & Connectedness were viewed as less important and less feasible by all groups. When examined closely, youth perspectives differed from caregiver and provider perspectives in the factors they prioritized and deemed feasible. Our findings have implications for community mental health services and positive youth development program practitioners.
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Affiliation(s)
- Milira Cox
- Institute for Research on Youth Thriving and Evaluation, Department of Family Science and Human Development, Montclair State University, 1 Normal Ave., UN 4144, Montclair, NJ 07043 USA
| | - Jennifer Brown Urban
- Institute for Research on Youth Thriving and Evaluation, Department of Family Science and Human Development, Montclair State University, 1 Normal Ave., UN 4144, Montclair, NJ 07043 USA
| | - Kristen Hassmiller Lich
- Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Rebecca Wells
- Department of Management, Policy, and Community Health, University of Texas School of Public Health, Houston, TX USA
| | | | - Nadira Kwaja
- Institute for Research on Youth Thriving and Evaluation, Department of Family Science and Human Development, Montclair State University, 1 Normal Ave., UN 4144, Montclair, NJ 07043 USA
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Elliott T, Floyd James K, Coleman KJ, Skrine Jeffers K, Nau CL, Choi K. Cross-sectional Comparison of Disparities by Race Using White vs Hispanic as Reference Among Children and Youths With Developmental Disabilities Referred for Speech Therapy. JAMA Netw Open 2022; 5:e2234453. [PMID: 36194413 PMCID: PMC9533182 DOI: 10.1001/jamanetworkopen.2022.34453] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE Health care research on racial disparities among children and youths has historically used the White race as a reference category with which other racial and ethnic groups are compared, which may inadvertently set up Whiteness as a standard for health. OBJECTIVE To compare 2 interpretations of an analysis of racial disparities in speech therapy receipt among children and youths with developmental disabilities: a traditional, White-referenced analysis and a Hispanic majority-referenced analysis. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used multiple logistic regression to analyze speech therapy referrals for children, adolescents, and transition age youths in an integrated health care system in Southern California from 2017 to 2020. Eligible participants were children and youths up to age 26 years with 1 or more diagnosed intellectual or developmental disability (eg, autism spectrum disorder, speech or language delay, developmental delay, Down syndrome, and others). EXPOSURES Child or youth race and ethnicity as reported by parents or caregivers (Asian, Black and African American, Hispanic and Latinx, American Indian or Alaskan Native, Native Hawaiian or Pacific Islander, White, multiple, and other). MAIN OUTCOMES AND MEASURES Receipt of speech therapy within 1 year of referral. RESULTS A total 66 402 referrals were included; 65 833 referrals (99.1%) were for children under age 17 years, 47 323 (71.3%) were for boys, and 39 959 (60.2%) were commercially insured. A majority of participants were identified as Hispanic (36 705 [55.3%]); 6167 (9.3%) were identified as Asian, 4810 (7.2%) as Black, and 14 951 (22.5%) as White. In the traditional racial disparities model where the reference category was White, referrals of children and youths who identified as Hispanic, Black, Pacific Islander, and other had lower odds of actual receipt of speech therapy compared with referrals for White children and youths (Hispanic: OR, 0.79; 95% CI, 0.75-0.83; Black: OR, 0.72; 95% CI, 0.66-0.78; Pacific Islander: OR, 0.74; 95% CI, 0.57-0.98). When using the majority race group (Hispanic) as the reference category, referrals for children and youths who identified as White (OR, 1.26; 95% CI, 1.20-1.30), Asian (OR, 1.21; 95% CI, 1.12-1.30), and multiracial (OR, 1.35; 95% CI, 1.08-1.71) had higher odds of resulting in actual service receipt in comparison with referrals for Hispanic children and youths. CONCLUSIONS AND RELEVANCE The cross-sectional study demonstrates the value of decentering Whiteness in interpreting racial disparities research and considering racial differences against multiple referents. Racial disparities researchers should consider investigating multiple between-group differences instead of exclusively using White as the default reference category.
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Affiliation(s)
- Thomas Elliott
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Kortney Floyd James
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Karen J. Coleman
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
- Southern California Permanente Medical Group, Kaiser Permanente Southern California, Pasadena
| | | | - Claudia L. Nau
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Kristen Choi
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
- School of Nursing, University of California, Los Angeles
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
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Pope L, Light J, Franklin A. Black Children With Developmental Disabilities Receive Less Augmentative and Alternative Communication Intervention Than Their White Peers: Preliminary Evidence of Racial Disparities From a Secondary Data Analysis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2159-2174. [PMID: 36044883 PMCID: PMC9458617 DOI: 10.1044/2022_ajslp-22-00079] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/06/2022] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Ensuring equitable access to augmentative and alternative communication (AAC) intervention services for children with complex communication needs (CCN) is crucial. Evidence suggests that racial disparities exist in access to communication interventions, disadvantaging Black children. However, no research has investigated specifically the evidence for racial disparities in AAC services for children with developmental disabilities and CCN. METHOD The current study applied post hoc data analysis methods within a preexisting, open-access data set to explore preliminary evidence of racial disparities in AAC intervention. Amount of AAC intervention was compared for Black versus white 1 preschool students at study initiation (M age = 3;8 [years;months]) and 2 years later at study completion (M age = 5;10). RESULTS Black preschool students were reported to receive significantly less AAC intervention per week as compared to their white peers, both at study initiation and 2 years later. By study end, 75% of the Black children were receiving less than 60 min of AAC intervention per week, an inadequate amount to achieve meaningful gains given their significant disabilities. CONCLUSIONS It is unclear what mechanisms may contribute to the observed disparities; however, it is critical that concrete steps are taken by individual speech-language pathologists, school districts, preservice preparation programs, and researchers to identify inequities in AAC services and take actions to rectify them. Future research is essential to investigate the potential factors contributing to inequalities and determine effective interventions to address them.
