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Gilmore D, Hand BN. Diabetes mellitus in privately insured autistic adults in the United States. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1785-1794. [PMID: 37886796 DOI: 10.1177/13623613231206421] [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] [Indexed: 10/28/2023]
Abstract
LAY ABSTRACT Diabetes is a chronic health condition that is challenging to manage. Estimates of how common diabetes is among non-autistic adults are available, but improved estimates for autistic adults are needed. The purpose of this study was to obtain improved diabetes estimates for autistic adults. We analyzed a large private health insurance claims database to estimate how common diabetes was among autistic adults, and how likely autistic adults were to have diabetes compared to non-autistic adults at 5-year age intervals throughout adulthood (e.g. 18-22, 23-27). We found that diabetes was more common among autistic adults than non-autistic adults and that autistic adults were significantly more likely than non-autistic adults to have diabetes throughout most of adulthood. Our findings suggest that autistic adults may be more likely than non-autistic adults to experience diabetes in adulthood. The development of diabetes support services and programs that accommodate autistic adults' individual needs are important for future study to promote positive diabetes outcomes for autistic adults.
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Brady MJ, Jenkins CA, Gamble-Turner JM, Moseley RL, Janse van Rensburg M, Matthews RJ. "A perfect storm": Autistic experiences of menopause and midlife. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1405-1418. [PMID: 38622794 PMCID: PMC11135000 DOI: 10.1177/13623613241244548] [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: 04/17/2024]
Abstract
LAY ABSTRACT Previous studies report that menopause can be a very difficult transition for some autistic people. This study focuses on how autistic people experience menopause and what support and information might help them. Autistic Community Research Associates played an important role in the research and co-authored this article. We held four focus groups and eight interviews online with 24 autistic participants who lived in either Canada (n = 13) or the United Kingdom (n = 11). We analysed participant conversations using a method called reflexive thematic analysis. Participants described many intense challenges during menopause. Four themes and eight subthemes were identified across participant groups: (1) Complexity, multiplicity and intensity of symptoms (0 subthemes); (2) Life experience and adversity converging at midlife (three subthemes); (3) The importance of knowledge and connection (two subthemes); and (4) Barriers to support and care (three subthemes). The experiences of our participants may not be the same as other autistic people, and the study could have been more inclusive of diverse autistic groups. However, hearing about the experiences of others may provide reassurance to autistic people who struggle with menopause and let them know they are not alone.
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Pineo T. Clinical progress note: Caring for hospitalized Autistic adults. J Hosp Med 2024; 19:520-523. [PMID: 38372081 DOI: 10.1002/jhm.13307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 02/20/2024]
Affiliation(s)
- Thomas Pineo
- Division of Hospital Medicine, University of Pittsburgh Medical Center, Harrisburg, Pennsylvania, USA
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Rast JE, Fernandes SJ, Schott W, Shea LL. Disparities by Race and Ethnicity in Inpatient Hospitalizations Among Autistic Adults. J Autism Dev Disord 2024; 54:1672-1679. [PMID: 36757545 DOI: 10.1007/s10803-023-05911-0] [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] [Accepted: 01/20/2023] [Indexed: 02/10/2023]
Abstract
This study examined hospitalizations in a large, all-payer, nationally representative sample of inpatient hospitalizations in the US and identified differences in rates of hospitalization for conditions by race and ethnicity in autistic adults. Conditions examined included mood disorders, epilepsy, schizophrenia, and ambulatory care sensitive conditions (ACSCs). Compared to white, non-Hispanic autistic adults, Black, Hispanic, Asian or Pacific Islander (API), and autistic adults of another race had lower prevalence of admission for a principal diagnosis of a mood disorder. Conversely, Black, Hispanic, API, and autistic adults of another race had higher odds of admission for epilepsy than white autistic adults. Black and Hispanic autistic adults were more likely to have schizophrenia as a principal diagnosis compared to white autistic adults, but only Black autistic adults had increased odds for admission for an ACSCs compared to white autistic adults. Differences in diagnosis prevalence among hospitalized autistic adults may suggest differential access to comprehensive outpatient care that could prevent such hospitalizations, while also pointing to concerns of differential validity of diagnostic tools and treatment approaches. Insurance policy and programs should prioritize optimizing outpatient care to ensure access to care and emphasize the need for equitable treatment.
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Affiliation(s)
- Jessica E Rast
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA.
| | - Sherira J Fernandes
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Whitney Schott
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Lindsay L Shea
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
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Ames JL, Anderson MC, Cronbach E, Lee C, Onaiwu MG, Vallerie AM, Croen LA. Reproductive healthcare in adolescents with autism and other developmental disabilities. Am J Obstet Gynecol 2024; 230:546.e1-546.e14. [PMID: 38218512 PMCID: PMC11070300 DOI: 10.1016/j.ajog.2024.01.005] [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] [Received: 06/30/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND Adults with developmental disabilities often have less access to reproductive health services than adults without these disabilities. However, little is known about how adolescents with developmental disabilities, including autism, access reproductive healthcare. OBJECTIVE We aimed to characterize the use of reproductive healthcare services among adolescents with autism and those with other developmental disabilities in comparison with adolescents with typical development. STUDY DESIGN We conducted a cohort study of a sample of adolescents who were continuously enrolled members of Kaiser Permanente Northern California, an integrated healthcare system, from ages 14 to 18 years. The final analytical sample included 700 adolescents with autism, 836 adolescents with other developmental disabilities, and 2187 typically developing adolescents who sought care between 2000 and 2017. Using the electronic health record, we obtained information on menstrual conditions, the use of obstetrical-gynecologic care, and prescriptions of hormonal contraception. We compared healthcare use between the groups using chi-square tests and covariate-adjusted risk ratios estimated using modified Poisson regression. RESULTS Adolescents with autism and those with other developmental disabilities were significantly more likely to have diagnoses of menstrual disorders, polycystic ovary syndrome, and premenstrual syndrome than typically developing adolescents. These 2 groups also were less likely than typically developing peers to visit the obstetrician-gynecologist or to use any form of hormonal contraception, including oral contraception, hormonal implants, and intrauterine devices. Adolescents in all 3 groups accessed hormonal contraception most frequently through their primary care provider, followed by an obstetrician-gynecologist. CONCLUSION Adolescents with autism and those with other developmental disabilities are less likely than their typically developing peers to visit the obstetrician-gynecologist and to use hormonal contraception, suggesting possible care disparities that may persist into adulthood. Efforts to improve access to reproductive healthcare in these populations should target care delivered in both the pediatric and obstetrics-gynecology settings.
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Affiliation(s)
- Jennifer L Ames
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.
| | | | - Emily Cronbach
- The Permanente Medical Group, Obstetrics and Gynecology, Kaiser Permanente Northern California Park Shadelands, Walnut Creek, CA
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Morénike Giwa Onaiwu
- Autistic Women and Nonbinary Network, Lincoln, NE; Rice University Center for the Study of Women, Gender, and Sexuality, Houston, TX; AJ Drexel Autism Institute, Drexel University, Philadelphia, PA
| | - Amy M Vallerie
- The Permanente Medical Group, Obstetrics and Gynecology Kaiser Permanente Northern California, Oakland, CA
| | - Lisa A Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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Greenwood E, Cooklin A, Barbaro J, Miller C. Autistic patients' experiences of the hospital setting: A scoping review. J Adv Nurs 2024; 80:908-923. [PMID: 37743597 DOI: 10.1111/jan.15880] [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: 04/14/2023] [Revised: 08/25/2023] [Accepted: 09/10/2023] [Indexed: 09/26/2023]
Abstract
AIM To explore the factors that affect the experiences of autistic patients in the hospital setting. DESIGN A scoping review. DATA SOURCES A systematic literature search using the databases CINAHL, Medline and Google Scholar was undertaken in September 2021 and updated in January 2023. This review is based on the methodological framework of Arksey and O'Malley (International Journal of Social Research Methodology, 8(1):19-32, 2005), which was further refined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. RESULTS Autistic patients, as well as their families and healthcare staff, face several barriers that can impact their healthcare experiences within hospital settings. Of 211 articles screened, 30 were eligible and included. Through our review, we identified two main themes. The first theme, 'challenges to hospital experiences', includes four sub-themes: (1) communication, (2) a mismatch between the needs for autistic patients and the hospital environment, (3) challenges related to parents' experiences and (4) challenges related to hospital systems. The second theme, 'facilitators that improve hospital experiences', includes three sub-themes: (1) provision of care pathways, (2) partnership between parents and experts and (3) facilitators to improve hospital systems. By understanding these themes, we can work to address the barriers that autistic patients and their families face, while leveraging the facilitators to improve their hospital experiences. CONCLUSION It is critical to understand the experiences of autistic patients in the hospital setting because they present a substantial risk of hospital admission due to their associated acute to chronic health conditions. Additionally, nurses and other medical staff must understand the unique hospital experiences and challenges of autistic patients to improve care and facilitate better hospital experiences. This review further highlights the crucial need to adopt a collaborative and inclusive approach between autistic patients, their families and healthcare staff. To achieve this, co-design initiatives that incorporate the perspectives and lived experiences of the autistic community are necessary. By placing autistic voices at the forefront of these initiatives, it is hoped that changes are meaningful, relevant and can be sustained. IMPACT Understanding the unique hospital experiences and challenges of autistic patients can improve their quality of life and well-being by reducing stress and anxiety during hospitalization, leading to better health outcomes and potentially shorter hospital stays. It can also promote a more positive view of healthcare among autistic individuals, encouraging them to seek medical care when needed and have broader societal impacts such as reducing healthcare costs and improving the overall health and well-being of the population. Autistic patients present a substantial risk of hospital admission due to their associated acute to chronic conditions. Nurses and other medical staff must understand the unique hospital experiences and challenges of autistic patients to improve care and facilitate better hospital experiences. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Elly Greenwood
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Amanda Cooklin
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Charne Miller
- Department of Nursing, School of Health Sciences, University of Melbourne Affiliated with School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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Failla C, Chilà P, Vetrano N, Doria G, Scarcella I, Minutoli R, Gismondo S, Pioggia G, Marino F. From crisis to opportunity: integrating insights from COVID-19 into the autism research. Front Psychiatry 2024; 15:1341737. [PMID: 38404473 PMCID: PMC10884285 DOI: 10.3389/fpsyt.2024.1341737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/17/2024] [Indexed: 02/27/2024] Open
Affiliation(s)
- Chiara Failla
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
- Classical Linguistic Studies and Education Department, Kore University of Enna, Enna, Italy
| | - Paola Chilà
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
- Faculty of Psychology, International Telematic University Uninettuno, Roma, Italy
| | - Noemi Vetrano
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
- Department of Cognitive, Psychological Science and Cultural Studies, University of Messina, Messina, Italy
| | - Germana Doria
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
- Faculty of Psychology, International Telematic University Uninettuno, Roma, Italy
| | - Ileana Scarcella
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
- Faculty of Psychology, International Telematic University Uninettuno, Roma, Italy
| | - Roberta Minutoli
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
- Faculty of Psychology, International Telematic University Uninettuno, Roma, Italy
| | - Stefania Gismondo
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
| | - Flavia Marino
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
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Bahry S, Gerhardt PF, Weiss MJ, Leaf JB, Putnam RF, Bondy A. The Ethics of Actually Helping People: Targeting Skill Acquisition Goals That Promote Meaningful Outcomes for Individuals with Autism Spectrum Disorder. Behav Anal Pract 2023; 16:672-695. [PMID: 37680332 PMCID: PMC10480108 DOI: 10.1007/s40617-022-00757-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2022] [Indexed: 12/14/2022] Open
Abstract
As a field that predominately supports individuals with autism spectrum disorder (ASD), we have an ethical duty as behavior analysts to ensure that the goals we write and interventions we prescribe promote best outcomes across the lifespan. This is critical, given that as it stands now, outcomes in adulthood for individuals with ASD are poor in every area assessed. The Ethics Code for Behavior Analysts can be interpreted to provide support for teaching the right goals, the right way, with respect to inherent rights of those we serve, in order to help affect positive changes in these outcomes. The present article highlights ethical themes that are relevant in order to affect these changes that are supported by the Code, as well as actionable steps to take next. The aim is to provide a resource for practitioners to use in clinical practice and in making ethical decisions that will help to improve outcomes for individuals with autism in adulthood. In addition, recommendations are made about integrating these values and approaches in terms of training, supervision, advocacy, and research.
