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McMaughan DJ, Lewis C, McGehee A, Noreen D, Parker E, Criss MM. Meaningful Social Inclusion and Mental Well-Being Among Autistic Adolescents and Emerging Adults: Protocol for a Community-Based Mixed Methods Study. JMIR Res Protoc 2024; 13:e52658. [PMID: 38483470 PMCID: PMC10979331 DOI: 10.2196/52658] [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: 09/12/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND In the United States, autistic people face high rates of co-occurring mental illnesses and premature death due to self-harm, which are indicators of threats to mental well-being. Social inclusion may enhance mental well-being and resilience among autistic people. According to Simplican and colleague's (2015) model of social inclusion for people with intellectual and developmental disabilities, social inclusion is an interaction between community participation and interpersonal relationships. There is limited research on social inclusion that includes the integration of interpersonal relationships and community participation among autistic people or the impact of social inclusion on the well-being of autistic people. Additionally, little evidence exists regarding how autistic people prefer to be included in the community or form interpersonal relationships. OBJECTIVE The long-term objective of this project is to improve social inclusion factors to support the mental well-being of autistic people. This protocol describes a community-based, mixed methods pilot study to develop a definition of meaningful social inclusion for autistic people and to understand the relationship between meaningful social inclusion and mental well-being among autistic adolescents and emerging adults. METHODS The project uses a community-based, sequential mixed methods design with a formative phase (Phase 1) that informs a survey phase (Phase 2) and concludes with a process evaluation of the community engagement process (Phase 3). During Phase 1, we will recruit 10 community partners (autistic adults and stakeholders) and conduct sharing sessions to cocreate a definition of meaningful social inclusion and a survey of meaningful social inclusion and well-being. During Phase 2, we will recruit 200 participants (100 autistic adolescents and emerging adults and 100 caregivers) to complete the survey. We will examine whether meaningful social inclusion predicts well-being given sociodemographic factors using ordered logistic regression, with well-being categorized as low, medium, and high. During Phase 3, the community partners from Phase 1 will complete a survey on their experiences with the project. RESULTS Ethics approval was obtained for this project in March 2023. We have recruited community partners and started the Phase 1 focus groups as of September 2023. Phase 2 and Phase 3 have not yet started. We expect to complete this study by March 2025. CONCLUSIONS Using a community-based, mixed methods approach, we intended to develop a definition of meaningful social inclusion for autistic people and understand the role meaningful social inclusion plays in the well-being of autistic people. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52658.
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Affiliation(s)
- Darcy Jones McMaughan
- Human Development and Family Science, Oklahoma State University, Stillwater, OK, United States
| | - Casey Lewis
- Human Development and Family Science, Oklahoma State University, Stillwater, OK, United States
| | - Amy McGehee
- Human Development and Family Science, Oklahoma State University, Stillwater, OK, United States
| | - Dani Noreen
- Neurodiversity Unbound, Aurora, CO, United States
| | - Elliot Parker
- Human Development and Family Science, Oklahoma State University, Stillwater, OK, United States
| | - Michael M Criss
- Human Development and Family Science, Oklahoma State University, Stillwater, OK, United States
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Orsmond GI, Krishnan SG, Munsell EGS, Cohn ES, Coster WJ. Describing Outcomes in Autistic Young Adults One Year After High School Graduation. J Autism Dev Disord 2024:10.1007/s10803-023-06152-x. [PMID: 38285097 DOI: 10.1007/s10803-023-06152-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE Research documents poor outcomes for autistic adults in the domains of employment, independent living, and social relationships. Measurement and sample limitations in prior studies may have amplified past estimates of poor outcomes. The goal of the current study was to improve upon past approaches and to create and describe a measurement approach to capture adult outcomes that reflected the context of young adulthood and the perspectives of autistic individuals, pairing objective outcome indicators with subjective satisfaction indicators. METHODS Thirty-six autistic young adults (mean age 19.8 years) and a parent completed self-report surveys. Using these data, we defined an objective and subjective (i.e., satisfaction) outcome indicator in each of three domains: productivity (employment or post-secondary education), social well-being (frequency of contact with friends), and living situation (autonomy). RESULTS Three-quarters of young adults experienced at least 5 out of 6 positive outcomes. Over 90% were engaged in school, work, or a structured transition program, and an equal percentage were satisfied with their productivity activity. Over three-quarters of adults had a good amount of contact with friends and were satisfied with their social life. Most young adults had a moderate level of autonomy in their daily lives, and all were satisfied with their living situation. CONCLUSION Tailoring outcome measurement approaches specifically for autistic young adults provided a more optimistic portrayal of outcomes than previously noted in the literature. The approach used better reflects a neurodiversity approach and may be useful for evaluating the effectiveness of transition services or interventions.