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Affiliation(s)
- Lauramarie Pope
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
| | - Janice Light
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
| | - Amber Franklin
- Department of Speech Pathology and Audiology, Miami University, Oxford, OH
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Randomized Study of Survey Recruitment Strategies for Parents of Autistic Children. J Pediatr Health Care 2022; 36:470-473. [PMID: 35705390 PMCID: PMC9813947 DOI: 10.1016/j.pedhc.2022.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/09/2022] [Accepted: 05/12/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION This study aimed to compare phone, email, or text message recruitment strategies for engaging parents of autistic children in an online survey. METHOD In this randomized study, a sample of 1,624 parents of autistic children spectrum disorder (autism) from an integrated health system in Southern California were sent an initial mailed letter and email simultaneously for baseline survey outreach. Then, participants were randomly assigned to one of three follow-up recruitment groups: phone, email, or text message. We compared the efficacy of recruitment strategies in multivariate models. RESULTS All three follow-up methods were equally effective for eliciting a survey response. Parents of girls were less likely to respond to survey outreach attempts than parents of boys. DISCUSSION Multiple modalities of survey recruitment, including digital and mobile approaches, effectively recruit parents of children in research.
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Crowley S. Interventions for Transition-Age Youth With Disabilities: A Meta-Analysis of Group Design Studies. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 127:169-193. [PMID: 35443051 DOI: 10.1352/1944-7558-127.3.169] [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: 08/25/2020] [Accepted: 11/09/2021] [Indexed: 06/14/2023]
Abstract
This meta-analytic review investigated interventions for transition-age youth diagnosed with autism, intellectual disability, or extensive support needs. Nineteen group design studies with 215 effect sizes met inclusion criteria. A robust variance estimation procedure that accounts for the clustering effect sizes within studies was used to synthesize effect sizes within each intervention and outcome type. Occupational Therapy/Physical Therapy interventions have significant and positive effects on gross motor outcomes (g = 0.73, p < 0.01). All remaining interventions and outcomes could not be synthesized due to a limited number of studies, but are further described in a narrative manner. Recommendations for future research include improving the methodological quality of intervention studies and further analyzing the effects of interventions for transition-age youth.
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Opportunities for Inclusion and Engagement in the Transition of Autistic Youth from Pediatric to Adult Healthcare: A Qualitative Study. J Autism Dev Disord 2022; 53:1850-1861. [PMID: 35262827 PMCID: PMC10123038 DOI: 10.1007/s10803-022-05476-4] [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: 02/01/2022] [Indexed: 10/18/2022]
Abstract
Transitioning autistic youth from pediatric to adult healthcare requires coordination of multiple stakeholders, including youth, caregivers, and pediatric and adult care providers, whose interests at times overlap but often differ. To understand barriers and facilitators to inclusive transition experiences, we conducted thematic analysis of interviews with 39 stakeholders from the same large, integrated healthcare system. We identified three major themes: (1) Navigating the healthcare transition without guidance, (2) Health consequences of a passive healthcare transition, and (3) Strategies for inclusion and continuous engagement. Facilitators included gradual transition planning, a warm handoff between providers, and support of shared healthcare decision-making. Providers also sought clinical tools and logistical supports such as care coordinators and longer transition-specific visit types to enhance patient-centered care.
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Steinbrenner JR, McIntyre N, Rentschler LF, Pearson JN, Luelmo P, Jaramillo ME, Boyd BA, Wong C, Nowell SW, Odom SL, Hume KA. Patterns in reporting and participant inclusion related to race and ethnicity in autism intervention literature: Data from a large-scale systematic review of evidence-based practices. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:2026-2040. [PMID: 35068190 PMCID: PMC9596958 DOI: 10.1177/13623613211072593] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are marked racial and ethnic disparities in diagnosis and services for individuals on the autism spectrum, yet race and ethnicity are underreported and underexamined in autism research. The current study examines the reporting of race and ethnicity and the inclusion of participants across racial and ethnic groups in studies included in a large-scale systematic review of autism intervention research (1990–2017). Trained research assistants reviewed 1013 articles and extracted data on the reporting of race and ethnicity data and the inclusion of participants from different racial and ethnic categories from each article. Only 25% of the articles reported any data on race and ethnicity and reporting over time has slowly increased across the 28 years of the review. Descriptive statistics suggest that race and ethnicity reporting varied by study design, intervention, and outcomes. In studies with reported data, White participants had the highest rate of participation (64.8%), with a large gap between the next highest rates of participation, which were among Hispanic/Latino (9.4%), Black (7.7%), and Asian (6.4%) participants. The lack of reporting and the limited inclusion of participants across minoritized racial and ethnic groups are concerning and suggest a need to examine practices in autism research from planning to dissemination.
