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Winters KL, Byrd CT. Caregiver Predictions of Their 3- to 6-Year-Old Child Who Stutters' Communication Attitude. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:2086-2105. [PMID: 38889195 PMCID: PMC11253804 DOI: 10.1044/2024_jslhr-23-00662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/11/2024] [Accepted: 04/24/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE Caregivers share critical insight during their child's stuttering evaluation; yet, there have been no empirical studies evaluating whether caregivers provide similar accounts of their 3- to 6-year-old child's communication attitude compared to their child's self-report. This study examined caregiver- and child-reported communication attitude and assessed potential moderators of more comparable caregiver and child ratings (i.e., caregiver confidence, caregiver-child conflict, observer-rated stuttering severity). METHOD One hundred thirteen children who stutter ages 3 through 6 years and a primary caregiver were recruited from clinical settings across the United States. Children completed the Communication Attitude Test for Preschool and Kindergarten Children Who Stutter (KiddyCAT) and three speaking samples, which were recorded to assess observer-rated stuttering severity using the Stuttering Severity Instrument-Fourth Edition. Caregivers predicted their child's communication attitude (C-KiddyCAT) and provided a confidence rating for their prediction. Caregivers also rated caregiver-child conflict using the Child-Parent Relationship Scale-Short Form (CPRS-SF). Multiple regression was used to (a) evaluate whether caregiver C-KiddyCAT scores predicted child KiddyCAT scores and (b) assess potential moderators of the relationship between C-KiddyCAT and KiddyCAT scores. RESULTS Caregiver ratings of their child's communication attitude (C-KiddyCAT) predicted child communication attitude ratings (KiddyCAT). A significant interaction between caregiver-child conflict (CPRS-SF) and caregiver ratings of their child's communication attitude (C-KiddyCAT) suggested caregiver-child conflict changed the underlying relationship between C-KiddyCAT and KiddyCAT scores, such that low conflict resulted in more similar C-KiddyCAT and KiddyCAT scores. Neither caregiver confidence nor observer-rated stuttering severity influenced the relationship between C-KiddyCAT and KiddyCAT scores. CONCLUSIONS Although many caregivers predicted communication attitude ratings that closely aligned with their child's report, some caregiver-child dyads provided divergent ratings. Clinicians should interpret caregiver predictions of their child's communication attitude within the context of their full evaluation and the caregiver-child relationship. Assessing both self-reported communication attitude and caregiver predictions of their child's communication attitude provides a meaningful starting point to counseling caregivers about cognitive components of stuttering for preschool- and kindergarten-age children who stutter.
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Affiliation(s)
- Katie L. Winters
- Department of Communication Sciences and Disorders, University of Cincinnati, OH
| | - Courtney T. Byrd
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
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Gore K, Gilbert M, Hawke M, Barbaro J. Investigating autism knowledge, self-efficacy, and confidence following maternal and child health nurse training for the early identification of autism. Front Neurol 2024; 14:1201292. [PMID: 38264089 PMCID: PMC10803615 DOI: 10.3389/fneur.2023.1201292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/17/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Early identification of children with a high likelihood of autism can lead to referral for diagnostic services and access to early supports, resulting in improved outcomes for children and families. Maternal and Child Health Nurses (MCHNs) in Victoria, Australia, are well-placed to monitor infants and toddlers for signs of autism, given children and caregivers attend free, regular, well-baby consultations from birth through to school age. This study aimed to identify the impact of personal and workplace factors on MCHNs' competencies of autism knowledge, self-efficacy in identifying autistic infants and toddlers, and confidence in speaking to parents/caregivers about autism. Additionally, the study sought to identify which personal and workplace factors might predict increased competency in these areas. Methods After identifying training needs and current competency levels via a training needs analysis (TNA), 1,428 MCHNs received training on the early signs of autism and in the use of the Social Attention and Communication Surveillance-Revised (SACS-R) tool for early autism identification; the training program was known as Monitoring of Social Attention, Interaction, and Communication (MoSAIC). Results Previous MCHN autism training and knowledge of autism community resources significantly contributed to increased MCHN self-efficacy in identifying autistic infants and toddlers, while knowledge of community resources was the best predictor of confidence in speaking with parents/caregivers about autism. Perceived self-efficacy and confidence in speaking with parents/caregivers about autism significantly increased following the MoSAIC autism training. Discussion Targeted autism training for primary health practitioners is an important first step for early autism identification and initiating conversations with parents/caregivers.
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Affiliation(s)
- Katherine Gore
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | | | | | - Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
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Buffle P, Armijos C, Naranjo A, Gentaz E. Feasibility of an observational procedure to enhance early identification of autism spectrum disorder in paediatric settings: A mixed-methods study on an Ecuadorian sample. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:84-94. [PMID: 37313623 PMCID: PMC10771021 DOI: 10.1177/13623613231175587] [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: 06/15/2023]
Abstract
LAY ABSTRACT In Ecuador, the low official estimate of the number of persons with autism spectrum disorder suggest that many children are not identified and are not receiving support. Screening tools are short parent-addressed questionnaires used to identify children that may be developing with autism. Their use is recommended, but their application can be perceived as challenging in paediatric routines. Some professionals prefer looking for autism-related behaviours in a child rather than using screening questionnaires. Although a short observation does not replace the use of validated screening questionnaires, tasks to guide the observation of autistic early signs can help professionals decide to screen or refer the family for assessment and early intervention. In this study, we tested observational tasks that could be adapted to the Ecuadorian paediatric contexts.
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Affiliation(s)
- Paulina Buffle
- University of Geneva, Switzerland
- Pontificia Universidad Católica del Ecuador, Ecuador
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Gilbert M, Gore K, Hawke M, Barbaro J. Development, delivery, and evaluation of a training program for the early identification of autism: Monitoring of Social Attention, Interaction, and Communication. Front Neurol 2023; 14:1201265. [PMID: 37483439 PMCID: PMC10361691 DOI: 10.3389/fneur.2023.1201265] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/06/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Early identification of Autistic children is an important precursor to diagnosis, and access to supports and services. Here we describe the training of the maternal and child health (MCH) workforce in the state of Victoria, Australia in the early identification of infants and toddlers with a high likelihood of autism. Methods In 2019, 1,428 MCH nurses completed early autism training held at venues across the state, with an additional 82 nurses completing online-only training. A training needs analysis enabled the research team to determine the workforce's current skill and knowledge levels, and to identify knowledge gaps, training needs and workplace barriers. The professional development program, known as Monitoring of Social Attention, Interaction, and Communication (MoSAIC), comprised: online pre-workshop modules; a face-to-face instructor-led workshop, which included the use of the Social Attention and Communication-Revised (SACS-R) tool; and online post-workshop modules, which included a recording of a face-to-face workshop with all accompanying resources. This was the first time that the MCH workforce received this training package. Attendees were asked to complete a training satisfaction survey immediately following the face-to-face instructor-led workshop and a follow-up survey regarding their autism knowledge and SACS-R implementation 4-6 weeks after the workshop. Results Over 90% (n = 325) of MCH nurses who completed the training satisfaction survey agreed or strongly agreed with statements that the training was clear and of high quality. Most nurses also reported that the training was well-presented and that they would recommend it to a colleague. In the 6 months following the training, a total of 82,581 SACS-R assessments were conducted by the MCH workforce, reflecting that MCH nurses had successfully integrated SACS-R assessments into their work practice after receiving the early autism identification training. Discussion This study demonstrated that training on the early identification of autism can be successfully designed, customized, and delivered to a large primary healthcare workforce for universal developmental surveillance of autism.
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Kilicaslan F, Karatas H, Kulu H, Solmaz A. Knowledge about childhood autism among nurses in family health centers in southeast Turkey. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 70:824-832. [PMID: 39131755 PMCID: PMC11308978 DOI: 10.1080/20473869.2022.2149063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 08/13/2024]
Abstract
Objective: This study was carried out to determine the knowledge levels of nurses working in Family Health Centers (FHCs) about childhood autism. Methods: This study is a descriptive and cross-sectional study. The sample of the study consisted of 361 nurses working in FHCs in the province with the highest child population rate in Turkey. Data were obtained using the personal information form and the Knowledge about Childhood Autism among Health Workers (KCAHW) questionnaire. Results: The findings show that the mean score for the KCAHW questionnaire was 10.95 ± 3.7. Gender, education level, previous employment in a mental health clinic, the presence of a person with autism in their environment or family, their previous participation in any autism-related education program, and knowledge of the autism screening and follow-up program conducted by the Ministry of Health significantly affected the scores that were obtained from the KCAHW questionnaire (p < 0.05). Conclusion: Educational practices that will increase the knowledge and awareness of nurses about autism can contribute to the diagnosis of children with autism at an earlier age.