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Affiliation(s)
- Gael I Orsmond
- Department of Occupational Therapy, Boston University, 635 Commonwealth Ave, Boston, MA, 02215, USA.
| | - Sharada G Krishnan
- Department of Occupational Therapy, Boston University, 635 Commonwealth Ave, Boston, MA, 02215, USA
| | | | - Ellen S Cohn
- Department of Occupational Therapy, Boston University, 635 Commonwealth Ave, Boston, MA, 02215, USA
| | - Wendy J Coster
- Department of Occupational Therapy, Boston University, 635 Commonwealth Ave, Boston, MA, 02215, USA
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Roux AM, Shea LL, Steinberg H, Rast JE, Anderson KA, Hotez E, Rosenau K, Kuo A, Assing-Murray E, Shattuck PT. Evidence from the Autism Transitions Research Project (2017-2022): Capstone review and services research recommendations. Autism Res 2023; 16:480-496. [PMID: 36622799 DOI: 10.1002/aur.2890] [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: 10/04/2022] [Accepted: 12/28/2022] [Indexed: 01/10/2023]
Abstract
Few funding sources have explicitly supported systems-wide research to identify mechanisms for improving access, service delivery, outcomes and wellbeing for autistic transition-age youth and young adults. We aimed to integrate findings from research produced through a five-year federal Autism Transition Research Project (ATRP) cooperative agreement. This capstone review sought to: (1) map the body of scientific evidence that emerged from this federal award, and (2) identify remaining evidence gaps to inform future autism transition services research. We used scoping review methods to assess 31 ATRP-funded published scientific studies. We charted study characteristics, topical domains, socio-ecological levels of variables, focus on equity, and inclusion of autistic participants. We evaluated how these topics were addressed across studies to identify continued gaps in the evidence base. Compared to prior published reviews and research agendas, we found improvements in characterization of study participants, broader examination of socio-ecological correlates, and examination of multiple outcome domains. However, we also identified continued deficits in inclusion of autistic study participants, use of multisectoral data, and research with a strong focus on equity. Our recommended priorities for autism transition services research to facilitate healthy life outcomes and wellbeing included: continued analysis of population-level data and improved data infrastructure; development of service delivery methods and interventions that target marginalized groups; expanded research to inform improvements in the performance and coordination of complex service ecosystems that interface with autistic youth; and bolstering the roles of autistic research participants.
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Affiliation(s)
- Anne M Roux
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Lindsay L Shea
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Hillary Steinberg
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Jessica E Rast
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Kristy A Anderson
- School of Social Work, Florida State University, Tallahassee, Florida, USA
| | - Emily Hotez
- Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Kashia Rosenau
- Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Alice Kuo
- Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Evva Assing-Murray
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland, USA
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Chen YJ, Duku E, Zaidman-Zait A, Szatmari P, Smith IM, Ungar WJ, Zwaigenbaum L, Vaillancourt T, Kerns C, Bennett T, Elsabbagh M, Thompson A, Georgiades S. Variable patterns of daily activity participation across settings in autistic youth: A latent profile transition analysis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:13623613231154729. [PMID: 36855223 PMCID: PMC10576904 DOI: 10.1177/13623613231154729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
LAY ABSTRACT What people do or engage in in their daily lives, or daily life participation, is often linked to their state of being happy and healthy, as well as potential for living independently. To date, little research has been conducted on daily activity participation by autistic youth at home, at school or in the community. Learning more about individual differences in participation levels and what might influence them can help to create custom supports for autistic youth and their families. In this study, 158 caregivers of autistic youth were asked how often their children took part in 25 common activities at two assessments, about one year apart. The analysis showed three profiles for each of the home and school settings and two profiles for the community setting. These profiles reflected distinct patterns in how often autistic youth took part in various daily activities, particularly in doing homework, school club activities and community gatherings. Most autistic youth were in profiles marked by often taking part at home but less often at school and in the community, and about three-fourths of them tended to stay in the same profile over time. Autistic youth with limited participation profiles were more likely to have lower scores on measures of cognitive ability and daily life skills and more challenging behaviour, and faced more barriers in their environment. These findings show how important it is to think about each autistic person's strengths and weaknesses, and changing needs, to better support their daily life participation.
