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Stein Elger R, Chowdhury SK, Pacheco Garrillo M, Sauls R, Sundaramurugan S, Rozen E, Puri H, Brice DJ, Liu J, Bakour C, Kirby RS. The Role of Adverse Childhood Experience in the Relationship Between Autism Severity and Early Intervention and Special Education Plan. J Autism Dev Disord 2024:10.1007/s10803-024-06444-w. [PMID: 38951310 DOI: 10.1007/s10803-024-06444-w] [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: 06/18/2024] [Indexed: 07/03/2024]
Abstract
The purpose of this study is to examine the association between autism spectrum disorder (ASD) severity and having a special education or early intervention plan and the impact of adverse childhood experiences (ACEs) on this association. This study used the 2020-2021 National Survey of Children's Health (NSCH) and included 2,537 children aged 3-17 years old who currently have ASD. Multivariable logistic regression, controlling for demographic and family characteristics and health status, was used to explore the association between autism severity and having an early intervention plan. The analysis was stratified by the number of ACEs to explore their role in the association. Children with moderate or severe ASD were more likely to have a special education or early intervention plan than those with mild ASD in the crude and adjusted models. This association continued to be true for children who experienced 1 ACE (aOR: 2.28, 95%CI: 1.09-4.77) but not true for those who experienced no ACEs (aOR: 1.16, 95%CI: 0.70-1.94) and 2 or more ACEs (aOR: 1.84, 95%CI: 0.92-3.69). Results demonstrate that children with moderate or severe autism were more likely to receive early intervention or special education. This association changed depending on the number of ACEs experiences.
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Affiliation(s)
- Rafaella Stein Elger
- College of Public Health, Chiles Center, - Affiliated to the University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612, USA.
| | - Suman Kanti Chowdhury
- College of Public Health, Chiles Center, - Affiliated to the University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612, USA
| | - Maria Pacheco Garrillo
- College of Public Health, Affiliated to the Ohio State University, 250 Cunz Hall, 1841 Neil Ave. Columbus, Columbus, OH, 43210, USA
| | - Rachel Sauls
- College of Public Health, Chiles Center, - Affiliated to the University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612, USA
| | - Suruthi Sundaramurugan
- College of Public Health, Chiles Center, - Affiliated to the University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612, USA
| | - Emily Rozen
- College of Public Health, Chiles Center, - Affiliated to the University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612, USA
| | - Harsha Puri
- College of Public Health, Chiles Center, - Affiliated to the University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612, USA
| | - Dowensly Jean Brice
- College of Public Health, Chiles Center, - Affiliated to the University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612, USA
| | - Jing Liu
- College of Public Health, Chiles Center, - Affiliated to the University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612, USA
| | - Chighaf Bakour
- College of Public Health, Chiles Center, - Affiliated to the University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612, USA
| | - Russell S Kirby
- College of Public Health, Chiles Center, - Affiliated to the University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612, USA
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Campisi C, Pham D, Rapoport E, Adesman A. Parenting Stress, Community Support, and Unmet Health Care Needs of Children in the US. Matern Child Health J 2024; 28:1010-1019. [PMID: 38353888 DOI: 10.1007/s10995-024-03912-8] [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: 11/02/2023] [Indexed: 05/01/2024]
Abstract
OBJECTIVES In 2018, approximately 2.3 million children in the United States had unmet healthcare needs (UHCN). To date, studies examining associations between UHCN and parent stress and support have had limited generalizability. This study aimed to investigate the relationship between children's UHCN and parenting stress and support using a nationally representative sample. Additionally, this study aimed to assess associations between unmet mental health needs and these parental well-being measures. METHODS Households with children ages 0-17 and complete data on UHCN in the combined 2016, 2017, 2018, and 2019 cohorts of the National Survey of Children's Health (NSCH) met inclusion criteria. Logistic regressions were used to evaluate associations between overall UHCN and outcome measures of parental coping, aggravation, emotional support, and neighborhood support. Associations between mental UHCN and these outcome measures were analyzed in a subset limited to children with mental health conditions. Regressions were adjusted for potential confounders, including demographics, household income, medical home status, and health insurance (adequacy/type). RESULTS In our sample of 131,299 children, overall UHCN were associated with poorer parental coping (aOR = 5.35, 95% CI: [3.60, 7.95]), greater parental aggravation (aOR = 3.35, 95% CI: [2.73, 4.12]), and non-supportive neighborhood (aOR = 2.22, 95% CI: [1.86, 2.65]). Mental UHCN were similarly associated with parental coping and aggravation and neighborhood support in the mental health subset. CONCLUSIONS FOR PRACTICE Healthcare professionals must address the needs of children with UHCN and collaborate with community organizations and child advocates to promote coordinated and comprehensive care and adequately support caregivers.
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Affiliation(s)
- Christine Campisi
- Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, NY, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Duy Pham
- Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, NY, USA
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Eli Rapoport
- Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, NY, USA
- Department of Urology, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Andrew Adesman
- Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, NY, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Division of Developmental and Behavioral Pediatrics, 1983 Marcus Avenue, Lake Success, NY, USA.