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Affiliation(s)
| | | | | | | | | | | | | | - Connie Wong
- California State University, Northridge, USA
| | | | | | - Kara A Hume
- University of North Carolina at Chapel Hill, USA
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Kuhn J, Szidon K, Kraemer B, Steinbrenner JR, Tomaszewski B, Hume K, DaWalt L. Implementation of a multi-family autism transition program in the high school setting. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:615-627. [PMID: 34991370 DOI: 10.1177/13623613211065533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Transitioning Together is an intervention that supports families of adolescents on the autism spectrum as they prepare for the transition to adulthood. While it has been delivered successfully and shown to result in positive outcomes for families in the university setting, questions remain about whether and how well it can be widely provided to families in real-world settings such as high schools. In this study, we analyzed predictors, facilitators, and barriers to providing Transitioning Together to families at 30 high schools across three US states, all of which received training from a team of researchers to deliver this intervention. Our findings highlight struggles and successes with real-world use of the intervention. Seventeen of the 30 schools were successful in providing Transitioning Together to families. Schools who had higher community socioeconomic status, higher quality family involvement, and higher quality transition planning programming before changing anything for this study were much more likely to provide this new intervention to families. Schools who used the intervention were mostly able to deliver it as designed and received positive feedback from families who participated. Common parts of the intervention that schools struggled with most included following the structure of the sessions, including group problem-solving and dialogue in the sessions, and collecting feedback from families. Future research is needed to learn how to make it even easier for public high schools and other service systems to provide this intervention to families, in a way that also maximizes its effectiveness and accessibility for historically underserved autism spectrum populations.
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Affiliation(s)
| | | | | | | | | | - Kara Hume
- University of North Carolina-Chapel Hill, USA
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34
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Odom SL, Hall LJ, Morin KL, Kraemer BR, Hume KA, McIntyre NS, Nowell SW, Steinbrenner JR, Tomaszewski B, Sam AM, DaWalt L. Educational Interventions for Children and Youth with Autism: A 40-Year Perspective. J Autism Dev Disord 2021; 51:4354-4369. [PMID: 33866461 PMCID: PMC8531076 DOI: 10.1007/s10803-021-04990-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 01/18/2023]
Abstract
Commemorating the 40 th anniversary of the Diagnostic and Statistical Manual (DSM) III, the purpose of this commentary is to describe school-based and school-relevant interventions and instructional approaches for children and youth with autism that have been developed and employed during that time period. The commentary begins with a brief description of foundational research that provides an historical context. Research themes shaped by science, ethics, social policy, and the changes in the DSM provide an organization for describing the evolution of intervention and instructional practices over the four previous decades. The commentary concludes with a discussion of school-contextual variables that influence implementation and the promise of the "iSciences" for closing the research to practice gap in the future.
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Affiliation(s)
- Samuel L Odom
- University of North Carolina At Chapel Hill, Chapel Hill, NC, USA.
- San Diego State University, San Diego, CA, USA.
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, CB 8040, Chapel Hill, NC, 27599-8040, USA.
| | | | | | | | - Kara A Hume
- University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | | | - Sallie W Nowell
- University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Ann M Sam
- University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
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Cheriyan C, Shevchuk-Hill S, Riccio A, Vincent J, Kapp SK, Cage E, Dwyer P, Kofner B, Attwood H, Gillespie-Lynch K. Exploring the Career Motivations, Strengths, and Challenges of Autistic and Non-autistic University Students: Insights From a Participatory Study. Front Psychol 2021; 12:719827. [PMID: 34744884 PMCID: PMC8568013 DOI: 10.3389/fpsyg.2021.719827] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022] Open
Abstract
Supports for the growing number of autistic university students often focus on helping them succeed in university. However, even educated autistic people experience discrimination and other challenges which can make it very difficult for them to obtain meaningful jobs. Little remains known about how universities can better support their autistic students and alumni in overcoming barriers to meaningful employment. In this participatory study, a team of autistic and non-autistic researchers asked autistic (n = 92) and non-autistic (n = 774) university students about their career aspirations, strengths they believe will help them succeed in their "dream jobs," and obstacles they expect to encounter. Autistic participants' top goal in attending college was to improve their career prospects. However, relatively few autistic students reported learning career-specific skills at university. Autistic students were more likely to seek an academic job and less likely to seek a career in healthcare than non-autistic students. Autistic students highlighted writing skills and detail orientation as strengths that could help them succeed in their dream jobs more often than non-autistic students. However, they were also more likely to expect discrimination, social, and psychological difficulties to stand in the way of their dream jobs. These findings suggest that universities should prioritize experiential learning opportunities to help autistic (and non-autistic) students develop employment-related skills while providing mental health supports. Universities should demonstrate their commitment to supporting diverse learners by seeking out and hiring autistic professionals and by teaching their own staff and employers how to appreciate and support autistic colleagues.
