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Floríndez LI, Como DH, Law E, Tran CF, Johnson R, Polido JC, Cermak SA, Stein Duker LI. Oral care interventions for autistic individuals: A systematic review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241260171. [PMID: 39056277 DOI: 10.1177/13623613241260171] [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: 07/28/2024]
Abstract
LAY ABSTRACT Oral care-related challenges are well documented in the autistic community; dental care remains one of the most prevalent unmet health needs among autistic individuals. This review examined interventions designed to improve oral health in autistic individuals from children and adult populations. Through a systematic process, 36 studies were identified. These studies focused on improving home-based oral care skills and routines and reducing fear, anxiety, and/or negative behaviors in the dental clinic. Studies incorporated different types of techniques for facilitating oral care practice, including preparatory interventions to support home-based hygiene activities or improve an approaching dental encounter (n = 29), most often using visual aids, and/or strategies to manage behavioral difficulties exhibited in the dental office (n = 17). Some studies used both approaches (n = 10), combining visual aids prior to a visit with behavior management. Using an evidence-based rubric, we reviewed the methodological quality of the studies and found that most were only "adequate" (n = 8) or "weak" (n = 23) in reporting their evidence. This review has two key findings: (1) there is support for preparatory home-based visual interventions to improve toothbrushing and/or ready patients for dental visits; and (2) distraction or sensory-reducing interventions may also improve experiences in the dental clinic. Only one study purposefully recruited autistic adults, and no studies included intervention elements tailored to race/ethnicity, culture, and/or socioeconomic status. This review highlights the need for more studies investigating the impact of oral care-related interventions for autistic individuals of all ages and identifies a gap in interventions for autistic adults and those from minoritized populations.
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Pang RCC, Ho MSH, Wong PWC. A Review of the Literature on the Multiple Forms of Stigmatization of Caregivers of Children with Autism Among Ethnic Minority Groups. J Racial Ethn Health Disparities 2024; 11:545-559. [PMID: 36877377 DOI: 10.1007/s40615-023-01540-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 03/07/2023]
Abstract
Multiple forms of stigmatization are experienced by caregivers of children with autism among ethnic minority (EM) groups in various countries. Such forms of stigmatization can lead to delayed assessment and services for mental health among children and caregivers. This review identified the research literature on the types of stigmatization experienced by caregivers of children with autism with an EM background. A total of 19 studies published after 2010 (i.e., 12 from the USA, 2 from the UK, 1 from Canada, and 1 from New Zealand) of caregivers of 20 ethnicities were identified and reviewed, and their reporting qualities systematically also assessed. Four main themes: (1) self-stigma, (2) social stigma, (3) stigma towards EM parents of children on the autism spectrum, and (4) service utilization stigma, and nine sub-themes were identified. The discrimination experienced by caregivers were extracted, synthesized, and further discussed. While the reporting quality of the studies included is good, the depth of the understanding of this under-researched yet important phenomenon is very limited. The multiple forms of stigmatization experiences are complex, and it may be difficult to disentangle whether the causes of stigmatization were autism and/or EM related, and the types of stigmatization can vary enormously among different ethnic groups in different societies. More quantitative studies are needed to quantify the impacts of multiple forms of stigmatization on families of children with autism in EM groups so that more socially inclusive support for caregivers with an EM background in host countries can be developed.
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Affiliation(s)
| | - Mimi S H Ho
- Department of Special Education and Counselling, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, Hong Kong
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Angell AM, Lindly OJ, Floríndez D, Floríndez LI, Duker LIS, Zuckerman KE, Yin L, Solomon O. Pediatricians' role in healthcare for Latino autistic children: Shared decision-making versus "You've got to do everything on your own". AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:2407-2421. [PMID: 37070240 PMCID: PMC10579452 DOI: 10.1177/13623613231163056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
LAY ABSTRACT Latino parents may choose to use complementary health approaches, such as vitamins, supplements, and special diets, for their autistic children. However, they might not tell their pediatrician about their complementary health approach use if they worry that the pediatrician will disapprove or judge them. This fear, along with pediatricians' lack of autism knowledge, creates barriers to "shared decision-making" between parents and pediatricians. Shared decision-making is a process where families and healthcare providers collaborate and exchange information in order to come to an agreement about treatment options. In our qualitative study with 12 bilingual Latino families of autistic children, we interviewed and observed families to learn about their experiences with both conventional healthcare (their pediatrician) and complementary health approaches. Our study results describe the parents' different pathways to an autism assessment, a process that is sometimes called the "diagnostic odyssey." The parents reported that conventional healthcare met their needs for their child's physical health but not for their child's developmental challenges. The parents who used complementary health approaches for their autistic children were more frustrated about a lack of autism information from pediatricians than those who did not use complementary health approaches. Finally, we describe two examples of successful shared decision-making between parents and pediatricians. We conclude that pediatricians who are able to talk about complementary health approaches with Latino families may help to facilitate shared decision-making and reduce healthcare disparities for Latino autistic children.
