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Angell AM, Lindly OJ, Floríndez D, Floríndez LI, Duker LIS, Zuckerman KE, Yin L, Solomon O. Pediatricians' role in healthcare for Latino autistic children: Shared decision-making versus "You've got to do everything on your own". AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:2407-2421. [PMID: 37070240 PMCID: PMC10579452 DOI: 10.1177/13623613231163056] [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: 04/19/2023]
Abstract
LAY ABSTRACT Latino parents may choose to use complementary health approaches, such as vitamins, supplements, and special diets, for their autistic children. However, they might not tell their pediatrician about their complementary health approach use if they worry that the pediatrician will disapprove or judge them. This fear, along with pediatricians' lack of autism knowledge, creates barriers to "shared decision-making" between parents and pediatricians. Shared decision-making is a process where families and healthcare providers collaborate and exchange information in order to come to an agreement about treatment options. In our qualitative study with 12 bilingual Latino families of autistic children, we interviewed and observed families to learn about their experiences with both conventional healthcare (their pediatrician) and complementary health approaches. Our study results describe the parents' different pathways to an autism assessment, a process that is sometimes called the "diagnostic odyssey." The parents reported that conventional healthcare met their needs for their child's physical health but not for their child's developmental challenges. The parents who used complementary health approaches for their autistic children were more frustrated about a lack of autism information from pediatricians than those who did not use complementary health approaches. Finally, we describe two examples of successful shared decision-making between parents and pediatricians. We conclude that pediatricians who are able to talk about complementary health approaches with Latino families may help to facilitate shared decision-making and reduce healthcare disparities for Latino autistic children.
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Affiliation(s)
- Amber M. Angell
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles CA
| | - Olivia J. Lindly
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ
| | | | - Lucía I. Floríndez
- Department of Nursing Research, Cedars Sinai Medical Center, Los Angeles CA
| | - Leah I. Stein Duker
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles CA
| | - Katharine E. Zuckerman
- Division of General Pediatrics and OHSU-PSU School of Public Health, Oregon Health & Science University, Portland OR
| | - Larry Yin
- Keck School of Medicine and Children’s Hospital Los Angeles, University of Southern California, Los Angeles CA
| | - Olga Solomon
- Department of Nursing Research, Cedars Sinai Medical Center, Los Angeles CA
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Abraham DA, Udayakumar N, Rajendran L, Rajendran R, Rajanandh MG. Herbal medicine as a first-line choice of complementary medicine for South Indian parents/caregivers in the management of ASD children. J Herb Med 2022. [DOI: 10.1016/j.hermed.2022.100583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Restricted Eating in Preschoolers with Autism: Mother Stressors and Solutions. J Autism Dev Disord 2021; 52:2589-2597. [PMID: 34189684 DOI: 10.1007/s10803-021-05078-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Abstract
Feeding interventions for children with Autism Spectrum Disorder (ASD) focus solely on the child, not the family milieu. This qualitative study aimed to understand mothers' perspectives on managing restricted eating among preschoolers with ASD. Focus groups were conducted with eleven mothers of preschoolers with ASD. Audio recordings were transcribed, and data analyzed for themes. Mothers experienced stressors balancing priorities of adequate nutrition with family mealtime demands and found solutions in support from other mothers, strategies from a wide array of sources, and resorting to trial and error to improve eating. Healthcare practitioners should explore and consider family stressors, competing demands, and coping skills when recommending mealtime interventions for optimal child and family well-being.