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Affiliation(s)
- Chinnu Cheriyan
- College of Staten Island, The City University of New York, Staten Island, NY, United States
| | - Sergey Shevchuk-Hill
- College of Staten Island, The City University of New York, Staten Island, NY, United States
| | - Ariana Riccio
- The Graduate Center, The City University of New York, New York, NY, United States
| | - Jonathan Vincent
- School of Education, Language and Psychology, York St John University, York, United Kingdom
| | - Steven K. Kapp
- Department of Psychology, University of Portsmouth, Portsmouth, United Kingdom
| | - Eilidh Cage
- Department of Psychology, University of Stirling, Stirling, United Kingdom
| | - Patrick Dwyer
- Center for Mind and Brain, University of California, Davis, Sacramento, CA, United States
| | - Bella Kofner
- College of Staten Island, The City University of New York, Staten Island, NY, United States
| | - Helen Attwood
- School of Education, Language and Psychology, York St John University, York, United Kingdom
| | - Kristen Gillespie-Lynch
- College of Staten Island, The City University of New York, Staten Island, NY, United States
- The Graduate Center, The City University of New York, New York, NY, United States
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Missing from the Narrative: A Seven-Decade Scoping Review of the Inclusion of Black Autistic Women and Girls in Autism Research. Behav Anal Pract 2021; 15:1093-1105. [PMID: 36605161 PMCID: PMC9745006 DOI: 10.1007/s40617-021-00654-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 01/09/2023] Open
Abstract
The intersectional experiences of Black autistic women and girls (BAWG) are missing from medical and educational research on autism spectrum disorder (ASD). Understanding the intersectional experiences of BAWG is important due to the rising prevalence of autism in Black children and girls (Centers for Disease Control and Prevention (CDC), 2020) and the concurrent lack of availability of culturally relevant autism-related interventions (Maenner et al., 2020; West et al., 2016). Intersectionality is the study of the overlapping discrimination produced by systems of oppression (Collins, 2019; Crenshaw, 1989, 1991) and allows the researcher to simultaneously address race and disability in special education (Artiles, 2013). In this scoping review, the authors used the PRISMA-ScR checklist (Tricco et al., 2018) and Arskey and O'Malley's (2005) framework to investigate the degree to which autism-related research (ARR) has included the intersectional experiences of BAWG. Utilizing narrative synthesis, strengths and gaps across the current body of literature are identified in order to set new directions for intersectional ARR. Overall, the authors found that across a 77-year period, three studies foregrounded BAWG and none addressed intersectionality as measured through criteria advanced by García and Ortiz (2013). These results reveal the scholarly neglect BAWG face in ARR, discourse, policy, and practice. A future agenda including research, practice, and policy priorities is identified and discussed.
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Lestishock L, Nova S, Disabato J. Improving Adolescent and Young Adult Engagement in the Process of Transitioning to Adult Care. J Adolesc Health 2021; 69:424-431. [PMID: 33762131 DOI: 10.1016/j.jadohealth.2021.01.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/14/2020] [Accepted: 01/23/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Health care transition (HCT) is the complex process of changing from pediatric to adult-centered care. Comprehensive HCT processes have been associated with improved outcomes in all elements of the Triple Aim. Nationally accepted best practices emphasize Six Core Elements of HCT, including the use of transition readiness assessment tools completed during clinic visits. Specifically, Got Transition's tools include two 0-10 point self-report scales on the validated domains of importance of changing to an adult provider and managing their healthcare, and confidence in their ability to transition. The aim of this quality improvement project (QIP) was to improve the engagement of adolescents and young adults (AYAs), aged 14-20, in the process of transitioning from pediatric to adult care. The sub-aim focused specifically on parent/caregiver engagement in transition, using the same scales in a tool for parents/caregivers. An urban federally qualified health center initiated this QIP. METHODS This QIP utilized the Institute for Healthcare Improvement Model for Improvement and plan-do-study-act cycles. RESULTS Eighty-five AYAs and 40 parents/caregivers completed readiness assessments twice. Scores improved overall, reaching statistical significance with a small change in AYA mean scores for importance (.94) and confidence (.75). Provision of a transition policy and completion of readiness assessments by AYAs and parents/caregivers met the 70% goal. Patient portal enrollments increased from 4.2% to 12.5%, although did not meet the 30% goal. CONCLUSIONS Engagement of AYAs and parents/caregivers was improved as a result of this QIP. Successful routine implementation of transition process measures demonstrated improved clinic-wide communication.