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Mehra S, Salinas-Miranda AA, Buro AW, Marshall J, Kirby RS. The role of adverse childhood experiences in obesity among adolescents with autism spectrum disorder: National survey of Children's health 2018-2019. Disabil Health J 2024; 17:101550. [PMID: 37968201 DOI: 10.1016/j.dhjo.2023.101550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Adolescents with autism spectrum disorder (ASD) are at an increased risk of overweight/obesity and adverse childhood experiences (ACEs). OBJECTIVE This study examined whether ACEs increased the odds of overweight/obesity in adolescents with ASD. METHODS This cross-sectional study used National Survey of Children's Health (NSCH) 2018-2019 data (N = 31,533 children ages 10-17 years, including n = 480 children with mild ASD and n = 423 children with moderate/severe ASD with normal or overweight/obese BMI). Parent-reported body mass index (BMI) was coded as overweight/obesity vs. normal weight. The independent variable was the count of nine ACEs. Binary logistic regression was conducted, controlling for social ecological factors. RESULTS The odds of overweight/obesity in adolescents with ASD with 1-2 ACEs (OR 1.3, CI 1.1-1.4) and 3+ ACEs (OR 1.6, CI 1.3-2.0) were higher than those with 0 ACEs; odds increased with higher counts of ACEs. Household income level was the most significant sociodemographic influence on odds of obesity in adolescents with ASD (0-99 % Federal Poverty Level: OR 1.9, CI 1.6-2.3). Adolescents with moderate/severe ASD (OR 1.7, CI 1.2-2.5) and mild ASD (OR 1.6, CI 1.0-2.4) had higher odds of overweight/obesity after accounting for ACEs, race/ethnicity, sex, household income, and physical activity. CONCLUSION Findings indicated ACEs are associated with ASD, which calls for integration of ACEs information within trauma-informed care practices for obesity prevention and intervention for adolescents with ASD. Persistent disparities of overweight/obesity exist by race/ethnicity, sex, and household income within this population, which indicates the need for tailoring trauma-informed approaches to the unique needs of this population.
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Affiliation(s)
- Saloni Mehra
- University of South Florida, College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, United States.
| | - Abraham A Salinas-Miranda
- University of South Florida, College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, United States.
| | - Acadia W Buro
- University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, United States.
| | - Jennifer Marshall
- University of South Florida, College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, United States.
| | - Russell S Kirby
- University of South Florida, College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, United States.
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Barreca J, Swiggum M. Trauma-Informed Care in Pediatric Physical Therapy as a Standard Precaution: The Time Is Here. Pediatr Phys Ther 2024; 36:278-284. [PMID: 38568276 DOI: 10.1097/pep.0000000000001095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
In this special communication, an overview of the research on trauma, resilience, and action items for the pediatric physical therapist (PT) is addressed. The experiences of early childhood, positive and negative, impact overall development and well-being throughout the lifespan. Childhood trauma can include exposure to abuse, neglect, violence, racism, or medical procedures. These adverse childhood experiences are associated with poor physical and mental health outcomes that can extend into adulthood and can appear in the pediatric rehabilitative realm as caregivers who become labeled noncompliant. Trauma is common and impacts all children; however, some populations, such as children with disabilities, have greater risk for experiencing adversity. An individual's trauma history is not always visible, necessitating a standard approach. Pediatric PTs must take an intentional approach to address the detrimental effects of trauma on those we serve. Many organizations recommend adopting trauma-informed care as the standard of care for all populations.
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Affiliation(s)
- Jessica Barreca
- Center for Interprofessional Education and Research (Dr Barreca), Saint Louis University, Saint Louis, Missouri; Doctor of Physical Therapy Program (Dr Swiggum), Wingate University, Wingate, North Carolina
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Bortoletto R, Bassani L, Garzitto M, Lamberti M, Simonati A, Darra F, Bhattacharyya S, Comacchio C, Balestrieri M, Arcangeli D, Colizzi M. Risk of psychosis in autism spectrum disorder individuals exposed to psychosocial stressors: A 9-year chart review study. Autism Res 2023; 16:2139-2149. [PMID: 37929657 DOI: 10.1002/aur.3042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023]
Abstract
Psychosocial stressors have been suggested to precipitate psychotic episodes in patients with pre-existing psychosis and otherwise healthy subjects. However, such a risk has never been formally investigated in individuals with autism spectrum disorder (ASD). Sixty-nine autistic adolescents hospitalized for psychotic/manic symptoms (PSY) and other mental health issues (NPSY) over a 9-year period were compared with reference to their previous exposure to psychosocial stressors. ASD diagnoses satisfied the International Classification of Diseases (ICD)-10 criteria. Psychotic/manic symptom assessment followed the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Psychosocial stressor exposure was collected separately at each admission. Preliminarily, univariate between-group comparisons were conducted. Then, a binomial model was adopted to investigate associations with previous exposure to psychosocial stressors. Results were reported with a change in AIC (ΔAIC). PSY patients presented with higher previous exposure to adverse life events (30.43% vs. 6.52%, OR = 6.079 [1.209, 40.926], p = 0.013) and school/work difficulties (30.43% vs. 8.70%, OR = 4.478 [0.984, 23.846], p = 0.034) than NPSY ones. Admissions for psychotic/manic symptoms occurred more likely in the context of family disturbances (OR = 2.275 [1.045, 5.045], p = 0.030) and adverse life events (OR = 3.489 [1.194, 11.161], p = 0.014). The fitted binomial model was found to be significant compared to the random effects model (ΔAIC = -1.962; χ2 10 = 21.96, p = 0.015), with the risk of presenting psychotic/manic symptoms being increased by family disturbances (z = +4.118) and school/work difficulties (z = +2.455). The results suggest a potential psychosis-inducing effect of psychosocial stressors in ASD, which has clinical and policy implications.