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Affiliation(s)
- Fethiye Kilicaslan
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Harran University, Şanlıurfa, Turkey
| | - Hulya Karatas
- Department of Pediatric Nursing, Faculty of Health Sciences, Harran University, Şanlıurfa, Turkey
| | - Hasan Kulu
- Department of Pediatric Nursing, Faculty of Health Sciences, Harran University, Şanlıurfa, Turkey
| | - Abdullah Solmaz
- Department of Pediatry, Faculty of Medicine, Harran University, Şanlıurfa, Turkey
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Buffle P, Gentaz E, Vivanti G. Perception, Beliefs, and Causal Attribution of Autism Early Signs in Ecuadorian General Population. Front Psychol 2022; 13:915817. [PMID: 35814115 PMCID: PMC9260421 DOI: 10.3389/fpsyg.2022.915817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/06/2022] [Indexed: 11/30/2022] Open
Abstract
The identification and diagnosis of children with autism currently rely on behavioral presentation and developmental history. Cultural norms and other socio-demographic factors can influence what is expected or non-expected behaviors in a developing child. Perceptions, beliefs, and causal attribution of early signs can influence families’ help-search behaviors. Lack of recognition of autism’s first manifestations can critically delay the age of diagnosis, the provision of informed guidance to families, and the implementation of adapted interventions during the critical period of early development. Furthermore, a lack of understanding of early signs as the manifestations of a developmental condition may increase stigma and non-conventional explanations. Still, cultural and socio-demographic factors are largely understudied, particularly in low-and middle-income settings. Based on the hypothesis that non-specialists such as family members and friends are one of the first sources of referral in Latin American contexts, we aimed to study the general population’s perceptions and the explanatory causes of autism’s early signs. One-hundred-and-eighty-three Ecuadorian adults responded to a questionnaire developed for this study, describing sixteen ASD-related behaviors. Results indicated that, with the exemption of language impairment and self-injurious behaviors, a substantial proportion of participants did not endorse many behaviors as “concerning and requiring professional attention.” Also, language impairment was the only behavior identified as related to a developmental disorder. Additionally, most participants attributed the majority of behaviors listed in the questionnaire to causes unrelated to ASD, such as child personality. We discuss the impact of those findings in clinical practice and on awareness programs.
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Affiliation(s)
- Paulina Buffle
- Department of Psychology and Education, Université de Genève, Geneva, Switzerland
- *Correspondence: Paulina Buffle,
| | - Edouard Gentaz
- Department of Psychology and Education, Université de Genève, Geneva, Switzerland
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Giacomo Vivanti
- AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, United States
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Waddington H, Macaskill E, Whitehouse AJO, Billingham W, Alvares GA. Parent-reported atypical development in the first year of life and age of autism diagnosis. J Autism Dev Disord 2022:10.1007/s10803-022-05506-1. [PMID: 35441920 DOI: 10.1007/s10803-022-05506-1] [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: 02/24/2022] [Indexed: 10/18/2022]
Abstract
This study examined whether parent-reported atypical development in their child's first year was associated with age of diagnosis and age when parents first needed to consult a specialist about their child's development. It involved 423 children who participated in the Australian Autism Biobank. Most parents retrospectively identified ≥ 1 domain of atypical child development. Atypical development in most domains was associated with an earlier age when parents felt specialist consultation was needed. Atypical development in the "gaze abnormalities", "lack of response to social stimuli", and "no social communication" subdomains within the social domain was associated with an earlier age of diagnosis, as was atypical development in the "hypo/hypersensitivity" and "preoccupation with parts of objects" subdomains within the stereotyped/restricted behavior domain.
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Affiliation(s)
- Hannah Waddington
- School of Education, Victoria University of Wellington, Wellington, New Zealand.
| | - Ella Macaskill
- School of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Andrew J O Whitehouse
- Telethon Kids Institute, University of Western Australia, Perth, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia
| | - Wesley Billingham
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Gail A Alvares
- Telethon Kids Institute, University of Western Australia, Perth, Australia
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Barbaro J, Sadka N, Gilbert M, Beattie E, Li X, Ridgway L, Lawson LP, Dissanayake C. Diagnostic Accuracy of the Social Attention and Communication Surveillance-Revised With Preschool Tool for Early Autism Detection in Very Young Children. JAMA Netw Open 2022; 5:e2146415. [PMID: 35275169 PMCID: PMC8917423 DOI: 10.1001/jamanetworkopen.2021.46415] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/07/2021] [Indexed: 12/15/2022] Open
Abstract
Importance Early identification of children on the autism spectrum is crucial to facilitate access to early supports and services for children and families. The need for improved early autism identification tools is highlighted by the lack of sufficient diagnostic accuracy in current tools. Objectives To examine the diagnostic accuracy of the Social Attention and Communication Surveillance-Revised (SACS-R) and SACS-Preschool (SACS-PR) tools when used with a large, community-based, convenience sample and identify the prevalence of autism in this sample. Design, Setting, and Participants This diagnostic accuracy study was conducted in Melbourne, Australia, training maternal and child health nurses who monitored 13 511 children aged 11 to 42 months using the SACS-R and SACS-PR during their routine consultations (June 1, 2013, to July 31, 2018). Children identified as being at high likelihood for autism (12-24 months of age: n = 327; 42 months of age: n = 168) and at low likelihood for autism plus concerns (42 months of age: n = 28) were referred by their maternal and child health nurse for diagnostic assessment by the study team. Data analysis was performed from April 13, 2020, to November 29, 2021. Exposures Children were monitored with SACS-R and SACS-PR at 12, 18, 24, and 42 months of age. Main Outcomes and Measures Diagnostic accuracy of the SACS-R and SACS-PR was determined by comparing children's likelihood for autism with their diagnostic outcome using clinical judgment based on standard autism assessments (Autism Diagnostic Observation Schedule-Second Edition and Autism Diagnostic Interview-Revised). Results A total of 13 511 children (female: 6494 [48.1%]; male: 7017 [51.9%]) were monitored at least once with the SACS-R at their 12-, 18-, and 24-month-old routine maternal and child health consultations (mean [SD] age, 12.3 [0.59] months at 12 months; 18.3 [0.74] months at 18 months; 24.6 [1.12] months at 24 months) and followed up at their 42-month maternal and child health consultation (mean [SD] age, 44.0 [2.74] months) with SACS-PR (8419 [62.3%]). At 12 to 24 months, SACS-R showed high diagnostic accuracy, with 83% positive predictive value (95% CI, 0.77-0.87) and 99% estimated negative predictive value (95% CI, 0.01-0.02). Specificity (99.6% [95% CI, 0.99-1.00]) was high, with modest sensitivity (62% [95% CI, 0.57-0.66]). When the SACS-PR 42-month assessment was added, estimated sensitivity increased to 96% (95% CI, 0.94-0.98). Autism prevalence was 2.0% (1 in 50) between 11 and 30 months of age and 3.3% (1 in 31) between 11 and 42 months of age. Conclusions and Relevance The SACS-R with SACS-PR (SACS-R+PR) had high diagnostic accuracy for the identification of autism in a community-based sample of infants, toddlers, and preschoolers, indicating the utility of early autism developmental surveillance from infancy to the preschool period rather than 1-time screening. Its greater accuracy compared with psychometrics of commonly used autism screening tools when used in community-based samples suggests that the SACS-R+PR can be used universally for the early identification of autism.
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Affiliation(s)
- Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Indooroopilly, Queensland, Australia
| | - Nancy Sadka
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Melissa Gilbert
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Erin Beattie
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Xia Li
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia
| | - Lael Ridgway
- Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | - Lauren P. Lawson
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Indooroopilly, Queensland, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Indooroopilly, Queensland, Australia
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Experiences and Attitudes on Early Identification Practices of Autism: A Preliminary Survey of Pediatric Professionals in Ecuador. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9020123. [PMID: 35204844 PMCID: PMC8869979 DOI: 10.3390/children9020123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 11/16/2022]
Abstract
Early identification of children with autism is necessary to support their social and communicative skills and cognitive, verbal, and adaptive development. Researchers have identified several barriers to early diagnosis. Data collected in low- and middle-income contexts—where the vast majority of children in the world live—is scarce. In Ecuador, as in many other countries, estimates are lower compared to the global prevalence. Health authorities estimate a prevalence of 0.28% (0.18%–0.41%) in children aged five years old or less. Based on the hypothesis that, as in many parts of the world, children in Ecuador are not routinely screened and that this situation may result from poor recognition of this condition, our objective was to identify potential obstacles to case identification in pediatric settings. Several barriers, consistent with those identified in other countries, were reported by 153 participants on a survey, including lack of time, lack of resources to refer, fear of unnecessarily alarming families, and lack of information to guide families with concerns. The vast majority of participants are aware of the need for a screening tool for autism detection but report a lack of knowledge of its formal application. Most of the barriers reported in this study could be overcome by educational programs tailored to professional needs in order to support the well-being of children with autism and their families.
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Brief Report: Training New Zealand Well Child/Tamariki Ora Nurses on Early Autism Signs Using the Social Attention and Communication Surveillance-Revised. J Autism Dev Disord 2021; 52:5050-5057. [PMID: 34748134 PMCID: PMC8574927 DOI: 10.1007/s10803-021-05344-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 11/23/2022]
Abstract
Universal developmental surveillance is considered best practice for early identification of autism. We analysed data from 175 New Zealand Well-Child/Tamariki Ora nurses who attended a 1-day training in developmental surveillance for autism using the social attention and communication surveillance-revised (SACS-R) tool. We used a survey to measure nurses’ knowledge of typical development, knowledge of early signs of autism, general autism knowledge, and confidence in identifying and discussing early signs, prior to the workshop, after the workshop, and at follow-up. We measured perceived acceptability of the SACS-R after the workshop and at follow-up. Nurses showed improvements on all measures from pre-workshop to post-workshop and pre-workshop to follow-up. Implementation of the SACS-R across different contexts appears feasible and acceptable.