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Affiliation(s)
- Shanna Bahry
- Endicott College, Beverly, MA USA
- Meaningful HOPE, East Providence, RI USA
| | | | | | - Justin B. Leaf
- Endicott College, Beverly, MA USA
- Autism Partnership Foundation, Seal Beach, CA USA
| | - Robert F. Putnam
- Endicott College, Beverly, MA USA
- May Institute, Randolph, MA USA
| | - Andy Bondy
- Pyramid Educational Consultants, New Castle, DE USA
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Chen Y, Gutierrez V, Morris L, Marti JL. Diagnostic Scrutiny and Patterns of Elevated Cancer Risk: Uncovering Overdiagnosis Through Standardized Incidence Ratios. Cureus 2023; 15:e42439. [PMID: 37637595 PMCID: PMC10447997 DOI: 10.7759/cureus.42439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Certain medical diagnoses and environmental or occupational exposures may be associated with elevated risk of cancer diagnosis, either through causal mechanisms or via increased detection of a subclinical reservoir through increased diagnostic scrutiny (overdiagnosis). The present study aimed to investigate the distribution of elevated cancer risks associated with different diagnoses and exposures. A systematic literature search was conducted to identify studies published in the last 30 years that examined the standardized incidence ratio (SIR) associated with exposures and risk factors. Meta-SIRs for each cancer type were calculated. The distribution of elevated cancer risks was then compared between cancer types previously reported to be susceptible to overdiagnosis and those that have not been associated with overdiagnosis. The review of 108 studies identified four patterns: SIR generally elevated for 1) only overdiagnosis-susceptible cancer types, 2) both overdiagnosed and non-overdiagnosed cancer types, 3) select cancers in accordance with risk factor or exposure, and 4) SIRs that did not exhibit a distinct increase in any cancer type. The distribution of elevated cancer risks may serve as a signature of whether the underlying risk factor or exposure is a carcinogenic process or a mechanism of increased diagnostic scrutiny uncovering clinically occult diseases. The identification of increased cancer risk should be viewed with caution, and analyzing the pattern of elevated cancer risk distribution can potentially reveal conditions that appear to be cancer risk factors but are in fact the result of exposure to medical surveillance or other healthcare activities that lead to the detection of indolent tumors.
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Affiliation(s)
- Yunchan Chen
- Department of Surgery, Weill Cornell Medicine, New York, USA
| | | | - Luc Morris
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Jennifer L Marti
- Division of Breast Surgical Oncology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, USA
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Gannotti ME, O’Neil ME, Fragala-Pinkham M, Gorton GE, Whitney DG. Policy brief: adaptive cycling equipment for individuals with neurodevelopmental disabilities as durable medical equipment. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1160948. [PMID: 37342677 PMCID: PMC10277568 DOI: 10.3389/fresc.2023.1160948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/04/2023] [Indexed: 06/23/2023]
Abstract
- Durable medical equipment (DME) policies require that the equipment be medically necessary; however, adaptive cycling equipment (bicycles and tricycles) are usually not deemed medically necessary. - Individuals with neurodevelopmental disabilities (NDD) are at high risk for secondary conditions, both physical and mental, that can be mitigated by increasing physical activity. - Significant financial costs are associated with the management of secondary conditions. - Adaptive cycling can provide improved physical health of individuals with NDD potentially reducing costs of comorbidities. - Expanding DME policies to include adaptive cycling equipment for qualifying individuals with NDD can increase access to equipment. - Regulations to ensure eligibility, proper fitting, prescription, and training can optimize health and wellbeing. - Programs for recycling or repurposing of equipment are warranted to optimize resources.
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Affiliation(s)
- Mary E. Gannotti
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, United States
| | - Margaret E. O’Neil
- Department of Physical Therapy & Kinesiology, University of Massachusetts Lowell, Lowell, MA, United States
| | - Maria Fragala-Pinkham
- Department of Physical and Occupational Therapy, Boston Children’s Hospital, Boston, MA, United States
| | - George E. Gorton
- Department of Research, Shriners Hospitals for Children, Springfield, MA, United States
| | - Daniel G. Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
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Holmes LG, Anderson K, Sieber GS, Shattuck PT. Sexual and reproductive health services for autistic young people in the United States: A conceptual model of utilization. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023; 55:49-61. [PMID: 36751875 DOI: 10.1363/psrh.12221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Sexual and reproductive health services promote the ability of people to have safe, satisfying, non-coercive sexual experiences and make informed decisions about pregnancy. Stakeholder input is needed to understand barriers or facilitators to service access for autistic people, who report unmet needs. METHODS We recruited 18 autistic people, 15 parents, and 15 service providers in the United States to participate in an interview and two surveys. Using their input, we created a conceptual model of sexual and reproductive health service needs, access barriers, and facilitators. RESULTS Stakeholders rated a variety of sexual and reproductive health services as important for autistic people, including those with intellectual disability or minimal verbal language. Stakeholders identified barriers to sexual and reproductive health service utilization including lack of service availability, lack of service providers with autism or neurodiversity training, lack of accurate information about autism and sexuality, verbal and communication differences that are not accommodated by service providers, and socio-cultural attitudes about sexuality. Stakeholders identified facilitators to service access including person-centered, trauma-informed care, service accommodations such as clear and detailed expectations, and long-enough appointments. We created a conceptual model based on the social ecological model of health to organize these utilization factors and support future research, provider, and policy action. Stakeholders provided feedback and responded favorably on the model's accuracy, utility for spurring research, practice, and policy improvements, and application to diverse groups of autistic people. CONCLUSIONS The model shows the many feasible ways to support equitable access to services for autistic people.
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Affiliation(s)
- Laura Graham Holmes
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
- Silberman School of Social Work, Hunter College, City University of New York, New York City, New York, USA
| | - Kristy Anderson
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
- Florida State University College of Social Work, Tallahassee, Florida, USA
| | - Greg S Sieber
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
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Davies C, Moosa M, McKenna K, Mittal J, Memis I, Mittal R, Eshraghi AA. Quality of Life, Neurosensory Disorders and Co-Occurring Medical Conditions in Individuals on the Spectrum, with a Special Focus on Females Diagnosed with Autism: A Systematic Review. J Clin Med 2023; 12:jcm12030927. [PMID: 36769575 PMCID: PMC9917678 DOI: 10.3390/jcm12030927] [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: 12/21/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that has a high prevalence and a significant economic impact. Our knowledge regarding neurosensory disorders and co-occurring medical conditions in the ASD population is limited, particularly for autistic women. Most of the studies include male participants or do not make comparisons with their female counterparts. The objective of this systematic review article is to explore the quality of life as well as the prevalence of neurosensory disorders and co-occurring medical conditions in individuals on the spectrum, with a special focus on autistic females. The literature search was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. A protocol of this systematic review was designed a priori and was registered in the PROSPERO database (registration number: CRD42022330368). We concluded that numerous medical areas were of concern. Autistic females are more likely than their male counterparts with ASD to suffer from psychiatric conditions such as post-traumatic stress syndrome, depression, and eating disorders. They are also more likely to report GI-related disturbances and chronic pain. Further investigations are warranted to determine quality of life, as well as the prevalence and severity of neurosensory disorders in individuals with ASD, specifically studies comparing autistic females with their male counterparts. The information derived from these studies will help develop better support systems for individuals with autism, particularly females on the spectrum, in pursuit of improving their quality of life.