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Affiliation(s)
- Riccardo Bortoletto
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Lorenzo Bassani
- Department of Child and Adolescent Psychiatry, Hospital of Merano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medizinischen Privatuniversität (PMU), Merano-Meran, Italy
| | - Marco Garzitto
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Marco Lamberti
- Department of Child and Adolescent Psychiatry, Hospital of Merano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medizinischen Privatuniversität (PMU), Merano-Meran, Italy
| | - Alessandro Simonati
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Francesca Darra
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Carla Comacchio
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Matteo Balestrieri
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Donatella Arcangeli
- Department of Child and Adolescent Psychiatry, Hospital of Merano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medizinischen Privatuniversität (PMU), Merano-Meran, Italy
| | - Marco Colizzi
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Hughes PM, Graaf G, deJong NA, Thomas KC. Emotional Support Among Parents of Children With Adverse Childhood Experiences. J Pediatr Health Care 2023; 37:557-565. [PMID: 37245128 PMCID: PMC10524602 DOI: 10.1016/j.pedhc.2023.05.003] [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] [Received: 04/05/2023] [Accepted: 05/10/2023] [Indexed: 05/29/2023]
Abstract
INTRODUCTION We assess the association between a child's exposure to adverse childhood experiences (ACEs) and the parent's current experiences of emotional support. METHOD This study used pooled cross-sectional data from the National Survey of Children's Health (N = 129,988). Emotional support for the parent was classified by the presence (any emotional support, no emotional support) and type (any formal support or only informal support). All models were adjusted for relevant predisposing, enabling, and need factors. RESULTS Having two or more ACEs was associated with a higher probability of any emotional support (average marginal effect = 0.017; 95% confidence interval = 0.002-0.032) and a higher probability of formal support (average marginal effect = 0.049; 95% confidence interval = 0.028-0.069). Several individual ACEs were associated with the presence and type of emotional support. DISCUSSION Parents of children with higher ACEs are likelier to have emotional support, especially formal support.
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Affiliation(s)
- Phillip M. Hughes
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy
- Division of Research, UNC Health Sciences at MAHEC, Asheville, NC
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
| | - Genevive Graaf
- School of Social Work, University of Texas at Arlington, Arlington, TX
| | - Neal A. deJong
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Kathleen C. Thomas
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
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Testa A, Jackson DB, Vaughn MG, Ganson KT, Nagata JM. Adverse Childhood Experiences, health insurance status, and health care utilization in middle adulthood. Soc Sci Med 2022; 314:115194. [PMID: 36283330 DOI: 10.1016/j.socscimed.2022.115194] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/05/2022] [Accepted: 07/01/2022] [Indexed: 01/26/2023]
Abstract
RATIONALE Adverse childhood experiences (ACEs) negatively impact health over the life-course. Yet, compared to the robust literature on the consequences for ACEs for health, substantially fewer studies assess the implications of exposure to ACEs for health insurance status and health care utilization in adulthood. OBJECTIVE To assess the association between accumulating ACEs and (1) an individual's health insurance status, and (2) usual source of care, as well as examine the mediating role of adult socioeconomic status. METHODS Data are from the National Longitudinal Study of Adolescent to Adult Health (N = 8,757). Multinomial logistic regression is used to assess the relationship between ACEs and health insurance status and the usual source of care. RESULTS Net of control and mediating variables, accumulating exposure to ACEs -particularly four or more ACEs- is associated with a higher likelihood of being uninsured and utilizing the emergency room as the usual source of care. Adult socioeconomic status including educational attainment, household income, employment status, and being uninsured-in the case of usual source of care-substantially mediates these associations. CONCLUSION ACEs carry negative repercussions for health insurance and patterns of healthcare utilization that spans into adulthood, and this is largely driven by poor adult socioeconomic status.
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Affiliation(s)
- Alexander Testa
- Department of Management, Policy and Community Health University of Texas Health Science Center at Houston, USA.
| | - Dylan B Jackson
- Johns Hopkins Bloomberg School of Public Health Johns Hopkins University, USA
| | - Michael G Vaughn
- College for Public Health and Social Justice Saint Louis University, USA
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work University of Toronto, Canada
| | - Jason M Nagata
- Department of Pediatrics University of California, San Francisco, USA
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Alcalá HE, Ng AE, Tkach N, Salam Z. Adverse Childhood Experiences and Utilization and forgoing of Health Care among Children: A Nationally Representative Study in the United States. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2108812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Héctor E. Alcalá
- Health Science Tower, Stony Brook University, Stony Brook, NY, USA
| | - Amanda E. Ng
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, College Park, MD, USA
| | | | - Zoha Salam
- Department of Global Health, McMaster University, Hamilton, Ontario, Canada
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Andrzejewski T, DeLucia EA, Semones O, Khan S, McDonnell CG. Adverse Childhood Experiences in Autistic Children and Their Caregivers: Examining Intergenerational Continuity. J Autism Dev Disord 2022:10.1007/s10803-022-05551-w. [PMID: 35412212 DOI: 10.1007/s10803-022-05551-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/25/2022]
Abstract
Although there is an urgent need to develop trauma-informed services for autistic youth, little research has evaluated adverse childhood experiences (ACEs) in autistic youth from an intergenerational perspective. 242 caregivers of autistic (n = 117) and non-autistic (n = 125) youth reported on ACEs that they experienced in their own childhoods and ACEs experienced by their children, as well as measures of depression, stress, and child autistic traits and behavioral concerns. Autistic youth and their caregivers both experienced significantly higher rates of ACEs than the non-autistic dyads. Intergenerational continuity, the association between caregiver and child ACEs, was significantly stronger for autistic youth. ACEs showed differential patterns of associations with parent depressive symptoms and child autistic traits across groups.