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Ann Abraham D, Narasimhan U, Christy S, Muhasaparur Ganesan R. Effect of L-Carnosine as adjunctive therapy in the management of children with autism spectrum disorder: a randomized controlled study. Amino Acids 2020; 52:1521-1528. [PMID: 33170378 DOI: 10.1007/s00726-020-02909-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/30/2020] [Indexed: 12/12/2022]
Abstract
L-Carnosine is an amino acid that acts as an anti-oxidant, anti-toxic and neuroprotective agent. There is a paucity of data about the effectiveness of L-Carnosine in the management of autism spectrum disorder (ASD) in children. This study aimed at investigating the effectiveness of L-Carnosine as adjunctive therapy in the management of ASD. This was a randomized controlled trial. Children aged 3-6 years with a diagnosis of mild to moderate ASD were assigned to standard care arm (occupational and speech therapy) and intervention care arm (L-Carnosine, 10-15 mg/kg in 2 divided doses) plus standard care treatment. The children were assessed at the baseline and the end of 2 months for the scores of Childhood Autism Rating Scale, Second Edition-Standard Version (CARS2-ST), Autism Treatment Evaluation Checklist (ATEC), BEARS sleep screening tool and 6-item Gastrointestinal Severity Index (6-GSI). Of the sixty-seven children enrolled, sixty-three children had completed the study. No statistically significant difference (p > 0.05) was observed for any of the outcome measures assessed. Supplementation of L-Carnosine did not improve the total score of CARS2-ST, ATEC, BEARS sleep screening tool and 6-GSI scores of children with ASD. Further investigations are needed with more objective assessments to critically validate the effectiveness of L-Carnosine on ASD children for more decisive results.
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Affiliation(s)
- Debi Ann Abraham
- Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, 600 116, India
| | - Udayakumar Narasimhan
- Department of Paediatric Medicine, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Senta Christy
- Karthikeyan Child Development Unit, Sri Ramachandra Medical Centre, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Rajanandh Muhasaparur Ganesan
- Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, 600 116, India.
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Narasimhan U, Rajendran R, Abraham DA, Rajendran L, Muhasaparur Ganesan R. Prevalence and Pattern of Complementary and Alternative Medicine for Autism Spectrum Disorder in Tamil Nadu. Indian J Pediatr 2020; 87:400. [PMID: 31897879 DOI: 10.1007/s12098-019-03142-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/21/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Udayakumar Narasimhan
- Department of Pediatrics, Sri Ramachandra Medical College and Research Institute, Deemed to be University, Porur, Chennai, Tamil Nadu, India
| | - Ramya Rajendran
- Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Deemed to be University, Porur, Chennai, Tamil Nadu, 600 116, India
| | - Debi Ann Abraham
- Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Deemed to be University, Porur, Chennai, Tamil Nadu, 600 116, India
| | - Lavanya Rajendran
- Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Deemed to be University, Porur, Chennai, Tamil Nadu, 600 116, India
| | - Rajanandh Muhasaparur Ganesan
- Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Deemed to be University, Porur, Chennai, Tamil Nadu, 600 116, India.
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Höfer J, Hoffmann F, Kamp-Becker I, Küpper C, Poustka L, Roepke S, Roessner V, Stroth S, Wolff N, Bachmann CJ. Complementary and alternative medicine use in adults with autism spectrum disorder in Germany: results from a multi-center survey. BMC Psychiatry 2019; 19:53. [PMID: 30709386 PMCID: PMC6359789 DOI: 10.1186/s12888-019-2043-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/28/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Complementary and Alternative Medicine (CAM) is widely used both in the general population and for the treatment of somatic and psychiatric disorders. Studies on CAM use among patients with autism spectrum disorder (ASD) have so far only focused on children and adolescents. The aim of this study was to investigate patterns of CAM use among adults with ASD. METHODS A questionnaire survey concerning current and lifetime use of CAM was distributed to adults with ASD between November 2015 and June 2016. Participants diagnosed by experienced clinicians using the current diagnostic gold standard were recruited from four ASD outpatient clinics in Germany. Questionnaire data was then linked to supplementary clinical data. RESULTS The final sample consisted of 192 adults (response: 26.8%) with a mean age of 31.5 years (80% male; diagnoses: Asperger's syndrome (58%), childhood autism (27%), atypical autism (12%)). 45% of the respondents stated that they were currently using or had used at least one CAM modality in their life. Among the participants with lifetime CAM use, almost half had used two or more different types of CAM. Alternative medical systems (e.g. homeopathy, acupuncture) were most frequently used, followed by mind-body interventions (e.g. yoga, biofeedback, animal assisted therapy). Overall, 20% of respondents stated that they would like to try at least one listed CAM modality in the future. CONCLUSIONS This is the first study on CAM use in adults with ASD, demonstrating considerable CAM use in this population. Given the popularity of CAM, patients should be informed about the effectiveness and potentially dangerous side effects of CAM treatments, as evidence for the majority of CAM methods in ASD is still limited.