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Affiliation(s)
- Camron Davies
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Moeed Moosa
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Keelin McKenna
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Jeenu Mittal
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Idil Memis
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Rahul Mittal
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Adrien A. Eshraghi
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Correspondence:
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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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Ames JL, Morgan EH, Giwa Onaiwu M, Qian Y, Massolo ML, Croen LA. Racial/Ethnic Differences in Psychiatric and Medical Diagnoses Among Autistic Adults. AUTISM IN ADULTHOOD 2022; 4:290-305. [PMID: 36601333 PMCID: PMC9807255 DOI: 10.1089/aut.2021.0083] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Racial/ethnic disparities in access to diagnostic services are pervasive for autistic children. However, a few studies have examined racial/ethnic health disparities among autistic adults, who commonly experience higher rates of health conditions than non-autistic adults. We aimed at examining the intersection of autism and race/ethnicity in association with psychiatric and medical diagnoses. Methods The study population included adult members of Kaiser Permanente Northern California enrolled from 2008 to 2012. We ascertained 1507 adults who had an autism diagnosis documented in their electronic medical records. We sampled a matched control group of adults without an autism diagnosis (N = 15,070) at a 10:1 ratio. Our sample was 46% White, 17% Hispanic, 16% Asian, 7% Black, and 14% other race/ethnicity. We compared health diagnoses (a) between autistic and non-autistic adults within strata of race/ethnicity and (b) across race/ethnicity within strata of autistic and non-autistic adults. Lastly, we examined the interaction between autism and race/ethnicity on both multiplicative and additive scales. Results Autistic adults were more likely to be diagnosed with most medical and psychiatric conditions compared with their non-autistic counterparts of the same race/ethnicity. Among autistic adults, Black, Hispanic, and Asian adults were less likely to be diagnosed with psychiatric conditions and Black and Hispanic autistic adults were more likely to be diagnosed with obesity than their White counterparts. In interaction models, we found that adults who were Black and autistic were disproportionately less likely to be diagnosed with psychiatric conditions and autoimmune disease and more likely to be diagnosed with hypertension than expected. Conclusion Health vulnerabilities may be compounded at the intersection of autism and race/ethnicity. Future research should continue to apply an intersectional lens toward understanding and addressing these disparities. Our findings likely underestimate the health disparities that exist in uninsured autistic adults and those living in other parts of the United States.
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Affiliation(s)
- Jennifer L. Ames
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Address correspondence to: Jennifer L. Ames, PhD, MS, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612-5190, USA
| | - Elizabeth H. Morgan
- College of Education California State University Sacramento, Sacramento, California, USA
| | - Morénike Giwa Onaiwu
- Center for the Study of Women, Gender, and Sexuality, Rice University, Houston, Texas, USA
| | - Yinge Qian
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Maria L. Massolo
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Lisa A. Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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15
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Taylor H, Ingham B, Mason D, Finch T, Wilson C, Scarlett C, Moss S, Buckley C, Urbanowicz A, Raymaker D, Seiboth C, Lees R, Garland D, Osbourne M, Lennox N, Cooper SA, Nicolaidis C, Parr JR. Co-design of an NHS primary care health check for autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 27:1079-1091. [PMID: 36409011 PMCID: PMC10115930 DOI: 10.1177/13623613221132921] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Autistic people experience more health conditions and earlier mortality. This study investigated views about a primary care health check for autistic adults to inform its design. Fifty-one people participated in consultation groups and interviews, comprising autistic adults (some with co-occurring intellectual disabilities), adults with intellectual disabilities, supporters and health professionals. Participants wanted the health check to cover physical and mental health and social functioning. They emphasised the importance of sharing information about individual needs and associated adjustments before the health check. They highlighted the need to change the way healthcare services communicate with autistic people, such as reducing phone contact and booking appointments online. They wanted individual choice in how the health check was completed, with video call or email offered alongside face-to-face. Participants raised the need for further training of primary care staff on autism, to highlight the diversity of experiences of autistic people and ways in which difficulties, such as pain, may present differently. Clinicians raised questions about the capacity of mental health and social care services to meet the additional needs potentially identified through the health check. This study represents a key step in the development and co-design of a UK primary care health check for autistic people. Lay abstract Autistic people are on average more likely to experience poor health than people who are not autistic. Health checks have been shown to improve access to effective healthcare. This study investigated people’s views about a primary care health check for autistic adults. We held discussion groups and interviewed autistic adults, adults with intellectual disabilities, supporters and health professionals. People wanted the health check to look at a person’s physical and mental health, and how they were doing socially. They thought people should be able to share information about their needs and the reasonable adjustments they would like before the health check. They wanted healthcare services to change the way they communicate with autistic people, such as being able to book appointments online rather than by telephone. They wanted a choice in how the health check was completed, with video call or email offered as well as face-to-face appointments. People thought further training of primary care staff on autism was needed, to increase awareness of the diversity of experiences of autistic people and ways in which difficulties, such as pain, may present differently to non-autistic people. Clinicians raised questions about whether mental health and social care services could meet the additional needs that might be identified through the health check. We used this information to design an NHS primary care health check for autistic people in collaboration with autistic people, supporters and health professionals.
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Affiliation(s)
| | - Barry Ingham
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | | | | | | | - Clare Scarlett
- NHS Newcastle Gateshead Clinical Commissioning Group, UK
- NHS North Tyneside Clinical Commissioning Group, UK
| | | | | | - Anna Urbanowicz
- The University of Queensland, Australia
- RMIT University, Australia
| | | | | | | | | | | | | | | | | | - Jeremy R Parr
- Newcastle University, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
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16
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Kyle G, Connolly A. Developing an e-learning curriculum to educate healthcare staff in the acute hospital setting about autism. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:894-900. [PMID: 36149418 DOI: 10.12968/bjon.2022.31.17.894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
When attending acute hospital settings, autistic children and adults rely on health professionals and ancillary staff to interact with them appropriately to facilitate accurate diagnoses and management of health concerns. Health outcomes for autistic people are adversely affected by comorbidities as well as difficulties in accessing and navigating acute healthcare environments. These factors demonstrate a need to develop targeted education for healthcare staff working in the acute hospital setting. This article discusses the background to the project, including the results of a literature review that highlighted some of the difficulties this patient group experiences in accessing health care. It discusses the development and evaluation of an e-learning education programme for healthcare staff working in an acute hospital setting using Kern et al's (1998) six-step approach to curriculum development. Staff reported a desire to learn more about autism and how to make patient consultations and experiences more accessible and productive. It was acknowledged that there are many undiagnosed autistic adults navigating the acute health system and it is anticipated that the e-learning programme will assist staff in identifying and meeting their needs. During research with an autism advocacy group, there was a clear recommendation for the use of the term 'autistic person' rather than 'person with autism', which is reflected in the resulting education programme and this article.
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Affiliation(s)
- Geraldine Kyle
- Nurse Tutor, Centre for Learning and Development, Tallaght University Hospital, Dublin, Ireland
| | - Aine Connolly
- Senior Clinical Neuropsychologist, Psychology Department, Tallaght University Hospital, Dublin, Ireland
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17
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Pellicano E, Fatima U, Hall G, Heyworth M, Lawson W, Lilley R, Mahony J, Stears M. A capabilities approach to understanding and supporting autistic adulthood. NATURE REVIEWS PSYCHOLOGY 2022; 1:624-639. [PMID: 36090460 PMCID: PMC9443657 DOI: 10.1038/s44159-022-00099-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 12/28/2022]
Abstract
There is little comprehensive research into autistic adulthood, and even less into the services and supports that are most likely to foster flourishing adult autistic lives. This limited research is partly because autism is largely conceived as a condition of childhood, but this focus of research has also resulted from the orthodox scientific approach to autism, which conceptualizes autistic experience almost entirely as a series of biologically derived functional deficits. Approaching autism in this way severely limits what is known about this neurodevelopmental difference, how research is conducted and the services and supports available. In this Review, we adopt an alternative research strategy: we apply Martha Nussbaum’s capabilities approach, which focuses on ten core elements of a thriving human life, to research on autistic adulthood. In doing so, we identify areas where autistic adults thrive and where they often struggle, and highlight issues to which researchers, clinicians and policymakers should respond. The resulting picture is far more complex than conventional accounts of autism imply. It also reveals the importance of engaging autistic adults directly in the research process to make progress towards genuinely knowing autism and supporting flourishing autistic lives. The focus on functional deficits in conventional autism research constrains understanding of autistic lives. In this Review, Pellicano et al. appraise research on autistic adulthood through a capabilities lens to identify areas where autistic adults thrive, and where more research and services are needed to enhance their quality of life.
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18
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Roestorf A, Howlin P, Bowler DM. Ageing and autism: A longitudinal follow-up study of mental health and quality of life in autistic adults. Front Psychol 2022; 13:741213. [PMID: 36081725 PMCID: PMC9447441 DOI: 10.3389/fpsyg.2022.741213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 06/29/2022] [Indexed: 12/27/2022] Open
Abstract
Background Poor mental health is known to adversely affect functional abilities, social isolation, and quality of life (QoL). It is, therefore, crucial to consider the long-term impacts of mental health conditions as autistic adults grow older. Objectives To explore, in a group of community-based autistic adults, the extent of: (i) autistic traits, co-occurring physical and mental health conditions; (ii) age-related differences in those conditions, and changes over time; and (iii) their impact on everyday living and QoL. Method About Sixty-eight autistic adults (aged 19–80 years) participated in the first study (T1); 49 participants from T1 took part in a follow-up at T2 (mean retest interval 2.4 years). Standardised self-report measures of autistic traits, mental health, and QoL were completed at both time points. Results Over two-thirds (71%) of autistic adult participants experienced at least one co-occurring condition, and over a third (37%) met the criteria for three or more co-occurring conditions. Mental and physical health difficulties were related to autistic traits and difficulties in everyday life and were consistent predictors of poor QoL at T1 and T2. Conclusion Mental health difficulties in autism persisted into older age and did not improve over time. These findings have important implications for mental health provision for autistic adults in older age.
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Affiliation(s)
- Amanda Roestorf
- Autism Research Group (ARG), Department of Psychology, City, University of London, London, United Kingdom
- *Correspondence: Amanda Roestorf,
| | - Patricia Howlin
- Department of Clinical Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Dermot M. Bowler
- Autism Research Group (ARG), Department of Psychology, City, University of London, London, United Kingdom
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19
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da Motta TP, Owens J, Abreu LG, Debossan SAT, Vargas-Ferreira F, Vettore MV. Malocclusion characteristics amongst individuals with autism spectrum disorder: a systematic review and meta-analysis. BMC Oral Health 2022; 22:341. [PMID: 35948958 PMCID: PMC9367144 DOI: 10.1186/s12903-022-02366-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background To estimate the prevalence of malocclusion in individuals with autism spectrum disorders (ASD) and to assess the relationship between ASD and malocclusion.