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11
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Whitehouse AJO, Varcin KJ, Pillar S, Billingham W, Alvares GA, Barbaro J, Bent CA, Blenkley D, Boutrus M, Chee A, Chetcuti L, Clark A, Davidson E, Dimov S, Dissanayake C, Doyle J, Grant M, Green CC, Harrap M, Iacono T, Matys L, Maybery M, Pope DF, Renton M, Rowbottam C, Sadka N, Segal L, Slonims V, Smith J, Taylor C, Wakeling S, Wan MW, Wray J, Cooper MN, Green J, Hudry K. Effect of Preemptive Intervention on Developmental Outcomes Among Infants Showing Early Signs of Autism: A Randomized Clinical Trial of Outcomes to Diagnosis. JAMA Pediatr 2021; 175:e213298. [PMID: 34542577 PMCID: PMC8453361 DOI: 10.1001/jamapediatrics.2021.3298] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Intervention for individuals with autism spectrum disorder (ASD) typically commences after diagnosis. No trial of an intervention administered to infants before diagnosis has shown an effect on diagnostic outcomes to date. OBJECTIVE To determine the efficacy of a preemptive intervention for ASD beginning during the prodromal period. DESIGN, SETTING, AND PARTICIPANTS This 2-site, single rater-blinded randomized clinical trial of a preemptive intervention vs usual care was conducted at 2 Australian research centers (Perth, Melbourne). Community sampling was used to recruit 104 infants aged 9 to 14 months showing early behaviors associated with later ASD, as measured by the Social Attention and Communication Surveillance-Revised. Recruitment occurred from June 9, 2016, to March 30, 2018. Final follow-up data were collected on April 15, 2020. INTERVENTIONS Infants were randomized on a 1:1 ratio to receive either a preemptive intervention plus usual care or usual care only over a 5-month period. The preemptive intervention group received a 10-session social communication intervention, iBASIS-Video Interaction to Promote Positive Parenting (iBASIS-VIPP). Usual care comprised services delivered by community clinicians. MAIN OUTCOMES AND MEASURES Infants were assessed at baseline (approximate age, 12 months), treatment end point (approximate age, 18 months), age 2 years, and age 3 years. Primary outcome was the combined blinded measure of ASD behavior severity (the Autism Observation Scale for Infants and the Autism Diagnostic Observation Schedule, second edition) across the 4 assessment points. Secondary outcomes were an independent blinded clinical ASD diagnosis at age 3 years and measures of child development. Analyses were preregistered and comprised 1-tailed tests with an α level of .05. RESULTS Of 171 infants assessed for eligibility, 104 were randomized; 50 infants (mean [SD] chronological age, 12.40 [1.93] months; 38 boys [76.0%]) received the iBASIS-VIPP preemptive intervention plus usual care (1 infant was excluded after randomization), and 53 infants (mean [SD] age, 12.38 [2.02] months; 32 boys [60.4%]) received usual care only. A total of 89 participants (45 in the iBASIS-VIPP group and 44 in the usual care group) were reassessed at age 3 years. The iBASIS-VIPP intervention led to a reduction in ASD symptom severity (area between curves, -5.53; 95% CI, -∞ to -0.28; P = .04). Reduced odds of ASD classification at age 3 years was found in the iBASIS-VIPP group (3 of 45 participants [6.7%]) vs the usual care group (9 of 44 participants [20.5%]; odds ratio, 0.18; 95% CI, 0-0.68; P = .02). Number needed to treat to reduce ASD classification was 7.2 participants. Improvements in caregiver responsiveness and language outcomes were also observed in the iBASIS-VIPP group. CONCLUSIONS AND RELEVANCE Receipt of a preemptive intervention for ASD from age 9 months among a sample of infants showing early signs of ASD led to reduced ASD symptom severity across early childhood and reduced the odds of an ASD diagnosis at age 3 years. TRIAL REGISTRATION http://anzctr.org.au identifier: ACTRN12616000819426.
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Affiliation(s)
- Andrew J. O. Whitehouse
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia,University of Western Australia, Crawley, Western Australia, Australia,Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, Queensland, Australia
| | - Kandice J. Varcin
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia,School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Sarah Pillar
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Wesley Billingham
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Gail A. Alvares
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Josephine Barbaro
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, Queensland, Australia,Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Catherine A. Bent
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Daniel Blenkley
- Perinatal Mental Health and Parenting Research Unit, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Maryam Boutrus
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia,Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, Queensland, Australia,School of Psychological Science, University of Western Australia, Crawley, Western Australia, Australia
| | - Abby Chee
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Lacey Chetcuti
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, Queensland, Australia,Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Alena Clark
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Emma Davidson
- Child and Adolescent Health Service, Child Development Service, West Perth, Western Australia, Australia
| | - Stefanie Dimov
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Cheryl Dissanayake
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, Queensland, Australia,Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Jane Doyle
- Child and Adolescent Health Service, Child Development Service, West Perth, Western Australia, Australia
| | - Megan Grant
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Cherie C. Green
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Megan Harrap
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Teresa Iacono
- Living with Disability Research Centre, College of Science, Health, and Engineering, Victoria, Australia
| | - Lisa Matys
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Murray Maybery
- School of Psychological Science, University of Western Australia, Crawley, Western Australia, Australia
| | - Daniel F. Pope
- Perinatal Mental Health and Parenting Research Unit, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Michelle Renton
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia,Child and Adolescent Health Service, Child Development Service, West Perth, Western Australia, Australia
| | - Catherine Rowbottam
- Child and Adolescent Health Service, Child Development Service, West Perth, Western Australia, Australia
| | - Nancy Sadka
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Leonie Segal
- Australian Centre for Precision Health, Allied Health and Human Movement, University of South Australia, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, Australia
| | - Vicky Slonims
- Children’s Neurosciences, Evelina London Children’s Hospital/Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
| | - Jodie Smith
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Carol Taylor
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Scott Wakeling
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Ming Wai Wan
- Perinatal Mental Health and Parenting Research Unit, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - John Wray
- Child and Adolescent Health Service, Child Development Service, West Perth, Western Australia, Australia
| | - Matthew N. Cooper
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom,Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Trust, Manchester, United Kingdom
| | - Kristelle Hudry
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, Queensland, Australia,Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
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12
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Shrestha R, Dissanayake C, Barbaro J. Implementing and evaluating Social Attention and Communication Surveillance (SACS) to prospectively identify autism in very young children in Nepal. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 115:104013. [PMID: 34144316 DOI: 10.1016/j.ridd.2021.104013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 05/31/2021] [Accepted: 06/06/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Although Autism Spectrum Disorder (ASD) can be identified as early as 12 months and diagnosed by 24 months, the mean age of diagnosis of ASD in Nepal is ∼58 months, with children missing the opportunity for early intervention. AIMS This study implemented and evaluated a Nepali version of the Social Attention and Communication Surveillance (SACS-N) tool, to identify children between 11-30 months who are at "high likelihood" of ASD in a local community in Nepal. METHODS Sixty Female Community Health Volunteers (FCHVs) were trained to monitor and identify the early signs of ASD using SACS-N. RESULTS Overall, 1926 children were monitored with the SACS-N, with 11 children (0.57 %) referred for further assessments at 11-15 months (n = 4), 16-21 months (n = 4), and 22-30 months (n = 3). Of these children, 10 children had a developmental disorder, including ASD and Global Developmental Delay; no information was available on one child who migrated. Hence, the positive predictive value (PPV) of SACS-N for all developmental disorders was 100 %. Of seven children attending a gold standard diagnostic/ developmental assessment, three had ASD (43 % PPV for ASD). The estimated prevalence of ASD ranged between 0.16 % to 0.26 %. CONCLUSION Community-based developmental monitoring of ASD and other developmental delays by FCHVs is a feasible, cost-effective and sustainable approach to promoting early identification of ASD in Nepal. Further training and awareness of autism is needed for more accurate and increased referral rates using the SACS-N, including regular supervision of FCHVs.
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Affiliation(s)
- Rena Shrestha
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Bundoora, Melbourne, VIC, 3086, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Bundoora, Melbourne, VIC, 3086, Australia
| | - Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Bundoora, Melbourne, VIC, 3086, Australia.
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13
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Influence of Ideational Praxis on the Development of Play and Adaptive Behavior of Children with Autism Spectrum Disorder: A Comparative Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115704. [PMID: 34073380 PMCID: PMC8197801 DOI: 10.3390/ijerph18115704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/08/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Traditionally, assessment of praxis skills in children with ASD has focused on the evaluation of aspects related to the planning and execution of actions. This study aimed to evaluate the ideational abilities of children with ASD and analyze possible relationships with the development of play and adaptive behaviors. METHODS 40 children between 4 to 6 years (TD = 20; ASD = 20) were evaluated with the Test of Ideational Praxis, the Revised Knox Preschool Play Scale, and the Adaptive Behavior Assessment System II. RESULTS Statistically significant relationships were obtained between ideational praxis and play skills development (r = 0.649; p = 0.01), adaptive leisure behavior (r = 0.338; p = 0.04) and social adaptive behavior (r = 0.319; p = 0.04). Results of multiple linear regression models found a linear relationship between ideational praxis and play development (p = 0.005) and adaptive leisure skills (p = 0.004), but not with social interaction skills (p > 0.05). CONCLUSIONS Objective evaluation with a specific ideational praxis assessment facilitates understanding of the ideational abilities and widens understanding of praxis skills and their impact on play and adaptive behaviors in children with ASD.
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14
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Shrestha R, Barbaro J, Dissanayake C. Changes in Knowledge on the Signs of Autism in Young Children (11-30 Months) among Female Community Health Volunteers in Nepal. J Autism Dev Disord 2021; 52:219-239. [PMID: 33709379 DOI: 10.1007/s10803-021-04944-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2021] [Indexed: 10/21/2022]
Abstract
Nepalese Female Community Health Volunteers' (FCHVs) knowledge on social attention and communication development and the early signs of autism was evaluated before, immediately after, and 12-months following training on typical and atypical social-communicative development in infants/toddlers, early signs of autism, and monitoring of key "markers" of autism using Social Attention and Communication Surveillance. FCHVs (N = 60) significantly improved their knowledge about autism and reported increased perceived confidence in monitoring and referring young children at high likelihood of autism following training, which was sustained one year later. FCHVs also reported a positive impact of training on their work. These findings indicate the effectiveness of training in improving FCHVs' knowledge and perceived confidence to monitor and refer young children at high likelihood of autism.