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Affiliation(s)
- Juliana Höfer
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstraße 140, 26129 Oldenburg, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstraße 140, 26129 Oldenburg, Germany
| | - Inge Kamp-Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University Marburg, Hans-Sachs-Str. 4, 35039 Marburg, Germany
| | - Charlotte Küpper
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry, University Medical Center Göttingen, Von-Siebold-Str. 5, 37075 Göttingen, Germany
| | - Stefan Roepke
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Medical Faculty of the Technical University Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Sanna Stroth
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University Marburg, Hans-Sachs-Str. 4, 35039 Marburg, Germany
| | - Nicole Wolff
- Department of Child and Adolescent Psychiatry, Medical Faculty of the Technical University Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Christian J. Bachmann
- Department of Child and Adolescent Psychiatry, LVR-Klinikum Düsseldorf/ Heinrich-Heine University Düsseldorf, Bergische Landstr. 2, 40629 Düsseldorf, Germany
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Höfer J, Bachmann C, Kamp-Becker I, Poustka L, Roessner V, Stroth S, Wolff N, Hoffmann F. Willingness to try and lifetime use of complementary and alternative medicine in children and adolescents with autism spectrum disorder in Germany: A survey of parents. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 23:1865-1870. [DOI: 10.1177/1362361318823545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Regardless of their limited evidence and potential adverse effects, use of complementary and alternative medicine is common in children with autism spectrum disorder. Nevertheless, data on complementary and alternative medicine use in children with autism spectrum disorder in Germany are lacking. Therefore, a questionnaire survey on the use of complementary and alternative medicine was distributed to parents of children with autism spectrum disorder from three academic autism spectrum disorder outpatient clinics in Germany. Of 211 respondents, 46% stated that their child currently used or had ever used some form of complementary and alternative medicine in their life. The complementary and alternative medicine modalities most frequently used were manipulative and body-based methods (e.g. craniosacral therapy). And 18% of caregivers expressed willingness to try complementary and alternative medicine treatments for their child with autism spectrum disorder in the future, with mind–body interventions predominating. Health professionals should be aware of the considerable complementary and alternative medicine use prevalence among children with autism spectrum disorder and offer parents information about its effectiveness and potential side effects.
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Lindly O, Thorburn S, Zuckerman K. Use and Nondisclosure of Complementary Health Approaches Among US Children with Developmental Disabilities. J Dev Behav Pediatr 2018; 39:217-227. [PMID: 29570567 PMCID: PMC5868424 DOI: 10.1097/dbp.0000000000000536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Many US children use complementary health approaches (CHAs), including some modalities that may be ineffective, unsafe, and/or costly. Yet, little is known about the prevalence and correlates of CHA use among children with developmental disabilities (DDs), as well as parent nondisclosure of CHAs used for children with DDs to health care providers. We, therefore, aimed to profile the use and nondisclosure of CHAs among US children with DDs. METHODS We analyzed data from the 2012 National Health Interview Survey, which included the most recent Child Complementary and Alternative Medicine Supplement. The study sample was comprised of 2141 children with DDs aged 4 to 17 years. RESULTS Nearly one-quarter (23%) of US children with DDs used CHAs. Among those with a personal health provider, 42% of parents did not disclose some or all CHAs used to the child's provider. The adjusted odds ratios of using CHAs were greater among those with female sex, higher household income, residences not in the South, difficulty accessing care, or comorbid conditions. CHA was most commonly used because "it is natural." Nondisclosure was associated with female sex, older age, having no functional limitations, less conventional services use, and use of fewer CHAs. The most common reason for nondisclosure was that the child's provider did not ask. CONCLUSION Complementary health approach use is prevalent among US children with DDs, and nondisclosure is likely among those who use CHAs. Future intervention targeting education and communication about CHAs for parents of children with DDs and their health care providers may promote disclosure.
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Affiliation(s)
- Olivia Lindly
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, 125 Nashua Street, Boston, MA 02114
- Divison of General Pediatrics, Oregon Health & Science University, 707 SW Gaines Road, Portland, OR 97239
| | - Sheryl Thorburn
- School of Social and Behavioral Health Sciences, Oregon State University, 410 Waldo Hall, Corvallis, OR 97331
| | - Katharine Zuckerman
- Divison of General Pediatrics, Oregon Health & Science University, 707 SW Gaines Road, Portland, OR 97239
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