Methods We searched electronic databases including PubMed, Scopus, Web of Science, Cochrane, Embase, SciELO LILACS, Proquest, OpenGrey and Google Scholar. There were no language or publication dates restrictions. Two researchers independently performed selection, data extraction and quality assessment. Quality assessment and risk of bias were evaluated through the Newcastle–Ottawa scale and ROBINS-E tool. Meta-analyses using random effect models were used to estimate pooled measures of prevalence of malocclusion characteristics in individuals with ASD and pooled odds ratio (OR) on the relationship between ASD and malocclusion characteristics. Subgroup meta-analyses were conducted according to children and adolescents, history of orthodontic treatment, and occurrence of other syndromes and medical conditions. Results Searching identified 5549 papers with 238 were selected for full assessment. Eighteen cross-sectional studies were included according to inclusion criteria. Of them, eleven studies were considered of moderate quality. A judgement of critical risk of bias occurred for thirteen studies. The most prevalent malocclusion characteristics in individuals with ASD were crowding (33%; 95% CI 22 to 44%) and increased maxillary overjet (39%; 95% CI 23 to 54%). Individuals with ASD had higher odds of Angle’s Class II (OR 1.92; 95% CI 1.36 to 2.72), Angle’s Class III (OR 2.33; 95% CI 1.29 to 4.23), open bite (OR 1.96; 95% CI 1.21 to 3.16), and increased maxillary overjet (OR 1.53; 95% CI 1.06 to 2.21) than individuals without ASD. Conclusions Angle’s Class II, Angle’s Class III, anterior open bite and increased maxillary overjet were more prevalent in individuals with ASD than those without ASD. Further high-quality studies are needed.
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Affiliation(s)
- Thiago Peixoto da Motta
- Department of Social and Preventive Dentistry, School of Dentistry, Federal University of Minas Gerais, Av. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG, CEP 312270-901, Brazil
| | - Janine Owens
- NIHR Applied Research Collaborative, Greater Manchester (NIHR ARC GM), Faculty of Biology, Medicine and Health, Division of Nursing, Midwifery and Social Work, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Lucas Guimarães Abreu
- Department of Child and Adolescent Oral Health, School of Dentistry, Federal University of Minas Gerais, Av. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG, CEP 312270-901, Brazil
| | - Suélen Alves Teixeira Debossan
- Department of Social and Preventive Dentistry, School of Dentistry, Federal University of Minas Gerais, Av. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG, CEP 312270-901, Brazil
| | - Fabiana Vargas-Ferreira
- Department of Social and Preventive Dentistry, School of Dentistry, Federal University of Minas Gerais, Av. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG, CEP 312270-901, Brazil
| | - Mario Vianna Vettore
- Department of Health and Nursing Sciences, Faculty of Health and Sports Sciences, University of Agder, Campus Kristiansand, Universitetsveien 25, 4630, Kristiansand, Norway.
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20
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Alain G, Gilmore D, Krantz M, Hanks C, Coury DL, Moffatt-Bruce S, Garvin JH, Hand BN. Expenditures and Healthcare Utilization of Patients Receiving Care at a Specialized Primary Care Clinic Designed with and for Autistic Adults. J Gen Intern Med 2022; 37:2413-2419. [PMID: 34990000 PMCID: PMC9360285 DOI: 10.1007/s11606-021-07180-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/28/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND We previously found that autistic adults who received care through a primary care embedded specialized clinic, called the Center for Autism Services and Transition (CAST), had higher satisfaction, continuity of care, and preventive care use than national samples of autistic adults. OBJECTIVE Examine the impact of CAST on healthcare utilization and expenditures. DESIGN Retrospective study of medical billing data. SAMPLE CAST patients (N = 490) were propensity score matched to Medicare-enrolled autistic adults (N = 980) and privately insured autistic adults (N = 980) using demographic characteristics. The median age of subjects was 21 years, 79% were male, and the median duration of observation was 2.2 years. MAIN MEASURES We quantified expenditures and utilization for primary care; emergency department (ED) visits; inpatient hospitalizations; mental health admissions; and outpatient visits. KEY RESULTS CAST patients had the highest primary care utilization and expenditures. However, CAST patients had significantly lower expenditures than Medicare-enrolled autistic adults for mental health admissions ($1074 vs $1903), outpatient visits ($1671 vs $2979), and total expenditures ($5893 vs $6987), as well as 57% fewer inpatient hospitalizations. Compared to privately insured autistic adults, CAST patients had significantly lower expenditures for mental health admissions ($1074 vs $1362), inpatient hospitalizations ($3851 vs $4513), and outpatient visits ($1671 vs $6070), as well as 16% fewer inpatient hospitalizations, 24% fewer ED visits, and 50% fewer outpatient visits. On average, CAST patients had more ED visits, mental health admissions, and outpatient visits than Medicare-enrolled autistic adults and more mental health admissions than privately insured autistic adults. CONCLUSIONS Although CAST patients had greater primary care utilization and expenditures, our findings suggest embedding specialized clinics within broader primary care settings could be an alternative to current standards of care and may reduce expenditures and healthcare utilization in other areas, particularly relative to standard care for privately insured autistic adults.
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Affiliation(s)
- Gabriel Alain
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, USA
| | - Daniel Gilmore
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, USA
| | - Morgan Krantz
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, USA
| | - Christopher Hanks
- Center for Autism Services and Transition, Columbus, USA.,Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, USA
| | | | | | - Jennifer H Garvin
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, USA
| | - Brittany N Hand
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, USA.
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21
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Brasher S, Stapel-Wax JL, Muirhead L. Racial and Ethnic Disparities in Autism Spectrum Disorder. Nurs Clin North Am 2022; 57:489-499. [DOI: 10.1016/j.cnur.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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22
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Weir E, Allison C, Baron-Cohen S. Autistic adults have poorer quality healthcare and worse health based on self-report data. Mol Autism 2022; 13:23. [PMID: 35619147 PMCID: PMC9135388 DOI: 10.1186/s13229-022-00501-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/13/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Recent research suggests that autistic individuals have shorter lifespans and experience worse health (greater health burden) than non-autistic individuals. Small, qualitative studies suggest that autistic adults also experience poor self-reported healthcare quality. METHODS An anonymized, cross-sectional, self-report questionnaire was administered to n = 4158 individuals. The study assessed prevalence of chronic health conditions, healthcare quality, differences in overall health inequality score, and effects of the coronavirus pandemic on healthcare quality. We used Fisher's exact tests, binomial logistic regression, and predictive machine learning tools, as appropriate. RESULTS The final sample included n = 2649 participants (n = 1285 autistic) aged 16-96 years. Autistic adults reported lower quality healthcare than non-autistic adults across 50/51 items, including poorer access to healthcare and poorer communication, alongside increased anxiety, sensory sensitivity, system-level problems, shutdowns, and meltdowns. Differences between groups were stark: aggregated health inequality scores predicted autism diagnosis, even after stratifying by sex. Autistic adults were also more likely to have chronic health conditions than non-autistic adults. There were no significant differences in healthcare quality for autistic adults before and during the pandemic, although they received relatively poorer quality healthcare than non-autistic adults across both periods. LIMITATIONS The study's sampling methods are not likely to capture the perspectives of all autistic individuals, especially those with intellectual disability. Both the autistic and control samples are biased towards UK residents, white individuals, those assigned female at birth, and those who completed an undergraduate degree or higher education. As such, these results may limit their generalizability to other groups. Finally, these results relate to self-reported differences in healthcare quality between autistic and non-autistic adults. The observed group differences may in part reflect differences in perception and communication rather than differences in actual healthcare quality. CONCLUSIONS Autistic adults are more likely to have chronic health conditions alongside self-reported lower quality healthcare than others. Health inequalities between these groups are widespread and dramatic; unfortunately, they existed before and have persisted after the onset of the coronavirus pandemic.
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Affiliation(s)
- Elizabeth Weir
- Department of Psychiatry, Autism Research Centre, University of Cambridge, 18b Trumpington Road, Autism Research Centre, Douglas House, Cambridge, CB2 8AH, UK.
| | - Carrie Allison
- Department of Psychiatry, Autism Research Centre, University of Cambridge, 18b Trumpington Road, Autism Research Centre, Douglas House, Cambridge, CB2 8AH, UK
| | - Simon Baron-Cohen
- Department of Psychiatry, Autism Research Centre, University of Cambridge, 18b Trumpington Road, Autism Research Centre, Douglas House, Cambridge, CB2 8AH, UK
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23
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Matin BK, Byford S, Soltani S, Kazemi-Karyani A, Atafar Z, Zereshki E, Soofi M, Rezaei S, Rakhshan ST, Jahangiri P. Contributing factors to healthcare costs in individuals with autism spectrum disorder: a systematic review. BMC Health Serv Res 2022; 22:604. [PMID: 35524328 PMCID: PMC9074281 DOI: 10.1186/s12913-022-07932-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals with autism spectrum disorder (ASD) are more likely to use healthcare than their counterparts without disabilities, which imposes high medical costs to families and health systems. This study aimed to investigate healthcare costs and its determinants among individuals with ASD. METHODS In this systematic review, we searched online databases (Web of Science, Medline through PubMed and Scopus) for observational and experimental studies that included data on service use and costs associated with ASD and published between January 2000 and May 2021. Exclusion criteria included non-English language articles, duplicates, abstracts, qualitative studies, gray literature, and non-original papers (e.g., letters to editors, editorials, reviews, etc.). RESULTS Our searches yielded 4015 articles screened according to PRISMA guidelines. Of 4015 studies identified, 37 articles from 10 countries were eligible for final inclusion. Therapeutic interventions, outpatient visits and medications constituted the largest proportion of direct medical expenditure on individuals with ASD. Included studies suggest lack of health insurance, having associated morbidities, more severe symptoms, younger age groups and lower socioeconomic status (SES) are associated with higher medical expenditure in individuals with ASD. CONCLUSIONS This systematic review identified a range of factors, including lower SES and lack of health insurance, which are associated with higher healthcare costs in people with ASD. Our study supports the formulation of policy options to reduce financial risks in families of individuals with ASD in countries which do not have a tax-based or universal health coverage system.