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Affiliation(s)
- Lisa Lestishock
- Ravenswood Family Health Center, East Palo Alto, California; Division of Adolescent Medicine, Stanford Children's Health, Menlo Park, California.
| | - Sandra Nova
- Ravenswood Family Health Center, East Palo Alto, California
| | - Jennifer Disabato
- College of Nursing & School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Maddox BB, Dickson KS, Stadnick NA, Mandell DS, Brookman-Frazee L. Mental Health Services for Autistic Individuals Across the Lifespan: Recent Advances and Current Gaps. Curr Psychiatry Rep 2021; 23:66. [PMID: 34402984 PMCID: PMC8961310 DOI: 10.1007/s11920-021-01278-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW This synthesis of recent mental health services research with autistic individuals presents significant advances, current gaps, and recommendations for improving mental healthcare for this population. RECENT FINDINGS Recent advances include improved understanding of co-occurring mental health conditions among autistic individuals, a growing evidence base for interventions to address them, the development and implementation of new service models to support mental health for this population, and a substantial increase in mental health services and implementation research focused on autism. Ongoing challenges include a lack of mental health interventions designed for community implementation with autistic individuals, limited workforce capacity, complex and disconnected service systems, and racial, ethnic, and socioeconomic disparities in accessibility and quality of mental health services. Despite the advances in our understanding of mental health needs and mental health services for autistic individuals, several critical gaps remain. We encourage future efforts to develop and test interventions that can be used in community settings, train and incentivize the workforce to provide them, realign policies and funding with best practice, and embrace an equity-focused approach to autism research and care.
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Affiliation(s)
- Brenna B Maddox
- Department of Psychiatry, TEACCH Autism Program, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
| | - Kelsey S Dickson
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Child and Family Development, San Diego State University, San Diego, CA, USA
| | - Nicole A Stadnick
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Dissemination and Implementation Science Center, University of California San Diego Altman Clinical and Translational Research Institute, San Diego, CA, USA
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Dissemination and Implementation Science Center, University of California San Diego Altman Clinical and Translational Research Institute, San Diego, CA, USA
- Rady Children's Hospital, San Diego, CA, USA
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Budavari AC, Pas ET, Azad GF, Volk HE. Sitting on the Sidelines: Disparities in Social, Recreational, and Community Participation Among Adolescents with Autism Spectrum Disorder. J Autism Dev Disord 2021; 52:3399-3412. [PMID: 34331628 PMCID: PMC8801542 DOI: 10.1007/s10803-021-05216-0] [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: 07/22/2021] [Indexed: 10/20/2022]
Abstract
Participation in extracurricular activities and community involvement during secondary school is important for the healthy social, emotional, mental, and physical development of adolescents, especially those with autism spectrum disorder (ASD). The current study utilized three waves of data (2016, 2017, and 2018) from the National Survey of Children's Health (NSCH) to examine disparities in extracurricular participation among 12- to 17-year old adolescents with ASD. Across the three waves, data demonstrate clear sociodemographic disparities among adolescents with ASD. These disparities were more evident in adolescents with caregivers that had less education and lower household income, as well as males. These disparities suggest a continued need for targeted interventions to promote engagement among adolescents with ASD to narrow this social disparity gap.
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Affiliation(s)
- Alexa C Budavari
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway HH798, Baltimore, MD, 21205, USA.
| | - Elise T Pas
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, Baltimore, MD, 21231, USA
| | - Gazi F Azad
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, Center for Autism and the Developing Brain, Weill Cornell Medicine, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Heather E Volk
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway HH798, Baltimore, MD, 21205, USA.,Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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40
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Taylor JL, Pezzimenti F, Burke MM, DaWalt LS, Lee CE, Rabideau C. Development, Feasibility, and Acceptability of a Nationally Relevant Parent Training to Improve Service Access During the Transition to Adulthood for Youth with ASD. J Autism Dev Disord 2021; 52:2388-2399. [PMID: 34232419 PMCID: PMC8262127 DOI: 10.1007/s10803-021-05128-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 11/24/2022]
Abstract
Many youth with autism spectrum disorder (ASD) face challenges accessing needed services as they transition to adulthood. The present study describes the development, feasibility and acceptability of a new intervention designed to teach parents of transition-aged youth with ASD about the adult service system and the most effective ways to access services and supports. As part of a randomized-controlled trial, the intervention—named ASSIST—was delivered to 91 participants in three states in the U.S. Results suggested that ASSIST is feasible and acceptable to participants. Though intended to be an in-person group-based program, due to COVID-19 restrictions ASSIST was primarily delivered online. Results and discussion explore the trade-offs and implications of these different treatment delivery modalities in relation to ASSIST.