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Affiliation(s)
- Amber M. Angell
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles CA
| | - Olivia J. Lindly
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ
| | | | - Lucía I. Floríndez
- Department of Nursing Research, Cedars Sinai Medical Center, Los Angeles CA
| | - Leah I. Stein Duker
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles CA
| | - Katharine E. Zuckerman
- Division of General Pediatrics and OHSU-PSU School of Public Health, Oregon Health & Science University, Portland OR
| | - Larry Yin
- Keck School of Medicine and Children’s Hospital Los Angeles, University of Southern California, Los Angeles CA
| | - Olga Solomon
- Department of Nursing Research, Cedars Sinai Medical Center, Los Angeles CA
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Luelmo P, Larios R, Castellon F. Latinx caregivers and autism identification: what we know a scoping review. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 70:571-581. [PMID: 38983495 PMCID: PMC11229736 DOI: 10.1080/20473869.2022.2114777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 08/14/2022] [Indexed: 07/11/2024]
Abstract
This is a scoping review driven by the broad research question: What are Latinx caregivers' specific facilitators and challenges, if any, in getting a timely diagnosis/identification for their child with autism? Our search resulted in 128 articles across various disciplines. A total of 43 articles were included in the final article set. Employing an inductive process, the experiences of Latinx caregiver(s) in obtaining a diagnosis/identification were coded and categorized. From that process, three broad themes were identified: (1) Diagnosis/identification barriers and facilitators (2) System changes and (3) Cultural adaptations and intersectionality. These themes represent the myriad of considerations that have been purported in the existing body of literature to frame an understanding of the experiences that Latinx/Hispanic caregivers encounter as they seek to obtain an autism diagnosis/identification for their child.
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Affiliation(s)
- Paul Luelmo
- Department of Special Education, San Diego State University, San Diego, CA, USA
| | - Rosalinda Larios
- Department of Special Education, California State Fullerton, Fullerton, CA, USA
| | - Fernanda Castellon
- Department of Education, University of California, Los Angeles, Los Angeles, CA, USA
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Cycyk LM, Coles K, O'Dea K, Moore H, Sanford-Keller H, Dolata J, De Anda S, Gomez M, Huerta L, Libak A, Zuckerman KE. Serving young children with communication disabilities from Latinx backgrounds and their families with equity: Provider perspectives. JOURNAL OF COMMUNICATION DISORDERS 2022; 99:106254. [PMID: 36027806 PMCID: PMC10069936 DOI: 10.1016/j.jcomdis.2022.106254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 07/22/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Latinx children with communication disorders from birth to age 5 and their families are increasingly served in United States (US) educational and medical settings where longstanding structural barriers threaten their access to equitable assessment and intervention. However, little is known about providers' perceptions serving this highly diverse population as they relate to reducing disparities in care for communication disorders. METHODS This exploratory qualitative study interviewed 24 speech-language pathologists (SLPs) and early intervention (EI)/early childhood special education (ECSE) developmental specialists serving young Latinx children with communication disorders to offer targeted recommendations toward improving equity. The semi-structured interview included questions regarding communication assessment, diagnostics/eligibility, intervention, interpretation, translation, and solutions to enhance EI/ECSE. Interviews were coded with content analysis using elements of grounded theory, and responses from SLPs in medical versus education settings and from EI/ECSE developmental specialists were compared. Data triangulation was used to validate themes. RESULTS Analysis revealed the following themes related to provider challenges and resources: family factors, provider factors, cultural and linguistic differences, assessment approaches, eligibility determinations, translation and interpretation, and institutional factors. Few variations in themes between provider types (SLPs vs. EI/ECSE developmental specialists) and settings (medical vs. educational) were found. Providers also offered several policy and practice solutions. CONCLUSIONS Findings suggest minimal advances in improving equity for young Latinx children with communication disorders over prior decades. Results also indicate that providers may benefit from reflecting on their cultures and biases as well as systemic racism within EI/ECSE.