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Affiliation(s)
- Rena Shrestha
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Bundoora, Melbourne, VIC, 3086, Australia
| | - Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Bundoora, Melbourne, VIC, 3086, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Bundoora, Melbourne, VIC, 3086, Australia.
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15
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Barbaro J, Masi A, Gilbert M, Nair R, Abdullahi I, Descallar J, Dissanayake C, Eastwood J, Hasan I, Jalaludin B, Karlov L, Khan F, Kohlhoff J, Liaw ST, Lingam R, Mendoza Diaz A, Ong N, Tam CWM, Unwin K, Woolfenden S, Eapen V. A Multistate Trial of an Early Surveillance Program for Autism Within General Practices in Australia. Front Pediatr 2021; 9:640359. [PMID: 33968847 PMCID: PMC8102783 DOI: 10.3389/fped.2021.640359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The early detection of developmental conditions such as autism is vital to ensure children can access appropriate and timely evidence-based supports, services, and interventions. Children who have undetected developmental conditions early in life are more likely to develop later health, developmental, learning, and behavioral issues, which in turn can have a cumulative effect over the life course. Methods: The current protocol describes a multi-site, cluster randomized control trial comparing a developmental surveillance pathway for autism to usual care, using opportunistic visits to general practitioners (GPs). Units of randomization are GP clinics across two Australian states (New South Wales and Victoria), with thirty clinics within each state, each of which will aim to recruit approximately forty children aged between ~18- and 24-months, for a total of ~2,400 participants. Children will be randomized to two clusters; namely, an autism surveillance pathway (ASP) or surveillance as usual (SaU). The screening process for the ASP arm involves primary and secondary screenings for developmental concerns for autism, using both parent and GP reports and observations. Children in both arms who show signs of developmental concerns for autism will be offered a full developmental assessment by the research team at 24 months of age to determine the efficacy of developmental surveillance in successfully identifying children with autism. Trial Registration: The trial is registered with ANZCTR (ACTRN12619001200178) and reporting of the trial results will be according to recommendations in the CONSORT Statement.
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Affiliation(s)
- Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, College of Science, Health & Engineering, La Trobe University, Bundoora, VIC, Australia.,Cooperative Research Centre for Living With Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia
| | - Anne Masi
- Cooperative Research Centre for Living With Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia.,Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Melissa Gilbert
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, College of Science, Health & Engineering, La Trobe University, Bundoora, VIC, Australia
| | - Radhika Nair
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, College of Science, Health & Engineering, La Trobe University, Bundoora, VIC, Australia
| | - Ifrah Abdullahi
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, College of Science, Health & Engineering, La Trobe University, Bundoora, VIC, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, College of Science, Health & Engineering, La Trobe University, Bundoora, VIC, Australia.,Cooperative Research Centre for Living With Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia
| | - John Eastwood
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Faculty of Medicine and Health, School of Medicine, University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine, School of Women and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Iqbal Hasan
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Bin Jalaludin
- Faculty of Medicine, School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Lisa Karlov
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Academic Unit of Psychiatry, Infant Child and Adolescent Mental Health Services, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Feroza Khan
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Jane Kohlhoff
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - S T Liaw
- Faculty of Medicine, School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Raghu Lingam
- Population Child Health Research Group, Faculty of Medicine, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Antonio Mendoza Diaz
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Academic Unit of Psychiatry, Infant Child and Adolescent Mental Health Services, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Natalie Ong
- Children's Hospital Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Chun Wah Michael Tam
- Faculty of Medicine, School of Population Health, University of New South Wales, Sydney, NSW, Australia.,Primary and Integrated Care Unit, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Katy Unwin
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, College of Science, Health & Engineering, La Trobe University, Bundoora, VIC, Australia
| | - Sue Woolfenden
- Population Child Health Research Group, Faculty of Medicine, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Valsamma Eapen
- Cooperative Research Centre for Living With Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia.,Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Academic Unit of Psychiatry, Infant Child and Adolescent Mental Health Services, South Western Sydney Local Health District, Sydney, NSW, Australia
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16
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Luu J, Jellett R, Yaari M, Gilbert M, Barbaro J. A Comparison of Children Born Preterm and Full-Term on the Autism Spectrum in a Prospective Community Sample. Front Neurol 2020; 11:597505. [PMID: 33343497 PMCID: PMC7744721 DOI: 10.3389/fneur.2020.597505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/12/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction: Previous research suggests children diagnosed with autism spectrum disorder (ASD or “autism”) born extremely and very preterm face substantially delayed development than their peers born full-term. Further, children born preterm are proposed to show a unique behavioral phenotype, which may overlap with characteristics of autism, making it difficult to disentangle their clinical presentation. To clarify the presentation of autism in children born preterm, this study examined differences in key indicators of child development (expressive language, receptive language, fine motor, and visual reception) and characteristics of autism (social affect and repetitive, restricted behaviors). Materials and Methods: One fifty-eight children (136 full-term, twenty-two preterm) diagnosed with autism, aged 22–34 months, were identified prospectively using the Social Attention and Communication Surveillance tools during community-based, developmental surveillance checks in the second year of life. Those identified at “high likelihood” of an autism diagnosis were administered the Mullen Scales of Early Learning and the Autism Diagnostic Observation Schedule. Results: The children born preterm and full-term did not differ significantly in their fine motor, visual reception, expressive language, or receptive language skills. No significant differences in social affect and repetitive and restrictive behavior traits were found. Discussion: The findings of this study differs from previous research where children diagnosed with autism born very or extremely preterm were developmentally delayed and had greater autistic traits than their term-born peers. These null findings may relate to the large proportion of children born moderate to late preterm in this sample. This study was unique in its use of a community-based, prospectively identified sample of children diagnosed with autism at an early age. It may be that children in these groups differ from clinic- and hospital-based samples, that potential differences emerge later in development, or that within the autism spectrum, children born preterm and full-term develop similarly. It was concluded that within the current sample, at 2 years of age, children diagnosed with autism born preterm are similar to their peers born full-term. Thus, when clinicians identify characteristics of autism in children born preterm, it is important to refer the child for a diagnostic assessment for autism.
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Affiliation(s)
- Jenny Luu
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Rachel Jellett
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Maya Yaari
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.,Goshen - Community Child Health and Well-Being, Haruv Campus for Children, Jerusalem, Israel
| | - Melissa Gilbert
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia
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17
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Young RL, Nah Y. Examining Autism Detection in Early Childhood (ADEC) in the Early Identification of Young Children with Autism Spectrum Disorders (ASD). AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Bernie C, Williams K, O'Connor B, Rogers S, May T. Referral, Assessment and Use of Screening Measures Related to Autism Spectrum Disorder at a Tertiary Hospital Setting. J Autism Dev Disord 2020; 51:2673-2685. [PMID: 33034784 DOI: 10.1007/s10803-020-04725-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Children with developmental concerns in Australia continue to experience inequitable healthcare and service-related delays, even when diagnostic risk is identified. This study sought to explore service and demographic pathway factors leading up to autism spectrum disorder (ASD) assessment, including value of screening measures applied at triage. Following a trial of centralised intake for referred young children with suspected ASD, observational, retrospective pathway data was explored using bivariate and regression analyses. The mean age of 159 children referred with autism symptoms was 3.6 years, and 64% were diagnosed with ASD. Service allocation was associated with diagnosis, whilst screening tool results were not. Improved pathways are needed to limit wasted waiting times and direct each child to needs-based services.
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Affiliation(s)
- C Bernie
- Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, 3058, Victoria, Australia.
- Department of Allied Health, The Royal Children's Hospital, Melbourne, VIC, Australia.
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.
| | - K Williams
- Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, 3058, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
- Department of Developmental Paediatrics, Monash Children's Hospital, Clayton, VIC, Australia
| | - B O'Connor
- Department of Allied Health, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - S Rogers
- Department of Allied Health, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Health and Human Services, Melbourne, VIC, Australia
| | - T May
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
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19
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Hatakenaka Y, Maeda M, Ninomiya H, Hachiya K, Fernell E, Gillberg C. ESSENCE-Q obtained in routine Japanese public child health check-ups may be a valuable tool in neurodevelopmental screening. Acta Paediatr 2020; 109:764-773. [PMID: 31545530 DOI: 10.1111/apa.15029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 09/17/2019] [Accepted: 09/20/2019] [Indexed: 11/29/2022]
Abstract
AIM Our aim was to extend the validity of a questionnaire developed for screening and identifying early symptomatic syndromes eliciting neurodevelopmental clinical examinations-questionnaire (ESSENCE-Q) in young children. METHODS Early symptomatic syndromes eliciting neurodevelopmental clinical examinations-questionnaire data for 207 children, living in Aki City, Japan, in 2014-2015, were obtained from mothers, public health nurses and psychologists at 20- and 40-month routine check-ups at child healthcare centres. These were checked against subsequent ESSENCE diagnoses made by physicians. Receiver operating characteristic curves were constructed, and the area under the curves was compared. Sensitivity, specificity, positive predictive values (PPVs) and negative predictive values were calculated at optimal cut-off values. The clinical utility index was also calculated. RESULTS When the ESSENCE-Q was used by public health nurses, it demonstrated good validity, in terms of high sensitivity and high NPVs, at the 20-month check-up, but not at 40 months. Psychologists demonstrated good validity at both ages, but mothers did not. Good negative utility indexes, indicating screening accuracy, were obtained from the psychologists at both check-ups and from nurses at 20 months. CONCLUSION The ESSENCE-Q results used by nurses and psychologists showed good validity. Future studies should confirm the effectiveness of this tool to identify children in need of clinical detailed neurodevelopmental assessment.