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Affiliation(s)
- Julie Lounds Taylor
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA. .,Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, USA.
| | | | - Meghan M Burke
- Department of Special Education, University of Illinois Urbana-Champaign, Champaign, USA
| | | | - Chung Eun Lee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA
| | - Carol Rabideau
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, USA
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41
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Benevides TW, Carretta HJ, Rust G, Shea L. Racial and ethnic disparities in benefits eligibility and spending among adults on the autism spectrum: A cohort study using the Medicare Medicaid Linked Enrollees Analytic Data Source. PLoS One 2021; 16:e0251353. [PMID: 34032811 PMCID: PMC8148358 DOI: 10.1371/journal.pone.0251353] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/24/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Research on children and youth on the autism spectrum reveal racial and ethnic disparities in access to healthcare and utilization, but there is less research to understand how disparities persist as autistic adults age. We need to understand racial-ethnic inequities in obtaining eligibility for Medicare and/or Medicaid coverage, as well as inequities in spending for autistic enrollees under these public programs. METHODS We conducted a cross-sectional cohort study of U.S. publicly-insured adults on the autism spectrum using 2012 Medicare-Medicaid Linked Enrollee Analytic Data Source (n = 172,071). We evaluated differences in race-ethnicity by eligibility (Medicare-only, Medicaid-only, Dual-Eligible) and spending. FINDINGS The majority of white adults (49.87%) were full-dual eligible for both Medicare and Medicaid. In contrast, only 37.53% of Black, 34.65% Asian/Pacific Islander, and 35.94% of Hispanic beneficiaries were full-dual eligible for Medicare and Medicare, with most only eligible for state-funded Medicaid. Adjusted logistic models controlling for gender, intellectual disability status, costly chronic condition, rural status, county median income, and geographic region of residence revealed that Black beneficiaries were significantly less likely than white beneficiaries to be dual-eligible across all ages. Across these three beneficiary types, total spending exceeded $10 billion. Annual total expenditures median expenditures for full-dual and Medicaid-only eligible beneficiaries were higher among white beneficiaries as compared with Black beneficiaries. CONCLUSIONS Public health insurance in the U.S. including Medicare and Medicaid aim to reduce inequities in access to healthcare that might exist due to disability, income, or old age. In contrast to these ideals, our study reveals that racial-ethnic minority autistic adults who were eligible for public insurance across all U.S. states in 2012 experience disparities in eligibility for specific programs and spending. We call for further evaluation of system supports that promote clear pathways to disability and public health insurance among those with lifelong developmental disabilities.
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Affiliation(s)
- Teal W. Benevides
- Department of Occupational Therapy, College of Allied Health Sciences, Augusta University, Augusta, GA, United States of America
| | - Henry J. Carretta
- College of Medicine, Florida State University, Tallahassee, FL, United States of America
| | - George Rust
- College of Medicine, Florida State University, Tallahassee, FL, United States of America
| | - Lindsay Shea
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA, United States of America
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Taylor J, Avellone L, Cimera R, Brooke V, Lambert A, Iwanaga K. Cost-benefit analyses of employment services for individuals with intellectual and developmental disabilities: A scoping review. JOURNAL OF VOCATIONAL REHABILITATION 2021. [DOI: 10.3233/jvr-201130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Understanding the cost-benefit of vocational rehabilitation services is critical to improve competitive integrated employment outcomes for individuals with intellectual and developmental disabilities (IDD). OBJECTIVE: The purpose of this scoping review was to analyze and synthesize micro and macroeconomic analyses of various types of vocational services which promote the employment outcomes of individuals with IDD. METHODS: This scoping review searched peer-reviewed and grey literature sources published between 2000 and 2020, examining both micro and macroeconomic analyses. RESULTS: A total of 26 studies met inclusion criteria. The majority of studies reported positive effects for the cost-benefit of integrated service approaches such as supported and customized employment. Conversely, our findings show no cost-benefit for sheltered workshops, and in some cases, negative effects. CONCLUSION: Limitations to the included studies as well as implications and recommendations for practice, policy, and future research are discussed.
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Affiliation(s)
- Joshua Taylor
- Rehabilitation Research & Training Center, Virginia Commonwealth University, Richmond, VA, USA
- School of Education, Virginia Commonwealth University, Richmond, VA, USA
| | - Lauren Avellone
- Rehabilitation Research & Training Center, Virginia Commonwealth University, Richmond, VA, USA
- School of Education, Virginia Commonwealth University, Richmond, VA, USA
| | - Rob Cimera
- College of Education, Health, and Human Services, Kent State University, Kent, OH, USA
| | - Valerie Brooke
- Rehabilitation Research & Training Center, Virginia Commonwealth University, Richmond, VA, USA
- School of Education, Virginia Commonwealth University, Richmond, VA, USA
| | - Aliza Lambert
- Rehabilitation Research & Training Center, Virginia Commonwealth University, Richmond, VA, USA
- School of Education, Virginia Commonwealth University, Richmond, VA, USA
| | - Kanako Iwanaga
- College of Health Professions, Department of Rehabilitation Counseling, Virginia Commonwealth University, Richmond, VA, USA
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43
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Cheak-Zamora N, Farmer JG, Crossman MK, Malow BA, Mazurek MO, Kuhlthau K, Stobbe G, Loftin R, Mirza-Agrawal M, Tapia M, Hess A, Davis K, Sohl K. Provider Perspectives on the Extension for Community Healthcare Outcomes Autism: Transition to Adulthood Program. J Dev Behav Pediatr 2021; 42:91-100. [PMID: 33044397 DOI: 10.1097/dbp.0000000000000872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 08/01/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Despite their complex health care needs, transition-aged youth diagnosed with autism spectrum disorder (TAY-ASD) receive few transition services and describe difficulty finding adult providers. A 12-week primary care provider (PCP) training was developed to improve the delivery of transition services for TAY-ASD [Extension for Community Healthcare Outcomes (ECHO) Autism: Transition to Adulthood program]. The current study examines the PCPs' perspectives and experiences of the program and application of the training material. METHODS This study used a qualitative descriptive framework to explore the experiences and perspectives of 10 PCPs who completed the ECHO Autism: Transition to Adulthood program. Semistructured focus groups, conducted through Zoom videoconferencing, were used to explore these topics. RESULTS Three overarching categories were identified: (1) beneficial and influential aspects of the ECHO, (2) perceived challenges, and (3) suggestions for improvements and adjustments. Overall, participants found the program highly beneficial, describing an increased sense of community and comprehensive recommendations from a multidisciplinary team. Challenges included difficulties participating in the program during clinical hours and difficulties meeting the educational needs of participants with a wide range of previous experience caring for TAY-ASD. Recommendations included embedding the location-specific material into the program to account for regional differences and the use of an online platform for participants to ask questions and discuss issues outside of the regular sessions. CONCLUSION The study results can inform the development and implementation of new virtual PCP trainings and future ECHOs, including the revision and broad implementation of the ongoing ECHO Autism: Transition to Adulthood program.