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Affiliation(s)
- Theresa Andrzejewski
- Department of Psychology, University of Wyoming, 1000 E. University Ave., Dept. 3415, Laramie, WY, 82071, USA.
| | - Elizabeth A DeLucia
- Department of Psychology, Virginia Polytechnic Institute and State University, 109 Williams Hall, Blacksburg, VA, USA
| | - Olivia Semones
- Department of Psychology, Virginia Polytechnic Institute and State University, 109 Williams Hall, Blacksburg, VA, USA
| | - Sanaa Khan
- Department of Psychology, Virginia Polytechnic Institute and State University, 109 Williams Hall, Blacksburg, VA, USA
| | - Christina G McDonnell
- Department of Psychology, University of Wyoming, 1000 E. University Ave., Dept. 3415, Laramie, WY, 82071, USA
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Robinson LA, Gaugh L, Yapo S, Al-Sumairi R, Lorenzo A, Weiss M. Defragmenting the path to diagnosis for underserved youth with Autism Spectrum Disorder in a community-based health system. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2022; 10:100597. [PMID: 35144168 DOI: 10.1016/j.hjdsi.2021.100597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/15/2021] [Accepted: 11/21/2021] [Indexed: 11/29/2022]
Abstract
Autism Spectrum Disorder (ASD) is a pervasive neurodevelopmental disorder that affects about 1 out of every 54 youth and is characterized by impairments in social communication and functioning. ASD is a treatable condition though, and early initiation of interventions in the home and community can lead to improved long-term outcomes. Despite the clear benefits of early diagnosis and intervention, many youth, particularly from impoverished and minoritized populations, face tremendous barriers to accessing a timely formal diagnosis and critical early supports. Many of these barriers are inherent features of a fragmented health care system that even the most resourced of families struggle to navigate. Informed by the principles of coproduction of health care, value-based care design, and health equity, we present a quality improvement initiative to defragment the experience of care for underserved families seeking a timely formal diagnosis of ASD in a safety-net community-based health system. Over the course of 2.5 years, we were able to partner with families to create clinical workflows that cut in half the duration of time from first developmental concern to ASD diagnosis, and lowered the median age of ASD diagnosis in our health system by more than 3 years. We share our process and lessons learned in the hopes of helping other health systems pursuing similar goals for patient- and family-centered care design.
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Affiliation(s)
- Lee A Robinson
- Cambridge Health Alliance, 1493 Cambridge St, Cambridge, MA, 02139, USA.
| | - Laura Gaugh
- Cambridge Health Alliance, 1493 Cambridge St, Cambridge, MA, 02139, USA
| | - Scott Yapo
- Cambridge Health Alliance, 1493 Cambridge St, Cambridge, MA, 02139, USA
| | - Rami Al-Sumairi
- Cambridge Health Alliance, 1493 Cambridge St, Cambridge, MA, 02139, USA
| | - Aileen Lorenzo
- Cambridge Health Alliance, 1493 Cambridge St, Cambridge, MA, 02139, USA
| | - Margaret Weiss
- Cambridge Health Alliance, 1493 Cambridge St, Cambridge, MA, 02139, USA
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McDonnell CG, Andrzejewski T, Dike J. Intergenerational trauma: Parental PTSD and parent-reported child abuse subtypes differentially relate to admission characteristics in the autism inpatient collection. Autism Res 2022; 15:665-676. [PMID: 35018722 DOI: 10.1002/aur.2669] [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: 08/02/2021] [Revised: 11/19/2021] [Accepted: 12/24/2021] [Indexed: 11/11/2022]
Abstract
Autistic youth experience high rates of maltreatment. Little research has considered how distinct abuse dimensions differentially relate to meaningful outcomes, nor taken an intergenerational approach to consider how caregiver trauma and child maltreatment are related. This study sought to identify how parent-reported child abuse subtypes and parent posttraumatic stress disorder (PTSD) relate to each other and to admission characteristics upon inpatient service entry. Autistic youth (N = 527; 79% White, 21.3% girls, mean age = 12.94 years) participated in the autism inpatient collection. Parents reported on child abuse subtypes (physical, sexual, emotional) and their own PTSD, child behavior and emergency services, and parenting stress. Youth of parents with PTSD were nearly three times more likely to have parent-reported physical and emotional abuse. Autistic girls were more likely to experience parent-reported sexual abuse and a higher number of subtypes. Lower income related to higher rates of parent-reported child emotional abuse and parent PTSD. Emotional abuse associated with child behavior whereas both child physical and emotional abuse related to emergency services. Reported parent PTSD associated with child behavior and parental distress. When considered jointly, parent PTSD and number of parent-reported child abuse subtypes differentially related to child behavior and interacted to predict psychiatric hospitalizations. Intergenerational continuity of trauma is important to consider among autistic youth, and both parent-reported child abuse and parent PTSD relate to admission characteristics. Critical limitations include reliance on binary parent reports of child abuse and parent PTSD and the low representation of youth of minoritized identities. Implications for trauma-informed care are discussed.