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Affiliation(s)
- Yuhei Hatakenaka
- Faculty of Humanities and Sociologies University of the Ryukyus Nishihara Okinawa Japan
- Kochi Gillberg Neuropsychiatry Centre Kochi Prefectural Medical and Welfare Centre Kochi Japan
- Gillberg Neuropsychiatry Centre Sahlgrenska Academy Gothenburg Sweden
| | - Masato Maeda
- Kochi Gillberg Neuropsychiatry Centre Kochi Prefectural Medical and Welfare Centre Kochi Japan
- Department of Paediatrics Kochi Prefectural Aki General Hospital Aki Kochi Japan
| | - Hitoshi Ninomiya
- Kochi Gillberg Neuropsychiatry Centre Kochi Prefectural Medical and Welfare Centre Kochi Japan
- Faculty of Science and Engineering Department of Civil and Environmental Engineering Toyo University Kawagoe Saitama Japan
| | | | - Elisabeth Fernell
- Gillberg Neuropsychiatry Centre Sahlgrenska Academy Gothenburg Sweden
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20
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Abstract
Autism spectrum disorder (referred to here as autism) is one of several overlapping neurodevelopmental conditions that have variable impacts on different individuals. This variability results from dynamic interactions between biological and non-biological risk factors, which result in increasing differentiation between individuals over time. Although this differentiation continues well into adulthood, the infancy period is when the brain and behavior develop rapidly, and when the first signs and symptoms of autism emerge. This review discusses advances in our understanding of the causal pathways leading to autism and overlapping neurodevelopmental conditions. Research is also mapping trajectories of brain and behavioral development for some risk groups, namely later born siblings of children with autism and/or infants referred because of developmental concerns. This knowledge has been useful in improving early identification and establishing the feasibility of targeted interventions for infant risk groups before symptoms arise. However, key knowledge gaps remain, such as the discovery of protective factors (biological or environmental) that may mitigate the impact of risk. Also, the dynamic mechanisms that underlie the associations between risk factors and outcomes need further research. These include the processes of resilience, which may explain why some individuals at risk for autism achieve better than expected outcomes. Bridging these knowledge gaps would help to provide tools for early identification and intervention that reflect dynamic developmental pathways from risk to outcomes.
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Affiliation(s)
- Mayada Elsabbagh
- Montreal Neurological Institute, Azrieli Centre for Autism Research, McGill University, Montreal, Canada
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21
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Barbaro J, Yaari M. Study protocol for an evaluation of ASDetect - a Mobile application for the early detection of autism. BMC Pediatr 2020; 20:21. [PMID: 31952489 PMCID: PMC6969425 DOI: 10.1186/s12887-019-1888-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 12/15/2019] [Indexed: 11/18/2022] Open
Abstract
Background Autism Spectrum Conditions (ASC) can be reliably diagnosed by 24 months of age. However, despite the well-known benefits of early intervention, there is still a research-practice gap in the timely identification of ASC, particularly in low-resourced settings. The Social Attention and Communication Surveillance (SACS) tool, which assesses behavioural markers of autism between 12 to 24 months of age, has been implemented in Maternal and Child Health (MCH) settings, with excellent psychometric properties. ASDetect is a free mobile application based on the SACS, which is designed to meet the need for an effective, evidence-based tool for parents, to learn about children’s early social-communication development and assess their child’s ‘likelihood’ for ASC. Study aims The primary aim of this study is to evaluate the psychometric properties of ASDetect in the early detection of children with ASC. A secondary aim is to assess ASDetect’s acceptability and parental user experience with the application. Methods Families are recruited to download the application and participate in the study via social media, health professionals (e.g., MCH nurses, paediatricians) and word of mouth. All participating caregivers complete a demographic questionnaire, survey regarding their user experience, and the Social Responsiveness Scale-2 (SRS-2), an autism screening questionnaire; they are also invited to participate in focus groups. Children identified at ‘high likelihood’ for ASC based on the ASDetect results, the SRS-2 or parental and/or professional concerns undergo a formal, gold-standard, diagnostic assessment. Receiver Operating Characteristic analyses will be used to assess psychometric properties of ASDetect. Thematic analyses will be used to explore themes arising in the focus groups to provide insights regarding user experiences with the app. Multiple regression analyses will be carried out to determine the extent to which demographic factors, parental stress and beliefs on health surveillance and child results on ASDetect are associated with the parental user-experience of the application. Discussion With a strong evidence-base and global access, ASDetect has the potential to empower parents by providing them with knowledge of their child’s social-communication development, validating and reassuring any parental concerns, and supporting them in communicating with other health professionals, ultimately enhancing child and family outcomes and well-being.
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Affiliation(s)
- Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health. College of Science, Heath & Engineering. La Trobe University, Melbourne, Victoria, 3086, Australia.
| | - Maya Yaari
- Olga Tennison Autism Research Centre, School of Psychology and Public Health. College of Science, Heath & Engineering. La Trobe University, Melbourne, Victoria, 3086, Australia.,Goshen - Community Child Health and Well-Being. Haruv Campus for Children. Mount Scopus, 9765418, Jerusalem, Israel
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22
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Lawson LP, Joshi R, Barbaro J, Dissanayake C. Gender Differences During Toddlerhood in Autism Spectrum Disorder: A Prospective Community-Based Longitudinal Follow-Up Study. J Autism Dev Disord 2019; 48:2619-2628. [PMID: 29497988 DOI: 10.1007/s10803-018-3516-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Relatively few studies have examined gender differences in infants and toddlers, and most focus on clinically referred samples or high-risk infant cohorts. The current study aimed to examine gender differences in early autism manifestations and cognitive development in a community-ascertained sample. In total, 46 males and 21 females with ASD were seen at approximately 24 and 48 months of age. No significant gender differences were observed on overall cognitive ability, verbal skills, non-verbal skills, overall autism severity, or restricted repetitive behaviours. However, females were found to exhibit more social communication impairments than males. These findings may indicate that female toddlers with less severe or different, social communication impairments may be more likely to be missed during routine surveillance during toddlerhood.
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Affiliation(s)
- Lauren P Lawson
- Olga Tennison Autism Research Centre, La Trobe University, Kingsbury Drive, Melbourne, VIC, 3086, Australia.
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Australia.
| | - Rucha Joshi
- Autism Spectrum Australia, Melbourne, Australia
| | - Josephine Barbaro
- Olga Tennison Autism Research Centre, La Trobe University, Kingsbury Drive, Melbourne, VIC, 3086, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Kingsbury Drive, Melbourne, VIC, 3086, Australia
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Ben-Sasson A, Atun-Einy O, Yahav-Jonas G, Lev-On S, Gev T. Training Physical Therapists in Early ASD Screening. J Autism Dev Disord 2018; 48:3926-3938. [PMID: 29971656 DOI: 10.1007/s10803-018-3668-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Physical therapists (PTs) are often one of the first professionals to evaluate children at risk. To examine the effect of an early screening training on pediatric PTs': (1) knowledge of autism spectrum disorder (ASD), (2) clinical self-efficacy, and (3) identification of markers. Twenty-six PTs participated in a 2-day "Early ASD Screening" workshop. The ASD Knowledge and Self-Efficacy Questionnaire, and video case study analysis were completed pre- and post-training. Changes following training were significant for ASD knowledge related to etiology and learning performance, early signs, risk factors, and clinical self-efficacy. Rating the videoed case study after the training, was significantly more accurate than it was before. Training PTs is important for enhancing early identification of ASD.
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Affiliation(s)
- Ayelet Ben-Sasson
- Department of Occupational Therapy, University of Haifa, 3498838, Haifa, Israel.
| | - Osnat Atun-Einy
- Department of Physical Therapy, University of Haifa, 3498838, Haifa, Israel
| | - Gal Yahav-Jonas
- Association for Children at Risk, 9 Hazvi St., Tel Aviv, 67197, Israel
| | - Shimona Lev-On
- Weinberg Child Development Center, Sheba Tel-Hashomer Hospital, Ramat Gan, 52621, Israel
| | - Tali Gev
- Department of Psychology, Bar-Ilan University, Ramat Gan, 5290002, Israel
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Okuno M, Uehara T. Early childhood behavioral features that discriminate autism from other developmental problems in Japan. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2018; 31:23-29. [PMID: 30156364 DOI: 10.1111/jcap.12205] [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: 03/02/2018] [Revised: 05/31/2018] [Accepted: 07/15/2018] [Indexed: 11/29/2022]
Abstract
PROBLEM The criteria for early detection of autism spectrum disorder (ASD) and its discrimination from other developmental problems (ODP) are not clear. The Social Attention and Communication Study, which identified methods for early identification of ASD in community settings, was modified to the Japanese situation, and we examined its discriminant validity. METHODS This study followed a cohort of newborns in one town for 4 years. Structured behavioral assessments were added to the standardized health examination and performed five times during toddlerhood. Of the 264 children included in the statistical analysis, four were diagnosed with ASD, and four were diagnosed with ODP. FINDINGS A canonical discrimination analysis indicated two significant functions. Canonical 1, which involved disturbances of "eye contact" at 27 months and "concept comprehension" at 38 months, characterized both ASD and ODP. Canonical 2, which involved disturbances of "response name call" at 15 months, "showing" at 27 months, and negative loading of vocabulary development at 20 months, discriminated between ASD and ODP. The canonical plot showed good separation, but a few cases were misclassified. CONCLUSIONS Evaluations of early behavioral signs by public health nurses during general toddler examinations could be useful and convenient.