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Affiliation(s)
- Lauren M Cycyk
- University of Oregon, 1215 University of Oregon, Eugene, OR, United States.
| | - Katie Coles
- University of Oregon, 1215 University of Oregon, Eugene, OR, United States
| | - Kenneth O'Dea
- University of Oregon, 1215 University of Oregon, Eugene, OR, United States
| | - Heather Moore
- Western Washington University, 516 High St., Bellingham, WA, United States
| | - Hannah Sanford-Keller
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, United States
| | - Jill Dolata
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, United States
| | - Stephanie De Anda
- University of Oregon, 1215 University of Oregon, Eugene, OR, United States
| | - Mauricio Gomez
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, United States
| | - Lidia Huerta
- University of Oregon, 1215 University of Oregon, Eugene, OR, United States
| | - Alyssa Libak
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, United States
| | - Katharine E Zuckerman
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, United States
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Rivera-Figueroa K, Marfo NYA, Eigsti IM. Parental Perceptions of Autism Spectrum Disorder in Latinx and Black Sociocultural Contexts: A Systematic Review. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 127:42-63. [PMID: 34979034 PMCID: PMC8740628 DOI: 10.1352/1944-7558-127.1.42] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 03/30/2021] [Indexed: 05/15/2023]
Abstract
Parents of children with autism spectrum disorder (ASD) face challenges in accessing diagnostic and treatment services; these challenges vary by race, ethnicity, and culture. This systematic review examines parental perceptions of ASD within Latinx and Black American communities. Findings indicate that interconnections with family and religious groups promoted positive coping and describe positive impacts of having a child with ASD. Relative to White families, community members reported reduced access to information and more inaccurate beliefs about ASD, higher levels of ASD-related stigma, and more negative experiences with healthcare providers, which serve to exacerbate healthcare disparities. Conclusions are limited by an underrepresentation of minority groups in research. We call for efforts to address the specific needs of racial and ethnic minorities.
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Affiliation(s)
- Karla Rivera-Figueroa
- Karla Rivera-Figueroa, Nana Yaa A. Marfo, and Inge-Marie Eigsti, University of Connecticut
| | - Nana Yaa A Marfo
- Karla Rivera-Figueroa, Nana Yaa A. Marfo, and Inge-Marie Eigsti, University of Connecticut
| | - Inge-Marie Eigsti
- Karla Rivera-Figueroa, Nana Yaa A. Marfo, and Inge-Marie Eigsti, University of Connecticut
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Papoudi D, Jørgensen CR, Guldberg K, Meadan H. Perceptions, Experiences, and Needs of Parents of Culturally and Linguistically Diverse Children with Autism: a Scoping Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2020. [DOI: 10.1007/s40489-020-00210-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AbstractA scoping review of studies carried out in the UK and the USA was conducted to explore the perceptions, experiences, and needs of culturally and linguistically diverse families of children with autism. Overall, 32 articles met the inclusion criteria, 25 studies were conducted in the USA and 7 studies in the UK. Four themes emerged including (a) knowledge and beliefs about autism and their impact on the family; (b) autism and family life; (c) family experiences of accessing services and support, and parents’ needs; and (d) multilanguage. Findings highlighted that family perceptions of autism are influenced by an often-reported lack of knowledge; experiences include social stigma as well as difficulties in having access to services. Needs indicate the development of culturally sensitive interventions, information in multiple languages, and parent–professional collaboration. Implications for research, policy, and practice are included.
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Floríndez LI, Floríndez DC, Floríndez FM, Como DH, Pyatak E, Baezconde-Garbanati L, Polido JC, Cermak SA. Oral Care Experiences of Latino Parents/Caregivers with Children with Autism and with Typically Developing Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2905. [PMID: 31416123 PMCID: PMC6721061 DOI: 10.3390/ijerph16162905] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/03/2019] [Accepted: 08/09/2019] [Indexed: 12/17/2022]
Abstract
As a result of various barriers, several pediatric populations are at risk for poor oral health, including children with disabilities and children from under-represented populations, such as Latinos. To this end, this study aimed to better understand the factors that affect the oral health experiences of 32 Latino parents/caregivers from 18 families (n = 8 with a typically developing child and n = 10 with a child with Autism). Using a qualitative descriptive methodology, each family was interviewed twice. Interviews were audio-recorded, transcribed verbatim, and coded thematically to identify the individual, social, systemic, and culturally rooted factors contributing to oral health disparities in the families. The three themes that arose were "Why would I want to start trouble?": Latino parents' dissatisfaction with dental treatments, costs, and fear of the dentist and health care providers because of their ethnic minority status as key factors inhibiting receipt of dental care; "We have to put our children first": prioritizing the oral care activities of their children over their own individual oral care needs; and "We always keep baking soda around": familial and cultural influences on oral care habits. Understanding the oral health beliefs and experiences of Latino parents and caregivers of children with and without autism is critical for developing targeted prevention and intervention programs and reducing oral health disparities.
