The Transition to Adulthood for Young People with Autism Spectrum Disorder

A Patient-Centered Multidisciplinary Medical HOME for Persons With Intellectual and Developmental Disabilities

Innovative models of medical and psychiatric care are necessary to address the complex needs of individuals with intellectual and developmental disabilities (IDD), including autism. This article describes a subspecialty medical home program that has provided accessible, comprehensive, coordinated, patient- and family-centered care for this high-needs, underserved patient population. For more than two decades, the University of Utah Huntsman Mental Health Institute Neurobehavior HOME Program (HOME) has provided primary and behavioral health care for individuals with IDD across their lifespan. Program highlights include integrated medical and behavioral health, a unique funding structure, innovative care delivery, and case management. HOME is a clinical setting as well as a Medicaid managed care plan that has blended medical and psychiatric funding streams. This unique funding structure has demonstrated the fiscal sustainability of focusing care on preventive and proactive management of health concerns and responding to crises using a coordinated and comprehensive approach. Rethinking health care delivery and adopting models that are both financially sustainable and provide quality care to this vulnerable population is greatly needed.

Pilot study of a real-time early agitation capture technology (REACT) for children with intellectual and developmental disabilities

Objective

Children and adolescents with intellectual and developmental disabilities (IDD), particularly those with autism spectrum disorder, are at increased risk of challenging behaviors such as self-injury, aggression, elopement, and property destruction. To mitigate these challenges, it is crucial to focus on early signs of distress that may lead to these behaviors. These early signs might not be visible to the human eye but could be detected by predictive machine learning (ML) models that utilizes real-time sensing. Current behavioral assessment practices lack such proactive predictive models. This study developed and pilot-tested real-time early agitation capture technology (REACT), a real-time multimodal ML model to detect early signs of distress, termed "agitations." Integrating multimodal sensing, ML, and human expertise could make behavioral assessments for people with IDD safer and more efficient.

Methods

We leveraged wearable technology to collect behavioral and physiological data from three children with IDD aged 6 to 9 years. The effectiveness of the REACT system was measured using F1 score, assessing its usefulness at the time of agitation to 20s prior.

Results

The REACT system was able to detect agitations with an average F1 score of 78.69% at the time of agitation and 68.20% 20s prior.

Conclusion

The findings support the use of the REACT model for real-time, proactive detection of agitations in children with IDD. This approach not only improves the accuracy of detecting distress signals that are imperceptible to the human eye but also increases the window for timely intervention before behavioral escalation, thereby enhancing safety, well-being, and inclusion for this vulnerable population. We believe that such technological support system will enhance user autonomy, self-advocacy, and self-determination.

Improving adaptive behaviors for autistic adults without intellectual disability through executive function training

Executive functioning (EF) is a cognitive process used to perform various daily activities throughout one's lifespan. Autistic adults without intellectual disabilities (ID) also experience difficulties with EF, which is closely associated with adaptive behaviors. For this reason, it is important to improve adaptive behaviors through enhanced use of EF for autistic adults to transition into adulthood successfully. This study aims to conduct a randomized controlled trial to evaluate the effectiveness of a newly developed and modified intervention program. Thirty autistic adults without ID were randomly assigned to the treatment or waitlist group. The participants and caregivers completed various assessments and self-report questionnaires to measure everyday EF and adaptive behaviors. We performed linear mixed-effect modeling to compare the two groups. Data collected at pre-, middle, post-, and follow-up based on participants who completed the program were used to explore changes across time. While there were significant differences in the EF utility-scale (F=5.46, p = .027) between the treatment and waitlist groups, no group x time interactions were detected in other measures. Everyday EF and adaptive behaviors improved when comparing measurements at different time points (p < .001). Our program is Korea's first evidence-based intervention to improve everyday EF and adaptive behaviors for autistic adults without ID.

Stress and Anxiety Among Parents of Transition-Aged Children with Autism Spectrum Disorder: a Systematic Review of Interventions and Scales

The period between adolescence to young adulthood can be stressful for parents of transition-aged children (14 to 22 years old) with autism spectrum disorder. A systematic review was undertaken to examine if existing interventions address the unique parental stressors of this phase and if the scales used to measure parental stress and anxiety are suitable for this group. Of the 9813 studies screened, only 13 studies met the inclusion criteria. Findings indicated that interventions focused on mindfulness, social functioning, or multiple components, of which only two addressed the transition period and only three specifically targeted parents of this age group. Moreover, of the six scales which assessed stress or anxiety, none were designed for these parents. Findings highlight the urgent need for more suitable scales and targeted interventions.