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Affiliation(s)
| | | | - Janey Dike
- Department of Psychology, Virginia Tech, Blacksburg, Virginia, USA
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Mutluer T, Aslan Genç H, Özcan Morey A, Yapici Eser H, Ertinmaz B, Can M, Munir K. Population-Based Psychiatric Comorbidity in Children and Adolescents With Autism Spectrum Disorder: A Meta-Analysis. Front Psychiatry 2022; 13:856208. [PMID: 35693977 PMCID: PMC9186340 DOI: 10.3389/fpsyt.2022.856208] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/29/2022] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED Psychiatric comorbidity in autism spectrum disorder (ASD) is a subject of critical scientific importance, affecting the quality of life, prognosis, and functional outcomes. The prevalence of psychiatric disorders vary considerably according to variables such as index subject characteristics, study setting, sampling frame, diagnostic methods used, as well as country of geographic origin. To date, most studies comprise clinical or treatment referral samples in tertiary care or subjects enrolled in clinical trials and genetic cohort collections. Such samples carry the potential for overestimation of both the frequency and severity of psychiatric comorbidity. A systematic literature search was performed using PubMed and Web of Science databases restricted to population-based study publications in the English between May 1, 2015, and May 31, 2020. A comprehensive keyword list was generated to investigate co-occurrence of psychiatric disorders in children and adolescents with ASD. A wide range of DSM-5 based disorders such as anxiety, mood, ADHD, intellectual disability/intellectual developmental disorder, eating/feeding, gender dysphoria and sleep-wake disorders were assessed. Initial search revealed a total of 1674 articles after removal of duplicates. Two independent researchers conducted a parallel-blinded screening process to identify the eligible studies based on titles and abstracts; 39 studies were analyzed in the current review. The main findings show prevalence estimates of 22.9% (95% CI: 17.7- 29.2) for intellectual disability; 26.2% (22-31) for attention-deficit hyperactivity disorder; 11.1% (8.6-14.1) for anxiety disorders; 19.7% (11.9-30.7) for sleep disorders; 7% (5.2- 9.3) for disruptive disorders; 2% (1.3- 3.1) for bipolar disorders; 2.7% (1.8- 4.2) for depression; 1.8% (0.4-8.7) for obsessive-compulsive disorder; and 0.6% (0.3-1.1) for psychosis. Psychiatric comorbidity in population-based studies is lower than in clinical and referred samples. However, our results also indicate that the frequency of psychiatric comorbidity in children and adolescents with ASD in the population context is considerable, without the influence of referral bias implicit in clinical and treatment samples. There is a need for better targeted diagnostic tools to detect psychiatric comorbidity in children and youth in future population-based studies, as an essential component in providing care as well as new insights into the nature and mechanisms of its underlying associations. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021234464].
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Affiliation(s)
- Tuba Mutluer
- Department of Psychiatry, School of Medicine, Koç University, Istanbul, Turkey.,Research Center for Translational Medicine (KUTTAM), Koç University, Istanbul, Turkey
| | - Herdem Aslan Genç
- Division of Child and Adolescent Psychiatry, Koç University Hospital, Istanbul, Turkey
| | - Aslihan Özcan Morey
- Division of Child and Adolescent Psychiatry, Koç University Hospital, Istanbul, Turkey
| | - Hale Yapici Eser
- Department of Psychiatry, School of Medicine, Koç University, Istanbul, Turkey.,Research Center for Translational Medicine (KUTTAM), Koç University, Istanbul, Turkey
| | | | - Merve Can
- Department of Child and Adolescent Psychiatry, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Mental Health and Nervous Disorders, Istanbul, Turkey
| | - Kerim Munir
- Developmental Medicine Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
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13
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Anyigbo C, Tarini BA, Wang J, Lanier P. Clusters of adverse childhood experiences and unmet need for care coordination. CHILD ABUSE & NEGLECT 2021; 122:105334. [PMID: 34571356 PMCID: PMC8612971 DOI: 10.1016/j.chiabu.2021.105334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 08/04/2021] [Accepted: 09/14/2021] [Indexed: 06/01/2023]
Abstract
BACKGROUND The lack of consensus on how to measure ACEs limits our estimation of their impact on health outcomes and understanding of which ACE clusters drive unmet care coordination (CC) needs. OBJECTIVES 1) Identify latent classes of ACEs among a representative group of U.S. children; 2) Examine the association between these classes and unmet needs for CC. PARTICIPANT AND SETTING Using the 2016-2017 National Survey of Children's Health, we sampled children ages 0-17 the who had seen >1 healthcare provider within 12 months (n = 38,758). METHODS We conducted latent class analyses and weighted logistic regression analyses to examine associations between latent classes and unmet need for CC. RESULTS We identified seven distinct classes: household poverty and parental divorce, household poverty and parental death, household poverty only, household substance abuse and witnessing violence, multiple ACEs, household poverty and child discrimination, and household poverty and household mental illness. Children in the following classes had the greatest odds of unmet need for CC: household poverty only (AOR 2.0; 95% CI, 1.42-2.84), household poverty and household mental illness (AOR 1.67; 95% CI, 1.15-2.44), multiple ACEs (AOR 2.31; 95% CI, 1.53-3.50), and household poverty and child discrimination (AOR 3.55; 95% CI, 1.71-7.37). CONCLUSIONS Children who experienced specific combinations of ACEs, have an increased risk of unmet need for CC, with those experiencing both poverty and discrimination having the highest odds of unmet need for CC. Discrimination widens the gap of unmet CC need for poor children.
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Affiliation(s)
- Chidiogo Anyigbo
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Division of General Pediatrics and Community Health, Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010, United States of America.
| | - Beth A Tarini
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Children's National Research Institute, Children's National Hospital, 1 Inventa Place Silver Spring, MD 20910, United States of America.
| | - Jichuan Wang
- Center for Translational Science, Children's Research Institute, 1 Inventa Place Silver Spring, MD 20910, United States of America.
| | - Paul Lanier
- School of Social Work, The University of North Carolina at Chapel Hill, Tate-Turner-Kuralt Building 548-K, 325 Pittsboro Street, Chapel Hill, NC 27599, United States of America.