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Affiliation(s)
- Behzad Karami Matin
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Shahin Soltani
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Ali Kazemi-Karyani
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Zahra Atafar
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ehsan Zereshki
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Moslem Soofi
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Satar Rezaei
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shiva Tolouei Rakhshan
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parvin Jahangiri
- Behavioral Disease Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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24
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Kuo AA, Hotez E, Rosenau KA, Gragnani C, Fernandes P, Haley M, Rudolph D, Croen LA, Massolo ML, Holmes LG, Shattuck P, Shea L, Wilson R, Martinez-Agosto JA, Brown HM, Dwyer PSR, Gassner DL, Onaiwu MG, Kapp SK, Ne'eman A, Ryan JG, Waisman TC, Williams ZJ, DiBari JN, Foney DM, Ramos LR, Kogan MD. The Autism Intervention Research Network on Physical Health (AIR-P) Research Agenda. Pediatrics 2022; 149:e2020049437D. [PMID: 35363290 DOI: 10.1542/peds.2020-049437d] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In the United States, autistic individuals experience disproportionate physical and mental health challenges relative to non-autistic individuals, including higher rates of co-occurring and chronic conditions and lower physical, social, and psychological health-related quality of life. The Autism Intervention Research Network on Physical Health (AIR-P) is an interdisciplinary, multicenter research network for scientific collaboration and infrastructure that aims to increase the life expectancy and quality of life for autistic individuals, with a focus on underserved or vulnerable populations. The current paper describes the development of the AIR-P Research Agenda. METHODS Development of the research agenda involved an iterative and collaborative process between the AIR-P Advisory Board, Steering Committee, and Autistic Researcher Review Board. The methodology consisted of 3 phases: (1) ideation and design, (2) literature review and synthesis; and (3) network engagement. RESULTS Six core research priorities related to the health of autistic individuals were identified: (1) primary care services and quality, (2) community-based lifestyle interventions, (3) health systems and services, (4) gender, sexuality, and reproductive health, (5) neurology, and (6) genetics. Specific topics within each of these priorities were identified. Four cross-cutting research priorities were also identified: (1) neurodiversity-oriented care, (2) facilitating developmental transitions, (3) methodologically rigorous intervention studies, and (4) addressing health disparities. CONCLUSIONS The AIR-P Research Agenda represents an important step forward for enacting large-scale health-promotion efforts for autistic individuals across the lifespan. This agenda will catalyze autism research in historically underrepresented topic areas while adopting a neurodiversity-oriented approach to health-promotion.
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Affiliation(s)
- Alice A Kuo
- Departments of Medicine and
- Pediatrics
- Graduate School of Education and Information Studies, University of California, Los Angeles, Los Angeles, California
| | | | - Kashia A Rosenau
- Graduate School of Education and Information Studies, University of California, Los Angeles, Los Angeles, California
| | | | | | | | - Dawn Rudolph
- Association of University Centers on Disabilities, Silver Spring, Maryland
| | - Lisa A Croen
- Kaiser Permanente Northern California, Los Angeles, California
| | - Maria L Massolo
- Kaiser Permanente Northern California, Los Angeles, California
| | | | | | - Lindsay Shea
- AJ Drexel Autism Institute, Philadelphia, Pennsylvania
| | | | | | | | - Patrick S R Dwyer
- Center for Mind and Brain
- Department of Psychology, University of California Davis, Davis, California
| | - Dena L Gassner
- School of Social Work, Adelphi University, Garden City, New York
- Department of Health Sciences, Towson University, Towson, Maryland
| | | | - Steven K Kapp
- Department of Psychology, University of Portsmouth, Portsmouth, United Kingdom
| | - Ari Ne'eman
- Harvard University, Cambridge, Massachusetts
| | - Jacalyn G Ryan
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - T C Waisman
- University of Calgary, Calgary, Alberta, Canada
| | - Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Brain Institute
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, Tennessee
| | - Jessica N DiBari
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
| | - Dana M Foney
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
| | | | - Michael D Kogan
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
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25
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Roux AM, Rast JE, Shea LL. Family Perceptions of Health Care Access for Autistic Young Adults Receiving Disability Services. Pediatrics 2022; 149:185644. [PMID: 35363289 DOI: 10.1542/peds.2020-049437s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Autistic young adults (YAs) often live with family and present with complex health needs. Adults with developmental disabilities (DDs) who live with family are the least likely to receive preventive health care compared with residents of other settings. No published studies have examined intersectionality between age, race or ethnicity, household income, and health needs in health care access for autistic YA. This study explored health care access among autistic YAs receiving state DD services compared with other age and disability groups. METHODS We analyzed data from the National Core Indicator's Adult Family Survey of families of DD service users ages 18 and older who lived in the respondent's home. We used bivariate analyses and multivariable logistic regression to examine family-reported access to health care providers when needed, the role of sociodemographics, and the complexity of health care needs in predicting consistent care. RESULTS Approximately 70% of autistic YAs had consistent access to health care when needed, similar to autistic adults but at lower rates than those with other disabilities. Odds of consistent health care access were higher among autistic YAs who were Black or lived in a rural area and lower among those with co-occurring health conditions or who needed extensive personal care support. CONCLUSIONS Nearly one-third of autistic YAs who lived with family and receive state DD services had difficulty consistently accessing needed health care. Improved surveillance of health care services in this population is needed in addition to innovations in Medicaid waivers, which fund DD services, to address health needs and support families in accessing care.
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26
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Parmar KR, Porter CS, Dickinson CM, Baimbridge P, Pelham J, Gowen E. Autism-friendly eyecare: Developing recommendations for service providers based on the experiences of autistic adults. Ophthalmic Physiol Opt 2022; 42:675-693. [PMID: 35315935 PMCID: PMC9313607 DOI: 10.1111/opo.12975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 12/27/2022]
Abstract
Purpose Autistic people face significant barriers when accessing healthcare services. Eye examinations present unique challenges. Accessibility of this healthcare sector for autistic people has not been investigated previously. The aim of this research was to investigate eye examination accessibility for autistic adults and produce recommendations for autism‐friendly eyecare. Methods Two qualitative studies were conducted. In Study 1, 18 autistic adults took part in focus groups to elicit their eye examination experiences. Transcripts of the recorded discussions were thematically analysed. Study 1 findings were used to design autism‐friendly eye examinations for autistic adults. These were conducted in Study 2. Twenty‐four autistic adults participated in these examinations, during which they were interviewed about their experience and how it might be improved by reasonable modifications. Audio recordings of the interviews were content analysed. Results Knowledge of what to expect, in advance of the eye examination, could greatly reduce anxiety. Participants liked the logical structure of the examination, and the interesting instrumentation used. However, the examination and practice environment did include sensory challenges, due to lights, sound and touch. Changes in practice layout, and interacting with multiple staff members, was anxiety provoking. Participants expressed a need for thorough explanations from the optometrist that outlined the significance of each test, and what the patient was expected to do. Conclusion A number of accessiblity barriers were identified. These suggested that UK eye examinations are not very accessible for autistic adults. Barriers began at the point of booking the appointment and continued through to the dispensing of spectacles. These caused anxiety and stress for this population, but could be reduced with easy‐to‐implement adaptations. Based on the findings, recommendations are presented here for the whole eyecare team which suggest how more autism‐friendly eye examinations can be provided.
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Affiliation(s)
- Ketan R Parmar
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Catherine S Porter
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Christine M Dickinson
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Peter Baimbridge
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | | | - Emma Gowen
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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27
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Strömberg M, Liman L, Bang P, Igelström K. Experiences of Sensory Overload and Communication Barriers by Autistic Adults in Health Care Settings. AUTISM IN ADULTHOOD 2022; 4:66-75. [PMID: 36600905 PMCID: PMC8992902 DOI: 10.1089/aut.2020.0074] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Autistic adults have an elevated risk of many health problems compared with the general population, making health care access extra critical. Unfortunately, autistic people often find health care settings quite aversive, and many medical providers report feeling unsure about how to interact with autistic patients. We aimed at characterizing specific challenges regarding sensory experiences and communicative barriers in health care settings. Methods We recruited adults to complete an anonymous online questionnaire on the topic of improving health care experiences for everyone. The questions covered demographics, sensory experiences in medical settings, and communication with health care providers. We quantified the associations between autism diagnosis and experiences of sensory discomfort and communication barriers in health care settings. We also did a qualitative analysis of text responses to questions on how to improve sensory environments and communication with providers. Results Swedish adults (62 autistic and 36 nonautistic) participated in the study. The cohort was well educated, and autistic participants received their autism diagnosis late in life (median age 36 years, range 13-57). Compared with nonautistic participants, autistic participants reported greater discomfort with background sound levels in health care settings and felt more misunderstood by health care providers. Thematic analyses showed that auditory stimuli and proximity to other people were particularly bothersome for autistic participants, causing stress or avoidance and affecting the ability to interact with providers. Providers contributed to communication barriers by failing to recognize the need for individualized information, especially when respondents' difficulties were not visible or taken seriously. Participants requested greater clarity and supplementary written information. Providers also misunderstood autistic adults' body language or eye contact patterns, as they interpreted their clients through the lens of neurotypical expectations. Conclusions Our results extend previous research by emphasizing sensory aspects of health care settings and suggesting specific and reasonable adaptations. The results also highlight how the provider's implicit expectations of nonverbal communication caused misinterpretations of autistic people who were socially skilled but did not use typical body language. Based on the data, we suggest specific adaptations, many of which may also benefit nonautistic people.