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Affiliation(s)
| | - Justin G Farmer
- Department of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
- Harvard Medical School, Boston, MA
| | - Morgan K Crossman
- Building Bright Futures, Department of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Beth A Malow
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Micah O Mazurek
- Department of Human Services, University of Virginia, Charlottesville, VA
| | - Karen Kuhlthau
- Department of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Gary Stobbe
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Rachel Loftin
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mavara Mirza-Agrawal
- Department of Humanities, Health and Society, Embrace Initiative, Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Mark Tapia
- Department of Special Education, University of Texas at Austin, Austin, TX
| | - Amy Hess
- Child Development Center, Nationwide Children's Hospital, Columbus, OH
| | | | - Kristin Sohl
- Department of Child Health, University of Missouri, Columbia, MO
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44
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Wisner-Carlson R, Uram S, Flis T. The Transition to Adulthood for Young People with Autism Spectrum Disorder. Psychiatr Clin North Am 2020; 43:673-686. [PMID: 33127001 DOI: 10.1016/j.psc.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The transition to adulthood for individuals with autism spectrum disorder is difficult and outcomes are suboptimal. Social cognition deficits and executive dysfunction continue to be barriers to young people's success, lack of societal acceptance and loss of previous support can exacerbate the condition, and mental health issues increase. All areas of adult functioning are affected. To help manage the transition and improve outcomes for this population, psychiatrists and other health care providers need to be aware of the issues and possible interventions, including social skills training, educational transition programs, and supported employment programs.
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Affiliation(s)
- Robert Wisner-Carlson
- Neuropsychiatry Outpatient Program, Adult Developmental Neuropsychiatry Clinic, Adult Inpatient Intellectual Disability and Autism Unit, Sheppard Pratt Autism Registry, Ethics Committee, Sheppard Pratt Health System, 6501 North Charles Street, Baltimore, MD 21204, USA.
| | - Sara Uram
- Adult Developmental Neuropsychiatry Clinic, Sheppard Pratt Health System, 6501 North Charles Street, Baltimore, MD 21204, USA
| | - Thomas Flis
- Sheppard Pratt Health System, 6501 North Charles Street, Baltimore, MD 21204, USA
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45
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Jones DR, Nicolaidis C, Ellwood LJ, Garcia A, Johnson KR, Lopez K, Waisman TC. An Expert Discussion on Structural Racism in Autism Research and Practice. AUTISM IN ADULTHOOD 2020; 2:273-281. [PMID: 36600959 PMCID: PMC8992862 DOI: 10.1089/aut.2020.29015.drj] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Desiree R. Jones
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, Texas, USA
| | - Christina Nicolaidis
- Editor-in-Chief, Autism in Adulthood.,School of Social Work, Portland State University, Portland, Oregon, USA.,Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | | | | | - Khalilah R. Johnson
- Division of Occupational Science and Occupational Therapy, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Kristina Lopez
- School of Social Work, Arizona State University, Phoenix, Arizona, USA
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46
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Selvakumaran S, Thompson-Hodgetts S, Nicholas D, Fan L, Fang H, Di Rezze B. An Umbrella Review of the Impact of Environment on the Productive Lives of Individuals with Autism and Other Neurodevelopmental Disabilities. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2020. [DOI: 10.1007/s40474-020-00211-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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47
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Long KA, Gordillo M, Orsmond GI. Improving the Validity and Generalizability of Adult Autism Research Through Incorporating Family and Cultural Contexts. AUTISM IN ADULTHOOD 2020; 2:177-184. [PMID: 32959029 DOI: 10.1089/aut.2019.0061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The relatively nascent empirical knowledge base regarding autism in adulthood provides an opportunity to adopt a contextual approach that conceptualizes autism features, outcomes, and supportive services as interactions between the characteristics of the condition and contextual factors across the life course. Although a contextual approach encompasses many aspects of a person's identity and social ecology, we focus here on the closely interrelated family and cultural contexts, which have been poorly integrated into adult autism research. We argue that designing studies with a priori attention to context (e.g., family and culture) will improve the relevance and comprehensiveness of findings, which in turn will improve construct validity and provide a more accurate understanding of autism-related outcomes in adulthood. Similarly, designing and/or selecting measures that have been validated with culturally and linguistically diverse samples will improve the utility of findings and reduce spurious or null effects. More contextually informed methodologies will lead to improved generalizability and practical applications of findings. We offer concrete guidance regarding how to increase the social ecological perspective within adult autism research as it relates to study conceptualization, methodology, and measurement.