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14
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Kenney MK, Chanlongbutra A, Fanflick PL, Ferrero A, Kim S, Novoa C. Systems of care among children and youth with special health care needs with and without adverse childhood events: National Survey of Children's Health 2016-2017. Disabil Health J 2021; 15:101226. [PMID: 34772650 DOI: 10.1016/j.dhjo.2021.101226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Knowledge of adverse childhood events (ACEs), the associated access to healthcare and unmet needs among children and youth with special health care needs (CYSHCN) is limited. OBJECTIVES Our objectives were to compare the likelihood of CYSHCN versus non-CYSHCN experiencing one or more ACEs and document differences in receipt of recommended and needed health care among CYSHCN with and without ACEs. METHODS We combined two years of data from the 2016 and 2017 National Survey of Children's Health (N = 71,181), providing a sample of 16,304 CYSHCN. Our primary outcome measures included eight adverse childhood events, compared to singular and aggregated ACEs among non-CYSHCN. We calculated associations between ACEs and secondary outcome measures for six components of well-functioning systems of care and unmet need for different types of health care using bivariate and multivariate analyses. RESULTS CYSHCN were more likely to have each of the ACEs measured and were likelier to experience aggregated levels of ACEs compared to non-CYSHCN. The likelihood of CYSHCN having a medical home with family-centered and coordinated care decreased with increased ACEs, while one or more ACES increased the likelihood of having unmet needs for mental health care. CONCLUSION The findings of the current study extend our understanding of the additional adverse event burden associated with special health care needs status, the accompanying limitations in access to family-centered and coordinated care in a medical home and unmet need for mental health care, indicating that much work remains in establishing appropriate care systems for this very vulnerable population.
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Affiliation(s)
- Mary Kay Kenney
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD, 20857, USA.
| | - Amy Chanlongbutra
- U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Office of Extramural Research, Education and Priority Populations, Rockville, MD, 20857, USA.
| | - Patricia L Fanflick
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD, 20857, USA.
| | - Ann Ferrero
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD, 20857, USA.
| | - Soohyun Kim
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD, 20857, USA.
| | - Cristina Novoa
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD, 20857, USA.
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15
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Morgart K, Harrison JN, Hoon AH, Wilms Floet AM. Adverse childhood experiences and developmental disabilities: risks, resiliency, and policy. Dev Med Child Neurol 2021; 63:1149-1154. [PMID: 33938573 DOI: 10.1111/dmcn.14911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 01/11/2023]
Abstract
Thanks to the seminal work of Robert Anda and Vincent Felitti, it is now widely accepted that adverse childhood experiences (ACEs) can have lifelong effects on physical, behavioral, and mental health and that many adult diseases can be considered developmental disorders that began early in life. Genomics has advanced the neurobiological understanding that underpins ACEs, wellness, and disease, which are modulated through stress pathways and epigenetic modifications. While data are currently limited, children with developmental disabilities have an increased ACE risk compared to typically developing peers. This recognition has important ramifications for health and policy interventions that address the root causes of ACEs, especially in this vulnerable population. With increased societal recognition, advances in policy will lead to medical, financial, and public benefits in years to come, hopefully changing healthcare models from 'sick care' to 'well care'. What this paper adds Adverse childhood experience (ACE) research has refocused medicine from the question 'What is wrong with you?' to 'What happened to you?'. Adopting ACE research into public policy can redirect healthcare models from providing 'sick care' to promoting 'well care'. Not exploring the role of ACEs in children with developmental disabilities leads to further vulnerability and morbidity. ACEs can be mitigated by early identification and implementation of evidence-based interventions.
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Affiliation(s)
| | - Joyce Nolan Harrison
- Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexander H Hoon
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Phelps Center for Cerebral Palsy and Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Anna Maria Wilms Floet
- Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
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16
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Langenfeld A, Kroupina M, Palmer A, Gustafson K, Augustyn M. Importance of Trauma-Informed Practice in Evaluation of Children Diagnosed with Autism Spectrum Disorder. J Dev Behav Pediatr 2021; 42:690-693. [PMID: 34433202 DOI: 10.1097/dbp.0000000000000999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 11/25/2022]
Abstract
CASE As part of a multidisciplinary adoption support clinic, Erin, a 5-year-old girl, adopted approximately 6 months before the clinic visit, presents for postadoption evaluation. Erin was born at full term. Her birth history was significant for reported maternal treatment for liver failure during pregnancy. Her previous medical history included hospitalization for a viral illness at age 2 months, recurrent ear infections, and a fractured forearm. Family history was significant for a maternal history of bipolar disorder, depression, anxiety, borderline personality disorder, and concern for substance abuse; a paternal history of attention-deficit/hyperactivity disorder (ADHD) and depression; and full biological brother with a history of ADHD and oppositional defiant disorder. Erin and her brother lived with their parents until she was approximately 3 years old. At that time, there were concerns for poor hygiene, inconsistent medical care, poor school attendance for her brother, financial instability, and significant neglect. Erin was reportedly confined to her crib for hours at a time. She and her older brother were removed from the home because of concerns for significant neglect and placed into foster care. Approximately 3 months after foster placement, Erin underwent testing because of concerns for abnormal behaviors and possible developmental delays. Symptoms included poor sleep, repetitive behaviors such as head banging, delayed speech that primarily involved grunting, and lack of toilet training. She was hyperactive and aggressive and had poor caregiver attachment. On evaluation, she was small for age, poorly groomed, and easily distracted with poor eye contact and did not tolerate interactions with examiners. Neuropsychological testing consisted of symptom checklists and caregiver interview only because she did not tolerate diagnostic testing. She was diagnosed with autism spectrum disorder and global developmental delay with intellectual and language impairments. Over the following year, Erin was transitioned to a second foster family and was subsequently adopted. She received speech, occupational, and physical therapy, along with trauma-informed therapy. She made significant gains in multiple domains and was able to graduate from trauma-informed therapy after 1 year. On examination, Erin greets you with appropriate eye contact and reports that she is feeling "good." She is verbal and interactive with her brother and parents. She looks to parents for support when asked to participate in the physical examination. She does not display any significant repetitive behaviors. Erin's parents are concerned that her initial diagnoses of autism spectrum disorder and global developmental delay do not accurately reflect her current level of functioning and are afraid she may have been misdiagnosed. How would you proceed with next steps to address these diagnoses?