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Affiliation(s)
- Maria Strömberg
- Division of Neurobiology, Department of Biomedical and Clinical Sciences, Linköping University, University Hospital Campus, Linköping, Sweden
| | - Lina Liman
- Division of Neurobiology, Department of Biomedical and Clinical Sciences, Linköping University, University Hospital Campus, Linköping, Sweden
| | - Peter Bang
- Division of Neurobiology, Department of Biomedical and Clinical Sciences, Linköping University, University Hospital Campus, Linköping, Sweden
| | - Kajsa Igelström
- Division of Neurobiology, Department of Biomedical and Clinical Sciences, Linköping University, University Hospital Campus, Linköping, Sweden.,Address correspondence to: Kajsa Igelström, PhD, Division of Neurobiology, Department of Biomedical and Clinical Sciences, Linköping University, University Hospital Campus, Linköping 581 85, Sweden
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28
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van Kessel R, Hrzic R, O'Nuallain E, Weir E, Wong BLH, Anderson M, Baron-Cohen S, Mossialos E. Digital Health Paradox: International Policy Perspectives to Address Increased Health Inequalities for People Living With Disabilities. J Med Internet Res 2022; 24:e33819. [PMID: 35191848 PMCID: PMC8905475 DOI: 10.2196/33819] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/26/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
The COVID-19 pandemic accelerated the uptake of digital health worldwide and highlighted many benefits of these innovations. However, it also stressed the magnitude of inequalities regarding accessing digital health. Using a scoping review, this article explores the potential benefits of digital technologies for the global population, with particular reference to people living with disabilities, using the autism community as a case study. We ultimately explore policies in Sweden, Australia, Canada, Estonia, the United Kingdom, and the United States to learn how policies can lay an inclusive foundation for digital health systems. We conclude that digital health ecosystems should be designed with health equity at the forefront to avoid deepening existing health inequalities. We call for a more sophisticated understanding of digital health literacy to better assess the readiness to adopt digital health innovations. Finally, people living with disabilities should be positioned at the center of digital health policy and innovations to ensure they are not left behind.
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Affiliation(s)
- Robin van Kessel
- Department of International Health, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands.,Studio Europa, Maastricht University, Maastricht, Netherlands.,Global Health Workforce Network Youth Hub, World Health Organization, Geneva, Switzerland
| | - Rok Hrzic
- Department of International Health, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Ella O'Nuallain
- Public Sector Strategy Team, Deloitte Consulting Pty Ltd, Sydney, Australia
| | - Elizabeth Weir
- Autism Research Center, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Brian Li Han Wong
- Global Health Workforce Network Youth Hub, World Health Organization, Geneva, Switzerland.,The Lancet and Financial Times Commission on Governing Health Futures 2030: Growing up in a digital world, Global Health Centre, The Graduate Institute, Geneva, Switzerland.,Steering Committee, European Public Health Association Digital Health Section, Utrecht, Netherlands
| | - Michael Anderson
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Simon Baron-Cohen
- Autism Research Center, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom.,Institute of Global Health Innovation, Imperial College London, London, United Kingdom
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29
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Wigham S, Ingham B, Le Couteur A, Wilson C, Ensum I, Parr JR. A survey of autistic adults, relatives and clinical teams in the United Kingdom: And Delphi process consensus statements on optimal autism diagnostic assessment for adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1959-1972. [PMID: 35168407 PMCID: PMC9597166 DOI: 10.1177/13623613211073020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Accessing adult autism diagnostic pathways can be difficult. This study explored
perspectives of UK autistic adults, relatives and clinicians regarding the
characteristics of optimal adult autism assessment and diagnostic services. In
stage 1, three key stakeholder groups were surveyed about experiences of adult
autism diagnostic services (pre-assessment/assessment): 343 autistic adults, 45
relatives and 35 clinicians completed parallel surveys. Information from stage 1
surveys was used to devise statements for a modified Delphi process in stage 2
seeking consensus among clinicians on optimal diagnostic service
characteristics. Data analyses were non-parametric and descriptive. Over half of
adults were in contact with mental health services prior to autism diagnosis.
Clinicians reported that multidisciplinary diagnostic teams lacked key
professionals. Thirteen statements describing optimal autism diagnostic service
provision were developed. There was consensus from clinicians on 11 statements
relating to clear assessment pathways, updates for people while waiting,
pre-assessment information gathering/provision, co-occurring condition
identification and training/networking. Some autistic adults, relatives and
clinicians were positive about services, all stakeholders identified
improvements were needed. The findings describing optimal service provision are
relevant for UK clinicians, managers and commissioners to improve diagnostic
assessments for autistic adults, and have international relevance for similar
health systems.
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Affiliation(s)
- Sarah Wigham
- Population Health Sciences Institute, Newcastle University, UK
| | - Barry Ingham
- Population Health Sciences Institute, Newcastle University, UK.,Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | - Ann Le Couteur
- Population Health Sciences Institute, Newcastle University, UK
| | - Colin Wilson
- Population Health Sciences Institute, Newcastle University, UK
| | - Ian Ensum
- Bristol Autism Spectrum Service, Avon and Wiltshire Mental Health Partnership NHS Trust, UK
| | - Jeremy R Parr
- Population Health Sciences Institute, Newcastle University, UK.,Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
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30
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Tackling healthcare access barriers for individuals with autism from diagnosis to adulthood. Pediatr Res 2022; 91:1028-1035. [PMID: 33767375 PMCID: PMC7993081 DOI: 10.1038/s41390-021-01465-y] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/21/2020] [Accepted: 02/23/2021] [Indexed: 02/04/2023]
Abstract
Most individuals with autism spectrum disorder (ASD)-a complex, life-long developmental disorder-do not have access to the care required to address their diverse health needs. Here, we review: (1) common barriers to healthcare access (shortage/cost of services; physician awareness; stigma); (2) barriers encountered primarily during childhood (limited screening/diagnosis; unclear referral pathways), transition to adulthood (insufficient healthcare transition services; suboptimal physician awareness of healthcare needs) and adulthood (shortage of services/limited insurance; communication difficulties with physicians; limited awareness of healthcare needs of aging adults); and (3) advances in research/program development for better healthcare access. A robust understanding of barriers to accessing healthcare across the lifespan of autistic individuals is critical to ensuring the best use of healthcare resources to improve social, physical, and mental health outcomes. Stakeholders must strengthen healthcare service provision by coming together to: better understand healthcare needs of underserved populations; strengthen medical training on care of autistic individuals; increase public awareness of ASD; promote research into/uptake of tools for ASD screening, diagnosis, and treatment; understand specific healthcare needs of autistic individuals in lower resource countries; and conduct longitudinal studies to understand the lifetime health, social, and economic impacts of ASD and enable the evaluation of novel approaches to increasing healthcare access. IMPACT: Despite the growing body of evidence, our understanding of barriers to healthcare encountered by individuals with ASD remains limited, particularly beyond childhood and in lower resource countries. We describe current and emerging barriers to healthcare access encountered by individuals with ASD across the lifespan. We recommend that stakeholders develop evidence-informed policies, programs, and technologies that address barriers to healthcare access for individuals with ASD and consider broad, equitable implementation to maximize impact.
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31
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Calleja S, Kingsley J, Amirul Islam FM, McDonald R. Barriers to Accessing Healthcare: Perspectives from Autistic Adults and Carers. QUALITATIVE HEALTH RESEARCH 2022; 32:267-278. [PMID: 34906008 DOI: 10.1177/10497323211050362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Autistic adults have higher health needs compared to most, yet they continue to experience barriers to accessing appropriate healthcare. Presently, no qualitative research exists exploring these barriers which impact overall physical and mental health. We conducted a qualitative analysis in Victoria (Australia) of the perceived experiences of healthcare access for autistic adults (n = 9) and primary caregivers of autistic adults (n = 7). Specifically, a three-staged phenomenological approach was applied involving: (i) a communicative checklist, (ii) a health status survey and (iii) face-to-face interviews. Elements such as support, responsibilities and protective factors exhibited by caregivers, may impact healthcare access for autistic adults. Results indicate the need for further research exploring interdependent factors that impact healthcare access by caregivers, so evidence-based interventions can be developed to support caregivers in the future.
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Affiliation(s)
- Shenae Calleja
- Faculty of Health, Arts and Design, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Jonathan Kingsley
- Faculty of Health, Arts and Design, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
- Centre of Urban Transitions, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Fakir M Amirul Islam
- Faculty of Health, Arts and Design, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Rachael McDonald
- Faculty of Health, Arts and Design, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
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32
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Gilmore D, Longo A, Krantz M, Radford D, Hand BN. Five Ways Providers Can Improve Mental Healthcare for Autistic Adults: A Review of Mental Healthcare Use, Barriers to Care, and Evidence-Based Recommendations. Curr Psychiatry Rep 2022; 24:565-571. [PMID: 35969335 PMCID: PMC9376572 DOI: 10.1007/s11920-022-01362-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW We reviewed the literature from 2017 to 2022 on autistic adults' use of mental healthcare and barriers to care. To encourage immediate improvement in mental healthcare, we provide five strategies mental health providers can use to better care for autistic adults. RECENT FINDINGS Most autistic adults use mental healthcare and use it more often than non-autistic adults. Autistic adults' experiences with mental healthcare are characterized by (1) lack of providers knowledgeable about autism, (2) use of treatments that may not be accommodating to individual needs, and (3) difficulty navigating the complex healthcare system. These barriers contribute to prevalent unmet needs for mental healthcare. Autistic adults use mental healthcare frequently but have unmet mental health needs. As necessary systemic changes develop, providers can begin immediately to better care for autistic adults by learning about their needs and taking personalized care approaches to meet those needs.