Prevalence of epilepsy in autism spectrum disorders: A systematic review and meta-analysis

LAY ABSTRACT

Autistic individuals experience higher co-occurring medical conditions than the general population, and yet the estimates of autistic individuals with epilepsy are not updated. Co-occurrence of epilepsy in autistic individuals often aggravated cognitive impairment and increased the risk of poor long-term prognosis. Thus, an updated systematic review and meta-analysis was conducted to study the relevant articles published from inception to 2020, evaluate the prevalence of epilepsy in autistic individuals, and further explore the putative factors influencing the prevalence. A total of 66 studies from 53 articles were included in this study. The results showed that epilepsy is more common in autistic individuals than in the general population. The prevalence of epilepsy in autistic individuals in the clinical sample-based studies was higher than that in the population-based based cross-sectional or cohort studies. The prevalence of epilepsy in autistic adults was higher than that in autistic children. A significantly increased prevalence of epilepsy was detected in the autistic adolescent group (11-17 years old), and a higher trend of prevalence of epilepsy was observed in the autistic pre-school group (⩽ 6 -years-old) than that of the autistic school-aged group (7-10 years-old). The prevalence of epilepsy increased with age, female rate, and low intellectual function rate of autistic individuals. However, the human development index of countries was negatively associated with the pooled prevalence, which could be attributed to the different levels of awareness, diagnostic technologies, and autism-service support worldwide. About 1/10 autistic individuals also had epilepsy, which was common in the clinical setting, adolescents, adults, females, or patients with intellectual disability and less common in the country with high human development index. Thus, these findings provided critical and innovative views on the prevalence of epilepsy in autistic individuals and contributed to the targeted clinical management and preventive measures.

Reliability and validity of a novel caregiver-assessed skills system based on the ALSO conception in children with autism spectrum disorders

BACKGROUND

In responding to the potential challenges in the transition from childhood to adulthood for individuals with autism spectrum disorders (ASD) in China, a novel conception of "ALSO" was proposed to bridge the transitional needs and early intervention. To facilitate the application of ALSO in early intervention, ALSOLIFE skills assessment system (ALSOLIFE Assessment) was developed to enable caregivers to evaluate their children's skills guided by the ALSO conception. Given that the critical shortage of qualified professionals in China, many caregivers of children with ASD must function as home therapists. To address the practical needs of Chinese families of children with ASD, ALSOLIFE Assessment is designed as a free, online, technology-assisted, self-operated and behavioral intervention approaches supported system. The assessment report then further served as the basis for caregivers to deliver the tailored educational intervention to their children. Although ALSOLIFE Assessment provides caregivers a home-based intervention program, it is still unclear whether its evaluation is reliable and accurate. Therefore, we conduct this study to investigate the reliability and validity of the ALSOLIFE Assessment.

METHODS

A total of 1,050 children with ASD (1 to 10 years old) were recruited from 31 provinces of mainland China. Their caregivers participated simultaneously as ALSOLIFE Assessment evaluators. The testing results of Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) and Psychoeducational Profile-3 (PEP-3) were also collected for a portion of the child participants (VB-MAPP, N=34; PEP-3, N=31) to check criterion-related validity.

RESULTS

The reliability and validity of the ALSOLIFE Assessment satisfied psychometric requirements after the reduction from 511 to 464 items. Exploratory factor analysis (EFA) of ALSOLIFE Assessment scoring data yielded six factors, and confirmatory factor analysis (CFA) verified the best fitting construct model is a bifactorial model with one general factor and six group factors. Compared to the VB-MAPP and PEP-3, the ALSOLIFE Assessment exhibited good criterion-related validity across three levels: total scores, 6 skill domains, and 22 skill subdomains. The reliability tests indicated its strong internal consistency, test-retest reliability, and inter-rater reliability.

CONCLUSIONS

The reliability and validity of the revised ALSOLIFE Assessment (464-items) satisfied psychometric requirements. It is essential to develop validated and comprehensive evaluation tools, embedded on the needs of Chinese families of children with ASD.