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Affiliation(s)
- Lucía I Floríndez
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA.
| | | | | | - Dominique H Como
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA
| | - Elizabeth Pyatak
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA
| | | | - Jose C Polido
- Division of Dentistry, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA
| | - Sharon A Cermak
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA
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Broder-Fingert S, Qin S, Goupil J, Rosenberg J, Augustyn M, Blum N, Bennett A, Weitzman C, Guevara JP, Fenick A, Silverstein M, Feinberg E. A mixed-methods process evaluation of Family Navigation implementation for autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:1288-1299. [PMID: 30404548 DOI: 10.1177/1362361318808460] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
There is growing interest in Family Navigation as an approach to improving access to care for children with autism spectrum disorder, yet little data exist on the implementation of Family Navigation. The aim of this study was to identify potential failures in implementing Family Navigation for children with autism spectrum disorder, using a failure modes and effects analysis. This mixed-methods study was set within a randomized controlled trial testing the effectiveness of Family Navigation in reducing the time from screening to diagnosis and treatment for autism spectrum disorder across three states. Using standard failure modes and effects analysis methodology, experts in Family Navigation for autism spectrum disorder (n = 9) rated potential failures in implementation on a 10-point scale in three categories: likelihood of the failure occurring, likelihood of not detecting the failure, and severity of failure. Ratings were then used to create a risk priority number for each failure. The failure modes and effects analysis detected five areas for potential "high priority" failures in implementation: (1) setting up community-based services, (2) initial family meeting, (3) training, (4) fidelity monitoring, and (5) attending testing appointments. Reasons for failure included families not receptive, scheduling, and insufficient training time. The process with the highest risk profile was "setting up community-based services." Failure in "attending testing appointment" was rated as the most severe potential failure. A number of potential failures in Family Navigation implementation-along with strategies for mitigation-were identified. These data can guide those working to implement Family Navigation for children with autism spectrum disorder.
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Affiliation(s)
| | - Sarah Qin
- 2 The Children's Hospital of Philadelphia, USA
| | | | | | | | | | | | | | | | | | | | - Emily Feinberg
- 1 Boston University School of Medicine, USA.,5 Boston University School of Public Health, USA
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Angell AM, Carroll TC, Bagatell N, Chen C, Kramer JM, Schwartz A, Tallon MB, Hammel J. Understanding self-determination as a crucial component in promoting the distinct value of occupational therapy in post-secondary transition planning. JOURNAL OF OCCUPATIONAL THERAPY SCHOOLS AND EARLY INTERVENTION 2018; 12:129-143. [PMID: 31289605 DOI: 10.1080/19411243.2018.1496870] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
School-based occupational therapists are well-equipped to prepare adolescents to transition from the education system to work and live in their communities, but they report challenges in securing their place on post-secondary transition planning teams. We argue that occupational therapists' efforts to advocate for their role in post-secondary transition could be strengthened by a deeper engagement with what is considered 'best practice' in transition planning: improving students' ability and opportunity to exercise self-determination. In this commentary, we review the self-determination evidence-base; identify congruence between the underlying philosophies of self-determination and occupational therapy; and highlight gaps in existing self-determination models that occupational therapists are uniquely posed to fill by focusing on self-determination as they support transition age students.
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Affiliation(s)
- Amber M Angell
- University of Illinois at Chicago, Department of Occupational Therapy, 1919 W Taylor St (MC 811), Chicago, IL 60612
| | - Theresa Carlson Carroll
- University of Illinois at Chicago, Department of Occupational Therapy, 1919 W Taylor St (MC 811), Chicago, IL 60612
| | - Nancy Bagatell
- University of North Carolina at Chapel Hill, Division of Occupational Science and Occupational Therapy, Bondurant Hall CB #7122, Chapel Hill, NC 27599-7122
| | - Cheryl Chen
- Easterseals Academy Chicago, 1939 West 13th St, Suite 300, Chicago, IL 60608-1226
| | - Jessica M Kramer
- Boston University, Department of Occupational Therapy, 635 Commonwealth Ave., Boston, MA 02215
| | - Ariel Schwartz
- Boston University, Department of Occupational Therapy, 635 Commonwealth Ave., Boston, MA 02215
| | - Mary Betsey Tallon
- Easterseals Academy Chicago, 1939 West 13th St, Suite 300, Chicago, IL 60608-1226
| | - Joy Hammel
- University of Illinois at Chicago, Department of Occupational Therapy, 1919 W Taylor St (MC 811), Chicago, IL 60612
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