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Affiliation(s)
- Daniel Gilmore
- The Ohio State University, 228E Atwell Hall, 453 W 10th Ave., Columbus, OH 43210 USA
| | - Anne Longo
- The Ohio State University, 228E Atwell Hall, 453 W 10th Ave., Columbus, OH 43210 USA
| | - Morgan Krantz
- The Ohio State University, 228E Atwell Hall, 453 W 10th Ave., Columbus, OH 43210 USA
| | - Deondray Radford
- The Ohio State University, 228E Atwell Hall, 453 W 10th Ave., Columbus, OH 43210 USA
| | - Brittany N. Hand
- The Ohio State University, 228E Atwell Hall, 453 W 10th Ave., Columbus, OH 43210 USA
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33
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Baweja R, Brown SL, Edwards EM, Murray MJ. COVID-19 Pandemic and Impact on Patients with Autism Spectrum Disorder. J Autism Dev Disord 2022; 52:473-482. [PMID: 33689088 PMCID: PMC7943706 DOI: 10.1007/s10803-021-04950-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 12/20/2022]
Abstract
The COVID-19 infectious disease pandemic has caused significant fear and uncertainty around the world and had significant adverse psychological impact. Children, adolescents and adults with autism spectrum disorder (ASD) are a particularly vulnerable population, impacted by stay-at-home orders, closures at nonessential services, and social distancing standards. This commentary describes various challenges faced by individuals with ASD in the United States including disruptions caused by educational and vocational changes, challenges to home and leisure routines, limited access to behavioral health services and changes in health services delivery due to the pandemic. We highlight the need for ongoing skills development for individuals and development within systems to better respond to needs of the ASD population in future emergencies.
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Affiliation(s)
- Raman Baweja
- Department of Psychiatry and Behavior Health, Penn State University College of Medicine, 500 University Drive, H073, Hershey, PA, 17033-0850, USA.
| | - Sierra L Brown
- Department of Psychiatry and Behavior Health, Penn State University College of Medicine, 500 University Drive, H073, Hershey, PA, 17033-0850, USA
| | - Erin M Edwards
- Department of Psychiatry and Behavior Health, Penn State University College of Medicine, 500 University Drive, H073, Hershey, PA, 17033-0850, USA
| | - Michael J Murray
- Department of Psychiatry and Behavior Health, Penn State University College of Medicine, 500 University Drive, H073, Hershey, PA, 17033-0850, USA
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34
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Gilmore D, Krantz M, Weaver L, Hand BN. Healthcare service use patterns among autistic adults: A systematic review with narrative synthesis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:317-331. [PMID: 34881676 DOI: 10.1177/13623613211060906] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Autistic adults often have complex healthcare needs due to factors like having other health conditions, sensory sensitivities, and limited access to healthcare providers who are trained to provide care for them. All these factors may influence the healthcare services that autistic adults use. In this review, we searched six electronic research databases to gather the most recent evidence about how often autistic adults use five important healthcare services (the emergency department, hospitalization, outpatient mental health, preventive services, and primary care) compared to populations of non-autistic adults. A total of 16 articles were ultimately included in this review. Most articles found that autistic adults had equal or higher use of healthcare services than non-autistic adults. Autistic adults frequently used the emergency department and hospital. This may indicate that routine outpatient care in the community is not meeting their needs. Our findings show the importance of improving care at this level for autistic adults to reduce overuse of the emergency department (in this article referred to as ED) and hospital.
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35
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Abstract
Over the past four decades there have been significant advances in our understanding of autism, yet services for autistic adults continue to lag far behind those for children, and prospects for employment and independent living remain poor. Adult outcomes also vary widely and while cognitive and language abilities are important prognostic indicators, the influence of social, emotional, familial and many other factors remains uncertain. For this special issue marking the 40th anniversary of DSM-III, the present paper describes the changing perspectives of autism in adulthood that have occurred over this period, explores individual and wider environmental factors related to outcome, and suggests ways in which services need to be changed to improve the future for adults living with autism.
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Affiliation(s)
- Patricia Howlin
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.
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36
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DaWalt LS, Taylor JL, Movaghar A, Hong J, Kim B, Brilliant M, Mailick MR. Health profiles of adults with autism spectrum disorder: Differences between women and men. Autism Res 2021; 14:1896-1904. [PMID: 34213066 PMCID: PMC8592037 DOI: 10.1002/aur.2563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 04/02/2021] [Accepted: 05/29/2021] [Indexed: 11/08/2022]
Abstract
The purpose of the present study was to investigate the hypothesis that women with autism have poorer health compared with men with autism, and compared with women without autism. Utilizing electronic health records drawn from a single health care system serving over 2 million individuals, 2119 adults with diagnosed autism spectrum disorders were compared with age- and sex-matched controls. When considering health care utilization, we found evidence of multiplicative risk for conditions within some domains (i.e., nutrition conditions, neurologic disease, psychiatric conditions, and sleep disorders) such that women with autism spectrum disorder (ASD) experienced double jeopardy-meaning they had greater rates of health care utilization within a domain than what would separately be expected by virtue of being a woman and having ASD. For other domains (i.e., endocrine disorders, gastrointestinal disorders), the risk was additive such that being a female and having ASD were both associated with higher health care utilization, but there were no significant interaction effects. It was only with respect to one domain (cardiovascular) that rates of health care utilization were reflective of neither ASD diagnosis nor sex. Overall, our findings suggest that women with ASD are a vulnerable subgroup with high levels of health care utilization. LAY SUMMARY: This study asked whether women with autism have poorer health compared with men with autism, and compared with women without autism. To answer this question, we used data from electronic health records. We found that women with autism spectrum disorder (ASD) were at the greatest risk for health problems such as nutrition conditions, neurologic disease, psychiatric conditions, and sleep disorders. More research on health of women with ASD is needed.
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Affiliation(s)
| | - Julie Lounds Taylor
- Vanderbilt University Medical Center, 407C VKC/One Magnolia Circle BLD, Nashville, TN
| | - Arezoo Movaghar
- University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI 53705
| | - Jinkuk Hong
- University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI 53705
| | - Bryan Kim
- University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI 53705
| | - Murray Brilliant
- University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI 53705
| | - Marsha R. Mailick
- University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI 53705
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37
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Adams D. Child and Parental Mental Health as Correlates of School Non-Attendance and School Refusal in Children on the Autism Spectrum. J Autism Dev Disord 2021; 52:3353-3365. [PMID: 34331173 PMCID: PMC8323746 DOI: 10.1007/s10803-021-05211-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 12/28/2022]
Abstract
Children on the autism spectrum miss more school than their peers, but limited work has explored why this may be. This study aimed to document the frequency at which children on the autism spectrum miss half and full days of school and the reasons for these absences. Parents of 106 school-aged children on the autism spectrum completed online questionnaires on rates of school non-attendance, family factors, child anxiety, and parental mental health. On average across a four week period, children missed 6 full days of school. The most common reason for full-day absences was school refusal and for half-day absences was medical/therapy appointments. Parental employment status, increased child age, child anxiety, and differing aspects of parental mental health were identified as correlates of specific subtypes of school non-attendance.
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Affiliation(s)
- Dawn Adams
- Autism Centre of Excellence, School of Education and Professional Studies, Griffith University, Messines Ridge Road, Mt Gravatt, Brisbane, QLD, 4122, Australia. .,Griffith Institute of Educational Research, Griffith University, Brisbane, Australia.
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38
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Blaxill M, Rogers T, Nevison C. Autism Tsunami: the Impact of Rising Prevalence on the Societal Cost of Autism in the United States. J Autism Dev Disord 2021; 52:2627-2643. [PMID: 34278527 PMCID: PMC9114071 DOI: 10.1007/s10803-021-05120-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2021] [Indexed: 11/25/2022]
Abstract
The cost of ASD in the U.S. is estimated using a forecast model that for the first time accounts for the true historical increase in ASD. Model inputs include ASD prevalence, census population projections, six cost categories, ten age brackets, inflation projections, and three future prevalence scenarios. Future ASD costs increase dramatically: total base-case costs of $223 (175–271) billion/year are estimated in 2020; $589 billion/year in 2030, $1.36 trillion/year in 2040, and $5.54 (4.29–6.78) trillion/year by 2060, with substantial potential savings through ASD prevention. Rising prevalence, the shift from child to adult-dominated costs, the transfer of costs from parents onto government, and the soaring total costs raise pressing policy questions and demand an urgent focus on prevention strategies.
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Affiliation(s)
| | | | - Cynthia Nevison
- Institute for Alpine and Arctic Research, University of Colorado, Boulder, CO, USA
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39
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Simantov T, Pohl A, Tsompanidis A, Weir E, Lombardo MV, Ruigrok A, Smith P, Allison C, Baron-Cohen S, Uzefovsky F. Medical symptoms and conditions in autistic women. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:373-388. [PMID: 34184558 PMCID: PMC8814970 DOI: 10.1177/13623613211022091] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The sex bias in autism diagnosis suggests the involvement of sex-specific endocrine mechanisms during prenatal development, but these hormones affect health throughout life. Therefore, the current study examined the association of autism and autistic traits with conditions and symptoms related to the sex-steroid system in adult women. In total, 1230 women (361 autistic), aged 15–77 years, reported on autistic traits and medical history. Medical diagnoses and symptoms were grouped by unsupervised factor analysis, and associations with autism diagnosis and autistic traits were explored. Higher rates of reproductive system diagnoses (odds ratio = 1.035, p = 0.024), prediabetes symptoms (odds ratio = 1.319, p = 0.001), irregular puberty onset (odds ratio = 1.458, p = 0.009), and menstrual length (odds ratio = 1.368, p = 0.034) and lower rates of metabolic and vascular conditions (odds ratio = 0.654, p = 0.013) were associated with diagnosis. Reproductive system diagnoses (β = 0.114, p = 0.000), prediabetes symptoms (β = 0.188, p = 0.000), menstrual length (β = 0.071, p = 0.014), irregular puberty onset (β = 0.149, p = 0.000), excessive menstruation symptoms (β = 0.097, p = 0.003), and hyperandrogenism symptoms (β = 0.062, p = 0.040) were also associated with autistic traits. Many of the conditions and symptoms found to be associated with autism or autistic traits are also related to conditions of steroid hormones and, specifically, the sex-steroid system. The study suggests an important role for steroids in autistic women, beyond prenatal development. Clinical implications are discussed.