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Affiliation(s)
- Midori Okuno
- Department of Nursing, Nihon Institute of Medical Science, Saitama, Japan
| | - Toru Uehara
- Department of Social Welfare, Graduate School of Health and Welfare, Takasaki University of Health and Welfare, Takasaki, Japan
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Prevalence of Psychotropic Medicine Use in Australian Children with Autism Spectrum Disorder: A Drug Utilization Study Based on Children Enrolled in the Longitudinal Study of Australian Children. J Autism Dev Disord 2018; 49:227-235. [DOI: 10.1007/s10803-018-3718-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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26
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Hedley D, Brewer N, Nevill R, Uljarević M, Butter E, Mulick JA. The Relationship Between Clinicians' Confidence and Accuracy, and the Influence of Child Characteristics, in the Screening of Autism Spectrum Disorder. J Autism Dev Disord 2017; 46:2340-8. [PMID: 26975451 DOI: 10.1007/s10803-016-2766-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The study examined the confidence accuracy relationship, and the influence of child characteristics on clinician confidence, when predicting a diagnosis of Autism Spectrum Disorder during screening of 125 referred children aged under 3.5 years. The diagnostic process included observation, interview, language and developmental testing. Clinical judgement accuracy was compared against final diagnosis for high and low confidence levels (with confidence assessed on a 0-100 % scale). We identified a significant CA relationship with predictive accuracy highest at confidence levels of 90-100 %. Parent report of unusual behaviors was the only significant independent predictor of confidence. Clinicians' confidence may be important when evaluating decisions to refer, or not to refer, children for further diagnostic assessment.
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Affiliation(s)
- Darren Hedley
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia. .,Department of Pediatrics, Ohio State University, Columbus, OH, 43210, USA. .,Child Development Center, Nationwide Children's Hospital, Columbus, OH, 43210, USA.
| | - Neil Brewer
- School of Psychology, Flinders University, Adelaide, SA, 5042, Australia
| | - Rose Nevill
- Department of Pediatrics, Ohio State University, Columbus, OH, 43210, USA
| | - Mirko Uljarević
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, QLD, Australia
| | - Eric Butter
- Department of Pediatrics, Ohio State University, Columbus, OH, 43210, USA.,Child Development Center, Nationwide Children's Hospital, Columbus, OH, 43210, USA
| | - James A Mulick
- Department of Pediatrics, Ohio State University, Columbus, OH, 43210, USA
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Continuity and Change in Cognition and Autism Severity from Toddlerhood to School Age. J Autism Dev Disord 2017; 47:328-339. [PMID: 27848051 DOI: 10.1007/s10803-016-2954-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This paper charted the cognitive and behavioural profiles from toddlerhood to middle childhood in 48 children diagnosed with ASD at 24-months. The Mullen Scales of Early Learning (MSEL) was administered at 24- and 48-months and the Wechsler Abbreviated Scale of Intelligence (WASI) at school age. Autism severity was derived using The Autism Diagnostic Observation Schedule (ADOS) Results: Developmental Disability/Intellectual Disability (DD/ID; Developmental Quotient <70) reduced from 64% at 24-months to 8% at outcome. Seventy-three percent of children continued to meet ADOS cut-off at school age. CONCLUSION Diagnoses at 24-months, appear to be reliable and stable. Further research is needed to investigate whether early identification, which provides more opportunity to access early intervention, may in turn facilitate cognitive development over time.
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Lo BH, Klopper F, Barnes EH, Williams K. Agreement between concern about autism spectrum disorder at the time of referral and diagnosis, and factors associated with agreement. J Paediatr Child Health 2017; 53:742-748. [PMID: 28374573 DOI: 10.1111/jpc.13511] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 01/21/2017] [Indexed: 11/28/2022]
Abstract
AIM This study examined the level of agreement between referral reason and diagnostic outcome for pre-school aged children showing developmental delays and differences. In particular, the level of agreement when there was concern about autism spectrum disorder (ASD) was investigated. METHODS Clinical records for children (n = 677) assessed for developmental concerns at a multidisciplinary assessment clinic in Sydney, Australia, were examined. Referral reason and diagnostic outcome were compared. Referral sources and factors including age, developmental level and language functioning, were explored for potential association with the consistency between referral reason and diagnosis. RESULTS Approximately 30% of children referred for developmental assessment with ASD concern were not diagnosed with ASD. Agreement between referral reason and diagnosis was similar regardless of referral source and child age. Of children where diagnostic outcome was discordant with referral reason, 24% had delayed language. Variability in cognitive or developmental profiles was common (64%), regardless of diagnostic outcome. CONCLUSIONS Referral for ASD diagnostic assessments in the cases where ASD is not the primary cause for a child's difficulties increases pressure on assessment services, can delay access to ASD-specific intervention services for children who do have ASD, and can contribute to parent anxiety unnecessarily. The current evidence that a substantial minority of children were referred for ASD diagnostic assessments when ASD was not the primary cause for the difficulties emphasises the value of adopting a developmental differences framework, focusing on dimensions of behaviour and functioning, rather than an autism-specific service structure.
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Affiliation(s)
- Bee H Lo
- Parramatta Early Childhood Assessment Team, Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Felicity Klopper
- Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Elizabeth H Barnes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Katrina Williams
- Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Neurodevelopment and Disability, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Improving team-based care for children: shared well child care involving family practice nurses. Prim Health Care Res Dev 2017; 18:507-514. [PMID: 28578739 PMCID: PMC5577632 DOI: 10.1017/s1463423617000160] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Well child care (WCC) is the provision of routine preventative care and vaccinations to infants and children. In Canada, physicians provide the majority of this type of care, whereas in other developed countries, nurses provide most WCC. New models of shared care between nurses and family physicians should be explored. OBJECTIVE This pilot project aimed to evaluate the feasibility and acceptability of shared nurse-physician WCC for a cohort of healthy children. METHODS A total of 20 participants had nurse-physician alternating WCC visits, which were compared with physician-provided WCC visits. The feasibility was evaluated through chart audits and the acceptability was evaluated through interviews with the physicians, nurses, and the patients' parents. RESULTS The results showed that physicians and nurses discuss a similar percentage of Rourke Baby Record topics, and that families and clinic staff were accepting of this new model of care. CONCLUSION This intervention could liberate time for Canadian family physicians, thereby improving access to care.
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May T, Sciberras E, Brignell A, Williams K. Autism spectrum disorder: updated prevalence and comparison of two birth cohorts in a nationally representative Australian sample. BMJ Open 2017; 7:e015549. [PMID: 28490562 PMCID: PMC5623420 DOI: 10.1136/bmjopen-2016-015549] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/20/2017] [Accepted: 03/21/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This study aimed to (1) provide an update on the prevalence of parent-reported autism spectrum disorder (ASD) diagnosis and new information about teacher-reported ASD in two nationally representative Australian cohorts at ages 10-11 years, (2) examine differences in cohort demographic and clinical profiles and (3) compare the prevalence of teacher-reported ASD and any changes in categorisation over time across the cohorts. DESIGN Secondary analyses were undertaken using data from the Longitudinal Study of Australian Children (LSAC). PARTICIPANTS Children were recruited at kindergarten age (K cohort; birth year 1999/2000) and birth (B cohort; birth year 2003/2004), with follow-up of every 2 years for six waves. PRIMARY OUTCOME MEASURES Parent-reported and teacher-reported ASD diagnosis was ascertained at three time points (waves 4-6). RESULTS At age 10-11 years, the adjusted prevalence of parent-reported ASD diagnosis was 3.9% (95% CI 3.2 to 4.5) and 2.4% (95% CI 1.6 to 2.9) in the B and K cohorts, respectively. Teacher-reported prevalence of ASD was 1.7% (95% CI 1.2 to 2.1) in the B cohort and 0.9% (95% CI 0.56 to 1.14) in the K cohort. Parents reported fewer conduct and peer problems and teachers more pro-social behaviour in B relative to K cohort ASD children. Children reported only by parents in the later-born B cohort had milder behaviour problems than parent-agreed and teacher-agreed cases. Although individual switching to ASD from other categories from 8-9 to 10-11 years was low (K cohort n=5, B cohort n=6), teachers reported more children with ASD in the B than K cohort at 10-11 years and fewer children with emotional/ behavioural problems. CONCLUSIONS The higher prevalence of parent-reported and teacher-reported ASD diagnosis in the later-born cohort may be partially explained by identifying children with milder behavioural problems as ASD and a change in the use of diagnostic categories in schools.
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Affiliation(s)
- Tamara May
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Emma Sciberras
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Amanda Brignell
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Katrina Williams
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
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31
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Hatakenaka Y, Ninomiya H, Billstedt E, Fernell E, Gillberg C. ESSENCE-Q - used as a screening tool for neurodevelopmental problems in public health checkups for young children in south Japan. Neuropsychiatr Dis Treat 2017; 13:1271-1280. [PMID: 28546752 PMCID: PMC5436770 DOI: 10.2147/ndt.s132546] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Screening for developmental disorders is an important task for Child Health Care. The concept of ESSENCE (early symptomatic syndromes eliciting neurodevelopmental clinical examinations) was created to cover all types of early developmental disorders and the ESSENCE-Questionnaire (ESSENCE-Q containing 12 questions with possible total scores ranging from 0 to 22) was developed as a tool for early detection of these disorders. The aim of this study was to perform a validation study in a public health situation in Japan. METHODS The psychometric properties of the ESSENCE-Q, completed by mothers, public health nurses (PHNs), and psychologists at 18-month (n=143 children) and 36-month (n=149 children) checkups were evaluated in a small city of Japan. Results were validated against clinical ESSENCE diagnoses. Receiver operating characteristic curves were generated and compared by using the area under the curve (AUC). Optimal cutoff values were explored. RESULTS At the 18-month checkup, AUC by mothers was 0.72, by PHNs 0.86, and by psychologists 0.82. An optimal cutoff was 3 with a high negative predictive value (NPV). At the 36-month checkup, AUC by mothers was 0.57, by PHNs 0.82, and by psychologists 0.87. Optimal cutoff was 2 with high NPV. CONCLUSION The ESSENCE-Q completed by PHNs and psychologists had good diagnostic validity. The results suggested that almost all children scoring under cutoff would not have any ESSENCE problems/diagnoses.