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Affiliation(s)
- Adam Langenfeld
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Maria Kroupina
- Institute of Child Development, College of Education and Human Development, University of Minnesota, Minneapolis, MN
| | - Alyssa Palmer
- Birth to Three and Early Childhood Mental Health Program, Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Kimara Gustafson
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Marilyn Augustyn
- Boston University School of Medicine, Boston Medical Center, Boston, MA
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17
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Kipp C, Wilson DK, Sweeney AM, Zarrett N, Van Horn ML. Effects of Parenting and Perceived Stress on BMI in African American Adolescents. J Pediatr Psychol 2021; 46:980-990. [PMID: 33738484 DOI: 10.1093/jpepsy/jsab025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study set out to examine the role of parenting practices in protecting or exacerbating the negative effects of parent and adolescent stress on adolescent body mass index (BMI) over time. Separate longitudinal models were conducted to evaluate how parenting practices interacted with parental perceived stress and adolescent perceived stress in predicting adolescent BMI. METHODS Baseline data were collected from 148 African American adolescents (Mage = 12.93, SD = 1.75; Mz-BMI = 0.78, SD = 0.50; MBMI%-ile = 96.7, SD = 3.90) and their caregivers (Mage = 44.45, SD = 8.65; MBMI = 37.63, SD = 8.21) enrolled in the Families Improving Together for Weight Loss trial. Adolescents self-reported their perceptions of caregiver parenting style and feeding practices. Both caregivers and adolescents self-reported their perceptions of chronic stress. BMI for parents and adolescents was assessed objectively at baseline and 16 weeks post-intervention. RESULTS Hierarchical regression models predicting adolescent BMI z-score (z-BMI) indicated a significant interaction between parental perceived stress and parental pressure to eat. Simple slopes analyses demonstrated that for those parents that exhibit higher pressure to eat, parent stress was positively associated with adolescent z-BMI. CONCLUSIONS These findings provide preliminary support suggesting that certain parenting practices interact with chronic stress on adolescent weight-related outcomes and that future interventions may consider integrating these factors.
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Affiliation(s)
- Colby Kipp
- Department of Psychology, University of South Carolina
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina
| | | | | | - M Lee Van Horn
- Department of Educational Psychology, University of New Mexico
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18
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Koball AM, Domoff SE, Klevan J, Olson-Dorff D, Borgert A, Rasmussen C. The impact of adverse childhood experiences on healthcare utilization in children. CHILD ABUSE & NEGLECT 2021; 111:104797. [PMID: 33223306 DOI: 10.1016/j.chiabu.2020.104797] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/23/2020] [Accepted: 10/27/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are related to long-term negative outcomes. The impact of these experiences on healthcare utilization in children has been understudied. OBJECTIVE To examine the impact of ACEs on children's healthcare utilization, medical diagnoses, and pharmacological treatment. PARTICIPANTS AND SETTING Children aged 6 months to 17 years who were screened for ACEs in the Behavioral Health Department or in primary care locations as part of an initial consultation visit and who had at least one subsequent healthcare visit during the study period were included in the study. METHODS Adverse childhood experiences were measured using the ACE screening questionnaire designed by Felitti et al. (1998). Data from the year following administration of the ACE screening tool were retrospectively extracted from the electronic health record. RESULTS Overall, 1,183 children met study inclusion criteria. Children with any reported ACEs were more likely to no show appointments (1-3 ACEs incidence rate ratio (IRR) [95 % confidence interval (CI)]: 1.40 [1.11-1.77]; 4+ ACEs IRR [95 % CI]: 1.41 [1.08-1.84]) and to use emergency services (1-3 ACEs IRR [95 % CI]: 1.24 [1.00-1.53]; 4+ ACEs: IRR [95 % CI]: 1.42 [1.11-1.81) than children with no ACEs. Those with 4+ ACEs used the telephone nurse advisor less frequently (1-3 ACEs IRR [95 % CI]: 0.67 [0.53-0.84]; 4+ ACEs IRR [95 % CI]: 0.69 [0.53-0.90]). Although ACE scores were associated with healthcare utilization, insurance status was more robustly associated with healthcare utilization than ACE score. CONCLUSIONS Healthcare systems may employ results from this study to adopt trauma-informed care initiatives. Ensuring that all patients have insurance may be a first step toward improving healthcare utilization.
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Affiliation(s)
- Afton M Koball
- Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, United States.
| | - Sarah E Domoff
- Central Michigan University, 1200 S Franklin St., Mount Pleasant, MI, 48859, United States
| | - Judy Klevan
- Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, United States
| | - Denyse Olson-Dorff
- Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, United States
| | - Andrew Borgert
- Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, United States
| | - Cary Rasmussen
- Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, United States
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19
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Li W, Zhang X, Chu M, Li G. The Impact of Adverse Childhood Experiences on Mobile Phone Addiction in Chinese College Students: A Serial Multiple Mediator Model. Front Psychol 2020; 11:834. [PMID: 32477213 PMCID: PMC7237755 DOI: 10.3389/fpsyg.2020.00834] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 04/03/2020] [Indexed: 12/31/2022] Open
Abstract
Mobile phone addiction is a universal phenomenon that has attracted a lot of attention in recent years. Previous researches revealed a significant relation between adverse childhood experiences (ACEs) and addiction. This study further investigated the association between ACEs and mobile phone addiction, and the mediating effects of attachment styles and interpersonal relationships. The cross-sectional design and multiple questionnaires, namely, the Revised Adverse Childhood Experience Questionnaire, the Mobile Phone Addiction Index, the Revised Adult Attachment Scale (AAS), and the Interpersonal Relationship Comprehensive Diagnostic Scale (IRCDS) were used in the sample of 345 university students. Correlation analysis revealed that adverse childhood experience, attachment anxiety, attachment avoidance, interpersonal relationship, and mobile phone addiction were significantly positively correlated with each other. Results of regression analysis showed that attachment style and interpersonal relationship played multiple mediation roles in the association between adverse childhood experience and mobile phone addiction. That is, (1) adverse childhood experience was positively related to mobile phone addiction, (2) both attachment anxiety and interpersonal relationship played partial and parallel mediating roles between adverse childhood experience and mobile phone addiction, and (3) attachment anxiety/avoidance and interpersonal relationship mediated the relationship between adverse childhood experience and mobile phone addiction sequentially. These results indicated that mobile phone addiction among college students who had adverse childhood experience can be relieved by way of the remission of attachment anxiety, reduction of attachment avoidance, and improvement of interpersonal relationship.