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Affiliation(s)
- Kristin A Long
- Department of Psychological & Brain Sciences and Boston University, Boston, Massachusetts, USA
| | - Monica Gordillo
- Department of Psychological & Brain Sciences and Boston University, Boston, Massachusetts, USA
| | - Gael I Orsmond
- Department of Occupational Therapy, Boston University, Boston, Massachusetts, USA
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48
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Teagarden DL, Morton ML, Janocko NJ, Groover O, Villarreal HK, Evans L, Drane DL, Karakis I. Socioeconomic disparities in patients with psychogenic nonepileptic seizures and their caregivers. Epilepsy Behav 2020; 110:107160. [PMID: 32493610 DOI: 10.1016/j.yebeh.2020.107160] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE There is no information on disparities of patients with psychogenic nonepileptic seizures (PNES) and their caregivers. The objective of this exploratory study is to compare patients with PNES and caregivers with low socioeconomic status (SES) with those of high SES for disparities in healthcare use, seizures, medication adverse effects, psychosocial impact, and knowledge about epilepsy. METHODS Patients with PNES and caregivers completed surveys about the aforementioned outcomes during their Epilepsy Monitoring Unit (EMU) admission. Associations were evaluated using SES as a binary independent variable and the patient- and caregiver-related outcomes as dependent variables. RESULTS Forty-three patients and 28 caregivers were recruited. The majority of patients were on average 36 years old, single women, unemployed, with some college education. The majority had PNES for 8 years averaging 20 seizures per month and were maintained on ≥2 antiepileptic drugs (AEDs) prior to their EMU admission. Most caregivers were first-degree relatives with a mean age of 43 years, married employed women of higher educational attainment, typically cohabitating with the patients. Low SES patients showed poorer knowledge about epilepsy (p < 0.0001) and higher anxiety levels (p = 0.03). Conversely, high SES patients demonstrated poorer social functioning (p = 0.04). High SES caregivers showed higher caregiving burden (p = 0.01). CONCLUSION There are noteworthy disparities in patients with PNES of different SES and their caregivers. Identification of those disparities is a critical step in the creation of appropriate interventions to address them.
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Affiliation(s)
- Diane L Teagarden
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew L Morton
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Nicholas J Janocko
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Olivia Groover
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Hannah K Villarreal
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Latasha Evans
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, University of Washington, Seattle, WA, USA
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
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Wisner-Carlson R, Uram S, Flis T. The Transition to Adulthood for Young People with Autism Spectrum Disorder. Child Adolesc Psychiatr Clin N Am 2020; 29:345-358. [PMID: 32169266 DOI: 10.1016/j.chc.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The transition to adulthood for individuals with autism spectrum disorder is difficult and outcomes are suboptimal. Social cognition deficits and executive dysfunction continue to be barriers to young people's success, lack of societal acceptance and loss of previous support can exacerbate the condition, and mental health issues increase. All areas of adult functioning are affected. To help manage the transition and improve outcomes for this population, psychiatrists and other health care providers need to be aware of the issues and possible interventions, including social skills training, educational transition programs, and supported employment programs.
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Affiliation(s)
- Robert Wisner-Carlson
- Neuropsychiatry Outpatient Program, Adult Developmental Neuropsychiatry Clinic, Adult Inpatient Intellectual Disability and Autism Unit, Sheppard Pratt Autism Registry, Ethics Committee, Sheppard Pratt Health System, 6501 North Charles Street, Baltimore, MD 21204, USA.
| | - Sara Uram
- Adult Developmental Neuropsychiatry Clinic, Sheppard Pratt Health System, 6501 North Charles Street, Baltimore, MD 21204, USA
| | - Thomas Flis
- Sheppard Pratt Health System, 6501 North Charles Street, Baltimore, MD 21204, USA
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50
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Dotson VM, Duarte A. The importance of diversity in cognitive neuroscience. Ann N Y Acad Sci 2020; 1464:181-191. [DOI: 10.1111/nyas.14268] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/17/2019] [Accepted: 10/16/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Vonetta M. Dotson
- Department of Psychology and the Gerontology InstituteGeorgia State University Atlanta Georgia
| | - Audrey Duarte
- Department of PsychologyGeorgia Institute of Technology Atlanta Georgia
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