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Affiliation(s)
- Yuhei Hatakenaka
- Kochi Gillberg Neuropsychiatry Centre, Kochi Prefectural Medical and Welfare Center, Kochi, Japan.,Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hitoshi Ninomiya
- Integrated Centre for Advanced Medical Technologies, Kochi University Medical School, Kochi, Japan
| | - Eva Billstedt
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elisabeth Fernell
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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32
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Barbaro J, Dissanayake C. Diagnostic stability of autism spectrum disorder in toddlers prospectively identified in a community-based setting: Behavioural characteristics and predictors of change over time. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 21:830-840. [DOI: 10.1177/1362361316654084] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Autism spectrum disorder diagnoses in toddlers have been established as accurate and stable across time in high-risk siblings and clinic-referred samples. Few studies have investigated diagnostic stability in children prospective identified in community-based settings. Furthermore, there is a dearth of evidence on the individual behaviours that predict diagnostic change over time. The stability and change of autism spectrum disorder diagnoses were investigated from 24 to 48 months in 77 children drawn from the Social Attention and Communication Study. Diagnostic stability was high, with 88.3% overall stability and 85.5% autism spectrum disorder stability. The behavioural markers at 24 months that contributed to diagnostic shift off the autism spectrum by 48 months included better eye contact, more directed vocalisations, the integration of gaze and directed vocalisations/gestures and higher non-verbal developmental quotient. These four variables correctly predicted 88.7% of children into the autism spectrum disorder–stable and autism spectrum disorder–crossover groups overall, with excellent prediction for the stable group (96.2%) and modest prediction for the crossover group (44.4%). Furthermore, non-verbal developmental quotient at 24 months accounted for the significant improvement across time in ‘Social Affect’ scores on the Autism Diagnostic Observation Schedule for both groups and was the only unique predictor of diagnostic crossover. These findings contribute to the body of evidence on the feasibility of diagnoses at earlier ages to facilitate children’s access to interventions to promote positive developmental outcomes.
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33
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Early Identification of Autism Spectrum Disorder: Current Challenges and Future Global Directions. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2016. [DOI: 10.1007/s40474-016-0078-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Alexander KE, Brijnath B, Mazza D. The challenges of trying to increase preventive healthcare for children in general practice: results of a feasibility study. BMC FAMILY PRACTICE 2015; 16:94. [PMID: 26242986 PMCID: PMC4545853 DOI: 10.1186/s12875-015-0306-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 07/09/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND In Australia, general practice, the linchpin for delivery of preventive health care to large segments of the population, provides child-immunisation and preventive health alongside government services. Despite this, less than half of eligible children complete a Healthy Kids Check (HKC), a preschool preventative health assessment available since 2008. Using a rigorous theoretical process, the barriers that affected delivery and reduced general practitioner and practice nurse motivation to provide HKCs, were addressed. The resulting multifaceted intervention, aimed at increasing the proportion of children receiving evidence informed HKCs from general practice, was piloted to inform a future randomised controlled trial. METHODS The intervention was piloted in a before and after study at three sites located southeast of Melbourne, between February and October 2014. The HKC-intervention involved: 1) Delivery of training modules that motivated reception and clinical staff by delivering key messages about local prevalence rates and the "Core Story of Child Development" 2) Practical advice to prepare clinics for specific HKC-examinations 3) Workflow advice regarding systems that included all staff in the HKC process, and 4) Provision of a "Community Resources Folder" that enabled decision making and referrals. A major component of the intervention incorporated the promotion of structured developmental screening by the practice team using Parents' Evaluation of Developmental Status. RESULTS Twenty of 22 practitioners and practice managers agreed to join the study. Post-training questionnaires showed participants had developed their skills working with young children as a result of the training and all respondents believed they had successfully implemented standardised HKC services. Post intervention proportions of children completing HKCs significantly increased in two of the practices and quality improvements in HKC-processes were recorded across all three sites. CONCLUSION This pilot study confirmed the feasibility of delivering a multi-faceted intervention to increase HKCs from general practice and demonstrated that significant quality improvements could be made. Future studies need to extend the intervention to other states and research the health outcomes of HKCs.
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Affiliation(s)
- Karyn E Alexander
- Department of General Practice, School of Primary Health Care, Monash University, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia.
| | - Bianca Brijnath
- Department of General Practice, School of Primary Health Care, Monash University, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia.
| | - Danielle Mazza
- Department of General Practice, School of Primary Health Care, Monash University, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia.
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Davis T, Clifton D, Papadopoulos C. Identifying autism early: The Toddlers at Risk of Autism Clinic model. J Paediatr Child Health 2015; 51:699-703. [PMID: 25623060 DOI: 10.1111/jpc.12832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2014] [Indexed: 12/11/2022]
Abstract
AIM This paper describes the Toddlers at Risk of Autism Clinic (TRAC), which utilises the Social Attention and Communication Study (SACS) and/or Autism Detection in Early Childhood (ADEC) play-based assessments to facilitate the early diagnosis of autism. METHODS A retrospective audit was conducted of all 42 children assessed over a 3-year period in the TRAC. A semi-structured interview and play-based assessment (SACS and ADEC) were used to aid experienced clinicians in diagnosing autism. Intervention was recommended, and families were routinely followed up. Analysis was conducted on the tools used, the outcomes of assessment, diagnosis and stability of diagnosis on follow-up. RESULTS During this period, 35 boys and 7 girls were assessed, with a mean age of 25 months. The average waiting time for clinic was 11.6 weeks. Twenty-five patients were diagnosed with autism; 90.5% of toddlers given an initial diagnosis retained that diagnosis at follow-up. Out of the 17 children who were not diagnosed with autism in the TRAC, one child was later diagnosed with autism. CONCLUSION Experienced clinicians can use the SACS and/or ADEC to assist with a Diagnostic and Statistical Manual diagnosis of autism in toddlers.
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Affiliation(s)
- Tessa Davis
- Kogarah Developmental Assessment Service, Sydney, New South Wales, Australia
| | - Deirdre Clifton
- Kogarah Developmental Assessment Service, Sydney, New South Wales, Australia
| | - Con Papadopoulos
- Kogarah Developmental Assessment Service, Sydney, New South Wales, Australia
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36
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Vivanti G, Paynter J, Duncan E, Fothergill H, Dissanayake C, Rogers SJ. Effectiveness and feasibility of the early start denver model implemented in a group-based community childcare setting. J Autism Dev Disord 2015; 44:3140-53. [PMID: 24974255 DOI: 10.1007/s10803-014-2168-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A recent study documented the efficacy of the Early Start Denver Model (ESDM) delivered in a 1:1 fashion. In the current study we investigated the effectiveness and feasibility of the ESDM in the context of a long-day care community service, with a child-staff ratio of 1:3. Outcomes of 27 preschoolers with ASD undergoing 15-25 h per week of ESDM over 12 months were compared to those of 30 peers with ASD undergoing a different intervention program delivered in a similar community long-day care service. Children in both groups made gains in cognitive, adaptive and social skills. Participants in the ESDM group showed significantly higher gains in developmental rate and receptive language.
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Affiliation(s)
- Giacomo Vivanti
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University, Bundoora Campus, Melbourne, VIC, 3086, Australia,
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Doyle LW, Anderson PJ, Battin M, Bowen JR, Brown N, Callanan C, Campbell C, Chandler S, Cheong J, Darlow B, Davis PG, DePaoli T, French N, McPhee A, Morris S, O’Callaghan M, Rieger I, Roberts G, Spittle AJ, Wolke D, Woodward LJ. Long term follow up of high risk children: who, why and how? BMC Pediatr 2014; 14:279. [PMID: 25399544 PMCID: PMC4289257 DOI: 10.1186/1471-2431-14-279] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 10/15/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Most babies are born healthy and grow and develop normally through childhood. There are, however, clearly identifiable high-risk groups of survivors, such as those born preterm or with ill-health, who are destined to have higher than expected rates of health or developmental problems, and for whom more structured and specialised follow-up programs are warranted. DISCUSSION This paper presents the results of a two-day workshop held in Melbourne, Australia, to discuss neonatal populations in need of more structured follow-up and why, in addition to how, such a follow-up programme might be structured. Issues discussed included the ages of follow-up, and the personnel and assessment tools that might be required. Challenges for translating results into both clinical practice and research were identified. Further issues covered included information sharing, best practice for families and research gaps. SUMMARY A substantial minority of high-risk children has long-term medical, developmental and psychological adverse outcomes and will consume extensive health and education services as they grow older. Early intervention to prevent adverse outcomes and the effective integration of services once problems are identified may reduce the prevalence and severity of certain outcomes, and will contribute to an efficient and effective use of health resources. The shared long-term goal for families and professionals is to work toward ensuring that high risk children maximise their potential and become productive and valued members of society.