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Affiliation(s)
- Wenfu Li
- School of Mental Health, Jining Medical University, Jining, China
| | - Xueting Zhang
- School of Mental Health, Jining Medical University, Jining, China
| | - Minghui Chu
- School of Mental Health, Jining Medical University, Jining, China
| | - Gongying Li
- School of Mental Health, Jining Medical University, Jining, China
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20
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Srivastav A, Richard CL, Kipp C, Strompolis M, White K. Racial/Ethnic Disparities in Health Care Access Are Associated with Adverse Childhood Experiences. J Racial Ethn Health Disparities 2020; 7:1225-1233. [PMID: 32291577 DOI: 10.1007/s40615-020-00747-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 11/24/2022]
Abstract
There is a growing body of research documenting racial/ethnic differences in the relationship between adverse childhood experiences (ACEs) and negative health outcomes in adulthood. However, few studies have examined racial/ethnic differences in the association between ACEs and health care access. Cross-sectional data collected from South Carolina's Behavioral Risk Factor Surveillance System (2014-2016; n = 15,436) was used to examine associations among ACEs, race/ethnicity, and health care access among South Carolina adults. Specifically, logistic regression models were used to estimate the odds ratio (OR) and 95% confidence intervals (CI) for three health care access outcomes: having a personal doctor, routine checkup in the last 2 years, and delay in seeking medical care due to cost. Without adjusting for any covariates, in the overall population, the odds of having no personal doctor, no checkup in the last 2 years, and delay in medical care due to cost was significantly higher among those with at least one ACE, compared with those with no ACEs; and health care access varied by race, with significant relationships detected among Whites and Blacks. Among White adults, the odds of having no checkup in the last 2 years and delay in medical care due to cost was significantly higher among those with at least one ACE, compared with those with no ACEs. Among Black adults, a delay in medical care due to cost was significantly higher among those who reported ACEs compared with their counterparts. The results from this study suggest that ACEs may be an underrecognized barrier to health care for adults. Investing in strategies to mitigate ACEs may help improve health care access among adults.
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Affiliation(s)
- Aditi Srivastav
- Children's Trust of South Carolina, 1330 Lady Street, Suite 310, Columbia, SC, USA.
| | - Chelsea L Richard
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Colby Kipp
- Children's Trust of South Carolina, 1330 Lady Street, Suite 310, Columbia, SC, USA.,Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Melissa Strompolis
- Children's Trust of South Carolina, 1330 Lady Street, Suite 310, Columbia, SC, USA
| | - Kellee White
- Department of Health Policy and Management, University of Maryland, College Park, MD, USA
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21
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Aloisio D, Huron RF. Autism as Representative of Disability. Pediatr Clin North Am 2020; 67:341-355. [PMID: 32122564 DOI: 10.1016/j.pcl.2019.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pediatricians care for many children with autism spectrum disorder who demonstrate a wide range of abilities and needs. This population is vulnerable because of lags in diagnosis, difficulty accessing services, overlooked medical conditions, behavioral difficulties during medical visits, parental stress, bullying, comorbid mental health issues, and variable transitional care moving from adolescence to young adulthood. Comprehensive care includes earlier recognition of symptoms with timely referral to early intervention services. It includes primary pediatricians partnering with the family, developmental pediatricians, and other specialists to reduce the vulnerabilities by medical advocacy, family education, and appropriate behavior intervention to improve functioning.
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Affiliation(s)
- Denise Aloisio
- Hackensack Meridian Health, K. Hovnanian Children's Hospital - Jersey Shore University Medical Center, Division of Developmental Behavioral Pediatrics, Child Evaluation Center, 81 Davis Avenue, Suite 1, Neptune, NJ 07753, USA; Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ, USA.
| | - Randye F Huron
- Hackensack Meridian Health, Joseph M. Sanzari Children's Hospital - Hackensack University Medical Center, Institute for Child Development, 30 Prospect Avenue, Hackensack, NJ 07601, USA; Hackensack Meridian School of Medicine, Nutley, NJ, USA
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22
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McGarry ME, Williams WA, McColley SA. The demographics of adverse outcomes in cystic fibrosis. Pediatr Pulmonol 2019; 54 Suppl 3:S74-S83. [PMID: 31715087 PMCID: PMC6857719 DOI: 10.1002/ppul.24434] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 06/16/2019] [Indexed: 01/08/2023]
Abstract
Understanding variability in cystic fibrosis (CF) health outcomes requires an understanding of factors that go far beyond Cystic Fibrosis Transmembrane Receptor (CFTR) function caused by different gene mutations. Social and environmental factors that influence health have a significant influence on the trajectory of health in CF and in other chronic diseases. In this article, we review demographic factors associated with poorer health outcomes in CF, known and postulated biological mechanisms of these outcomes, and interventions that healthcare teams can implement that may reduce outcome disparities.
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Affiliation(s)
- Meghan E McGarry
- Department of Pediatrics, University of California San Francisco, San Francisco, California
| | - Wadsworth A Williams
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Susanna A McColley
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of Pulmonary and Sleep Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Stanley Manne Children's Research Institute, Chicago, Illinois
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