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Affiliation(s)
| | | | | | - Peter Szatmari
- The Hospital for Sick Children, Canada
- University of Toronto, Canada
- Centre for Addiction and Mental Health, Canada
| | | | - Wendy J Ungar
- The Hospital for Sick Children, Canada
- University of Toronto, Canada
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Tint A, Chung H, Lai MC, Balogh R, Lin E, Durbin A, Lunsky Y. Health conditions and service use of autistic women and men: A retrospective population-based case-control study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023:13623613221144353. [PMID: 36588296 PMCID: PMC10374994 DOI: 10.1177/13623613221144353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
LAY ABSTRACT This study used administrative data from Ontario, Canada to compare the health conditions and service use of autistic women and men with adults with other developmental disabilities and with adults without developmental disabilities. Autistic women and men were more likely to have physical and mental health conditions compared to adults without developmental disabilities. Rates of health conditions were similar or lower among autistic adults compared to adults with other developmental disabilities, except more autistic adults had psychiatric conditions. Autistic women and men used higher rates of psychiatric services compared to all other groups. When comparing autistic women with same aged autistic men, sex differences were found for specific physical (Crohn's disease/colitis, rheumatoid arthritis) and psychiatric conditions (psychotic disorders, non-psychotic disorders), as well differences in service use (emergency department visits, hospitalizations, family doctor and neurologist visits). These results further highlight the high health needs and service use of autistic women and men, as well as adults with other developmental disabilities. It is critical for future research to focus on mental health support for autistic adults and to better understand how to tailor supports to best serve autistic women.
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Affiliation(s)
- Ami Tint
- Centre for Addiction and Mental Health, Canada
| | | | - Meng-Chuan Lai
- Centre for Addiction and Mental Health, Canada.,University of Toronto, Canada.,The Hospital for Sick Children, Canada.,University of Cambridge, United Kingdom.,National Taiwan University Hospital, Taiwan
| | | | - Elizabeth Lin
- Centre for Addiction and Mental Health, Canada.,University of Toronto, Canada
| | - Anna Durbin
- ICES, Canada.,University of Toronto, Canada.,Unity Health, Canada
| | - Yona Lunsky
- Centre for Addiction and Mental Health, Canada.,ICES, Canada.,University of Toronto, Canada
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Song W, Nonnemacher SL, Miller KK, Anderson K, Shea LL. Living arrangements and satisfaction of current arrangement among autistic adults reported by autistic individuals or their caregivers. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:1174-1185. [DOI: 10.1111/jar.13003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 02/18/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Wei Song
- College of Public Health Temple University Philadelphia Pennsylvania USA
| | - Stacy L. Nonnemacher
- Pennsylvania Department of Human Services, Office of Developmental Programs Bureau of Supports for Autism and Special Populations Harrisburg Pennsylvania USA
| | - Kaitlin Koffer Miller
- A.J. Drexel Autism Institute, Policy and Analytics Center Drexel University Philadelphia Pennsylvania USA
| | - Kristy Anderson
- A.J. Drexel Autism Institute, Drexel University Philadelphia Pennsylvania USA
| | - Lindsay L. Shea
- A.J. Drexel Autism Institute, Drexel University Philadelphia Pennsylvania USA
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Bagatell N, Chan DV, Syu YC, Lamarche EM, Klinger LG. Sensory Processing and Community Participation in Autistic Adults. Front Psychol 2022; 13:876127. [PMID: 35719479 PMCID: PMC9201716 DOI: 10.3389/fpsyg.2022.876127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/17/2022] [Indexed: 11/28/2022] Open
Abstract
Background Sensory processing differences have been shown to impact involvement in community activities. However, relatively little is known about how these differences affect community participation in autistic adults. Objective The objective of this study was to explore how sensory processing patterns of autistic adults impact community participation, including where people go, what they do, the amount of time in the community, and preferred locations. Methods We used data gathered from six autistic adults and their caregivers who participated in two studies. From Study 1, we reviewed results of the Adolescent and Adult Sensory Profile (AASP) and transcripts from interviews with caregivers. From Study 2, we reviewed GPS tracking data and transcripts from structured interviews with autistic adults focused on community participation. We read transcript data, identified quotes related to sensory processing and community participation and constructed individual participant narratives which linked findings from interviews, AASP, and GPS tracking. Results Participants included three males and three females ranging in age from 29 to 51. Each participant had a unique sensory processing profile that influenced where they went, the activities in which they engaged, how much time they spent in the community, and their preferred locations. Those whose sensory processing patterns indicated sensory sensitivity and sensory avoiding described the experience of certain environments as overwhelming and fatiguing and thus spent less time in the community and visited fewer places than those with other sensory processing patterns. Conclusion Results highlight the importance of sensory processing, especially as it impacts participation in the community. Sensory processing patterns should be considered along with other personal and contextual factors when assessing community participation and personal sensory processing patterns should be matched with activities and environmental demands.
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Affiliation(s)
- Nancy Bagatell
- Division of Occupational Science and Occupational Therapy, Department of Allied Health Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- *Correspondence: Nancy Bagatell,
| | - Dara V. Chan
- Division of Clinical Rehabilitation and Mental Health Counseling, Department of Allied Health Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ya-Cing Syu
- Division of Occupational Science and Occupational Therapy, Department of Allied Health Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Elena M. Lamarche
- TEACCH® Autism Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Laura G. Klinger
- TEACCH® Autism Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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