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Affiliation(s)
- Lex W Doyle
- />Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria Australia
- />Department of Paediatrics, The University of Melbourne, Melbourne, Victoria Australia
- />Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria Australia
- />Premature Infant Follow-up Program, The Royal Women’s Hospital, Parkville, Victoria Australia
- />Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, 20 Flemington Road, Parkville, Victoria 3052 Australia
| | - Peter J Anderson
- />Department of Paediatrics, The University of Melbourne, Melbourne, Victoria Australia
- />Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria Australia
- />Premature Infant Follow-up Program, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Malcolm Battin
- />National Women’s Hospital, Auckland City Hospital, Auckland, New Zealand
| | - Jennifer R Bowen
- />Department of Neonatology, Royal North Shore Hospital, Sydney, New South Wales Australia
| | - Nisha Brown
- />Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria Australia
- />Department of Paediatrics, The University of Melbourne, Melbourne, Victoria Australia
- />Newborn Services, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Catherine Callanan
- />Premature Infant Follow-up Program, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Catherine Campbell
- />Neonatal Paediatrics, King Edward Memorial Hospital, Perth, Western Australia Australia
| | - Samantha Chandler
- />Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, 20 Flemington Road, Parkville, Victoria 3052 Australia
| | - Jeanie Cheong
- />Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria Australia
- />Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria Australia
- />Premature Infant Follow-up Program, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Brian Darlow
- />Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Peter G Davis
- />Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria Australia
- />Premature Infant Follow-up Program, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Tony DePaoli
- />Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania Australia
| | - Noel French
- />Neonatal Paediatrics, King Edward Memorial Hospital, Perth, Western Australia Australia
| | - Andy McPhee
- />Neonatal Services, Women’s and Children’s Health Network, North Adelaide, South Australia Australia
| | - Shusannah Morris
- />Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, 20 Flemington Road, Parkville, Victoria 3052 Australia
| | - Michael O’Callaghan
- />Paediatrics and Child Health, Mater Clinical School, University of Queensland, Brisbane, Queensland Australia
| | - Ingrid Rieger
- />Department of Neonatal Medicine, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales Australia
- />Faculty of Medicine, University of Sydney, Sydney, New South Wales Australia
| | - Gehan Roberts
- />Department of Paediatrics, The University of Melbourne, Melbourne, Victoria Australia
- />Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria Australia
- />Community Child Health, The Royal Children’s Hospital, Parkville, Victoria Australia
| | - Alicia J Spittle
- />Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria Australia
- />Department of Physiotherapy, The University of Melbourne, Parkville, Victoria Australia
| | - Dieter Wolke
- />Department of Psychology, The University of Warwick, Coventry, UK
| | - Lianne J Woodward
- />Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
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Henderson J, Koehne K, Verrall C, Gebbie K, Fuller J. How is Primary Health Care conceptualised in nursing in Australia? A review of the literature. HEALTH & SOCIAL CARE IN THE COMMUNITY 2014; 22:337-351. [PMID: 23952616 DOI: 10.1111/hsc.12064] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/21/2013] [Indexed: 06/02/2023]
Abstract
Australia, in common with many other countries, is expanding the role of Primary Health Care (PHC) to manage the growing burden of chronic disease and prevent hospitalisation. Australia's First National Primary Health Care Strategy released in 2010 places general practice at the centre of care delivery, reflecting a constitutional division of labour in which the Commonwealth government's primary means of affecting care delivery in this sector is through rebates for services delivered from the universal healthcare system Medicare. A review of Australian nursing literature was undertaken for 2006-2011. This review explores three issues in relation to these changes: How PHC is conceptualised within Australian nursing literature; who is viewed as providing PHC; and barriers and enablers to the provision of comprehensive PHC. A review of the literature suggests that the terms 'PHC' and 'primary care' are used interchangeably and that PHC is now commonly associated with services provided by practice nurses. Four structural factors are identified for a shift away from comprehensive PHC, namely fiscal barriers, educational preparation for primary care practice, poor role definition and interprofessional relationships. The paper concludes that while moves towards increasing capacity in general practice have enhanced nursing roles, current policy and the nature of private business funding alongside some medical opposition limit opportunities for Australian nurses working in general practice.
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Affiliation(s)
- Julie Henderson
- School of Nursing & Midwifery, Flinders University, Adelaide, SA, Australia
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Ben-Sasson A, Habib S, Tirosh E. Feasibility and validity of early screening for identifying infants with poor social-communication development in a well-baby clinic system. J Pediatr Nurs 2014; 29:238-47. [PMID: 24333238 DOI: 10.1016/j.pedn.2013.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 11/02/2013] [Accepted: 11/06/2013] [Indexed: 11/26/2022]
Abstract
UNLABELLED This study examined the feasibility and validity of implementing an autism spectrum disorders (ASD) screening for 12-month-old infants. METHOD Parents of 583 infants, 12months of age attending well baby clinics (WBCs), completed the First Year Inventory-Lite (FYI-L). Ten infants who failed the FYI-L and a subset of 12 infants who passed the identified FYI-L were evaluated using the Autism Observation Scale for Infants (AOSI) and the Mullen Scales of Early Learning. Information regarding social-communication development ≥24months of age was extracted from medical records of 153 of the 583 infants. RESULTS Mean response rate across clinics was 26.63%. Infants at risk compared to controls showed significantly higher scores on the AOSI, lower composite scores on the MSEL, and a higher rate of referral for a developmental evaluation. At 24months, 95% of infants who were negatively screened had no social-communication problems on their medical records; 60% of those who were screened positive had documented problems on medical records. CONCLUSION ASD screening using the FYI-L at 12months in a healthcare setting identifies infants with poor social-communication development, yet parents had low compliance with screening.
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Affiliation(s)
- Ayelet Ben-Sasson
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
| | - Sonia Habib
- Haifa District, Ministry of Health, Haifa, Israel
| | - Emanuel Tirosh
- Hannah Khousy Child Development Center, Bnai Zion Medical Center and Rappoport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Vivanti G, Barbaro J, Hudry K, Dissanayake C, Prior M. Intellectual development in autism spectrum disorders: new insights from longitudinal studies. Front Hum Neurosci 2013; 7:354. [PMID: 23847518 PMCID: PMC3701858 DOI: 10.3389/fnhum.2013.00354] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 06/20/2013] [Indexed: 11/29/2022] Open
Abstract
The presence/absence of Intellectual Disability (ID) is considered to be the most critical factor affecting outcomes in individuals with Autism Spectrum Disorders (ASD). However, the question of the specific nature of ID in ASD has received little attention, with the current view being that ID is a comorbid condition (i.e., one that is unrelated in etiology and causality from the ASD itself). Recent advances in developmental neuroscience, highlighting the importance of early exposure to social experiences for cognitive development, support an alternative view; that ID in ASD might emerge as a consequence of severe social-communication deficits on the experience-dependent mechanisms underlying neurocognitive development. We tested this prediction in two independent samples of young children with ASD (Ns = 23 and 60), finding that children with greater ASD severity at an initial assessment were more likely to present with poorer cognitive outcomes at a later assessment, irrespective of initial cognitive level. The results of this proof of principle study suggest that ASD symptom severity contributes to the extent to which the environmental input required to support “typical” brain development can be processed by the individual, so that the risk of developing ID increases as the number and severity of ASD social-communicative impairments increase.
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Affiliation(s)
- Giacomo Vivanti
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University , Melbourne, VIC , Australia ; Victorian Autism Specific Early Learning and Care Centre, La Trobe University , Melbourne, VIC , Australia
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Barbaro J, Dissanayake C. Developmental profiles of infants and toddlers with autism spectrum disorders identified prospectively in a community-based setting. J Autism Dev Disord 2013; 42:1939-48. [PMID: 22310906 DOI: 10.1007/s10803-012-1441-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This prospective, longitudinal, study charted the developmental profiles of young children with Autism Spectrum Disorders (ASD) identified through routine developmental surveillance. 109 children with Autistic Disorder (AD), 'broader' ASD, and developmental and/or language delays (DD/LD) were assessed using the Mullen Scales of Early Learning (MSEL) at 12-months (n = 10 assessments), 18-months (n = 45 assessments), and 24-months (n = 99 assessments). The children with AD performed most poorly, overall, than the ASD and DD/LD groups on the MSEL. Furthermore, the children with AD/ASD displayed an uneven cognitive profile, with poorer performance on verbal (particularly receptive language) relative to nonverbal skills. There was also evidence of developmental slowing in verbal skills from 18- to 24-months for children on the spectrum, especially those with AD. Given that the poor receptive, relative to expressive, language profile emerges very early in life for children with AD/ASD, this cognitive profile may serve as an additional red flag to social attention and communication deficits. Receptive language should therefore be stringently monitored in any developmental surveillance program for autism spectrum disorders in the second year of life.
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Affiliation(s)
- Josephine Barbaro
- School of Psychological Science, Olga Tennison Autism Research Centre, La Trobe University, Bundoora, VIC, 3083, Australia.
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Barbaro J, Dissanayake C. Early markers of autism spectrum disorders in infants and toddlers prospectively identified in the Social Attention and Communication Study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2012; 17:64-86. [PMID: 22735682 DOI: 10.1177/1362361312442597] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Social Attention and Communication Study involved the successful implementation of developmental surveillance of the early markers of autism spectrum disorders in a community-based setting. The objective in the current study was to determine the most discriminating and predictive markers of autism spectrum disorders used in the Social Attention and Communication Study at 12, 18 and 24 months of age, so that these could be used to identify children with autism spectrum disorders with greater accuracy. The percentage of 'yes/no' responses for each behavioural marker was compared between children with autistic disorder (n = 39), autism spectrum disorder (n = 50) and developmental and/or language delay (n = 20) from 12 to 24 months, with a logistic regression also conducted at 24 months. Across all ages, the recurring key markers of both autistic disorder and autism spectrum disorder were deficits in eye contact and pointing, and from 18 months, deficits in showing became an important marker. In combination, these behaviours, along with pretend play, were found to be the best group of predictors for a best estimate diagnostic classification of autistic disorder/autism spectrum disorder at 24 months. It is argued that the identified markers should be monitored repeatedly during the second year of life by community health-care professionals.
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Affiliation(s)
- Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University, Australia.
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Christian BJ. Research commentary-evaluating educational programs in pediatric nursing: translating research outcomes to improve practice. J Pediatr Nurs 2011; 26:383-4. [PMID: 21726791 DOI: 10.1016/j.pedn.2011.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Becky J Christian
- University of Alabama at Birmingham, School of Nursing, Birmingham, AL, USA.
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