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Hand BN, Gilmore D, Coury DL, Darragh AR, Moffatt-Bruce S, Hanks C, Garvin JH. Effects of a Specialized Primary Care Facility on Preventive Service Use Among Autistic Adults: a Retrospective Claims Study. J Gen Intern Med 2021; 36:1682-1688. [PMID: 33469770 PMCID: PMC8175546 DOI: 10.1007/s11606-020-06513-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/17/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND While in some studies, the patient-centered medical home has been linked with increased receipt of preventive services among other populations, there is a paucity of literature testing the effectiveness of medical homes in serving the healthcare needs of autistic adults. OBJECTIVE To compare the receipt of preventive services by patients at a patient-centered medical home specifically designed for autistic adults (called the Center for Autism Services and Transition "CAST") to US national samples of autistic adults with private insurance or Medicare. DESIGN Retrospective study of medical billing data. SAMPLE The study sample included CAST patients (N = 490) who were propensity score matched to Medicare-enrolled autistic adults (N = 980) and privately insured autistic adults (N = 980) using demographic characteristics. The median age of subjects was 21 years old, 79% were male, and the median duration of observation was 2.2 years. MAIN MEASURES The primary outcome measure was the receipt of any preventive service, as defined by the Medicare Learning Network and AAPC (formerly the American Academy of Professional Coders). Secondary outcome measures included receipt of specific preventive service types (i.e., general health and wellness services, screenings, counseling and therapies, vaccinations, and sexual/reproductive health services). KEY RESULTS CAST patients had significantly greater odds of receiving any preventive service than Medicare-enrolled (OR = 10.3; 95% CI = 7.6-13.9) and privately insured (OR = 3.1; 95% CI = 2.3-4.2) autistic adults. CAST patients were also significantly more likely to receive screenings and vaccinations than either Medicare beneficiaries (screenings OR = 20.3; 95% CI = 14.7-28.0; vaccinations OR = 5.5; 95% CI = 4.3-7.0) or privately insured beneficiaries (screenings OR = 2.0; 95% CI = 1.6-2.5; vaccinations OR = 3.3; 95% CI = 2.6-4.1). CONCLUSIONS Autistic adults receiving care through CAST were significantly more likely to recieve preventive care services than national samples of autistic adults. Future comparative effectiveness trials are needed to rigorously assess the impact of primary care-based initiatives to improve care for autistic adults.
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Affiliation(s)
| | | | - Daniel L Coury
- The Ohio State University, Columbus, OH, USA
- Nationwide Children's Hospital, Columbus, OH, USA
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Fuentes J, Hervás A, Howlin P. ESCAP practice guidance for autism: a summary of evidence-based recommendations for diagnosis and treatment. Eur Child Adolesc Psychiatry 2021; 30:961-984. [PMID: 32666205 PMCID: PMC8140956 DOI: 10.1007/s00787-020-01587-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 06/24/2020] [Indexed: 12/11/2022]
Abstract
Across Europe, there is increased awareness of the frequency and importance of autism spectrum disorder (ASD), which is now recognised not only as a childhood disorder but as a heterogeneous, neurodevelopmental condition that persists throughout life. Services for individuals with autism and their families vary widely, but in most European countries, provision is limited. In 2018, European Society of Child and Adolescent Psychiatry (ESCAP) identified the need for a Practice Guidance document that would help to improve knowledge and practice, especially for individuals in underserviced areas. The present document, prepared by the ASD Working Party and endorsed by the ESCAP Board on October 3, 2019, summarises current information on autism and focuses on ways of detecting, diagnosing, and treating this condition.
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Affiliation(s)
- Joaquin Fuentes
- Child and Adolescent Psychiatrists, Policlínica Gipuzkoa Research Consultant, GAUTENA Autism Society, Paseo de Miramón 174, 20016, San Sebastián, Spain.
| | - Amaia Hervás
- Child and Adolescent Psychiatrists, University Hospital MutuaTerrassa, AGAUR Clinical and Genetic Research Group IGAIN, Barcelona, Spain
| | - Patricia Howlin
- Emeritus Professor of Clinical Child Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
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Nicolaidis C, Schnider G, Lee J, Raymaker DM, Kapp SK, Croen LA, Urbanowicz A, Maslak J. Development and psychometric testing of the AASPIRE Adult Autism Healthcare Provider Self-Efficacy Scale. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:767-773. [PMID: 32859135 PMCID: PMC8204689 DOI: 10.1177/1362361320949734] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
LAY ABSTRACT The adult healthcare system is ill-prepared to provide high-quality care to autistic adults. Lack of provider training may contribute to the problem, but there are few previously tested survey instruments to guide provider training efforts. Our objective was to develop and test a measure of healthcare providers' confidence (or "self-efficacy") in providing healthcare to autistic adults and to use it to better understand their training needs. We used a community-based participatory research (CBPR) approach, in partnership with academic researchers, autistic adults, supporters, and healthcare providers, throughout the project. We developed a one-page questionnaire and surveyed 143 primary care providers from eight primary care clinics in Oregon and California, United States. Preliminary testing of the AASPIRE Adult Autism Healthcare Provider Self-Efficacy Scale suggests that the measure is reliable and valid. Using this scale, we found only a minority of providers reported high confidence in communicating with patients (25%); performing physical exams or procedures (43%); accurately diagnosing and treating other medical issues (40%); helping patients stay calm and comfortable during visits (38%); identifying accommodation needs (14%); and making necessary accommodations (16%). While providers need training across all aspects of care related to autism in adulthood, interventions should pay particular attention to helping providers communicate with patients, and identify and make necessary accommodations. Future research is needed to further validate this scale and to understand how to meet providers' training needs most effectively.
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Affiliation(s)
- Christina Nicolaidis
- Portland State University (PSU), USA
- Oregon Health & Science University (OHSU), USA
| | | | | | | | - Steven K Kapp
- Portland State University (PSU), USA
- University of Exeter, UK
| | | | - Anna Urbanowicz
- Portland State University (PSU), USA
- RMIT University, Australia
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Nicolaidis C, Zhen KY, Lee J, Raymaker DM, Kapp SK, Croen LA, Urbanowicz A, Maslak J, Scharer M. Psychometric testing of a set of patient-reported instruments to assess healthcare interventions for autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:786-799. [PMID: 33103457 PMCID: PMC8068734 DOI: 10.1177/1362361320967178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Interventions to improve healthcare for autistic adults are greatly needed. To evaluate such interventions, researchers often use surveys to collect data from autistic adults (or sometimes, their supporters), but few survey measures have been tested for use with autistic adults. Our objective was to create and test a set of patient- or proxy-reported survey measures for use in studies that evaluate healthcare interventions. We used a community-based participatory research (CBPR) approach, in partnership with autistic adults, healthcare providers, and supporters. We worked together to create or adapt survey measures. Three survey measures focus on things that interventions may try to change directly: (1) how prepared patients are for visits; (2) how confident they feel in managing their health and healthcare; and (3) how well the healthcare system is making the accommodations patients feel they need. The other measures focus on the outcomes that interventions may hope to achieve: (4) improved patient-provider communication; (5) reduced barriers to care; and (6) reduced unmet healthcare needs. We then tested these measures in a survey of 244 autistic adults recruited from 12 primary care clinics in Oregon and California, USA (with 194 participating directly and 50 participating via a proxy reporter). Community partners made sure items were easy to understand and captured what was important about the underlying idea. We found the survey measures worked well in this sample. These measures may help researchers evaluate new healthcare interventions. Future research needs to assess whether interventions improve healthcare outcomes in autistic adults.
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Affiliation(s)
- Christina Nicolaidis
- Portland State University (PSU), USA
- Oregon Health & Science University (OHSU), USA
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
| | - Kelly Y Zhen
- Portland State University (PSU), USA
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
| | | | - Dora M Raymaker
- Portland State University (PSU), USA
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
| | - Steven K Kapp
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
- University of Portsmouth, UK
| | | | - Anna Urbanowicz
- Portland State University (PSU), USA
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
- RMIT University, Australia
| | - Joelle Maslak
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
| | - Mirah Scharer
- Portland State University (PSU), USA
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
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Bartoshesky LE, Wright C. Intellectual Developmental Disabilities:: Definitions, Diagnosis, and Delivery of Care. Dela J Public Health 2021; 7:6-8. [PMID: 34467189 PMCID: PMC8352486 DOI: 10.32481/djph.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Louis E Bartoshesky
- Professor of Pediatrics, Sydney Kimmel Medical College, Thomas Jefferson University
- Medical Director, Center for Special Health Care Needs, ChristianaCare; Adjunct Assistant Professor of Medicine and Pediatrics, University of Pennsylvania
| | - Charmaine Wright
- Medical Director, Center for Special Health Care Needs, ChristianaCare; Adjunct Assistant Professor of Medicine and Pediatrics, University of Pennsylvania
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Caring for Adults With Autism Spectrum Disorder in the Emergency Department: Lessons Learned From Pediatric Emergency Colleagues. J Emerg Nurs 2021; 47:384-389. [PMID: 33637342 DOI: 10.1016/j.jen.2020.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 12/05/2020] [Accepted: 12/27/2020] [Indexed: 11/21/2022]
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Hotez E, Hotez PJ, Rosenau KA, Kuo AA. Prioritizing COVID-19 vaccinations for individuals with intellectual and developmental disabilities. EClinicalMedicine 2021; 32:100749. [PMID: 33585807 PMCID: PMC7863749 DOI: 10.1016/j.eclinm.2021.100749] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 01/24/2021] [Indexed: 10/27/2022] Open
Affiliation(s)
- Emily Hotez
- University of California, Los Angeles (UCLA) Department of Medicine, Los Angeles, CA USA
| | - Peter J. Hotez
- Texas Children's Center for Vaccine Development, Departments of Pediatrics and Molecular Virology & Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston TX USA
| | - Kashia A. Rosenau
- University of California, Los Angeles (UCLA) Department of Medicine, Los Angeles, CA USA
| | - Alice A. Kuo
- University of California, Los Angeles (UCLA) Department of Medicine, Los Angeles, CA USA
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Walsh C, Lydon S, Hehir A, O'Connor P. Development and evaluation of a novel caregiver-report tool to assess barriers to physical healthcare for people on the autism spectrum. RESEARCH IN AUTISM SPECTRUM DISORDERS 2020; 79:101680. [PMID: 33072182 PMCID: PMC7554131 DOI: 10.1016/j.rasd.2020.101680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/15/2020] [Accepted: 10/04/2020] [Indexed: 05/25/2023]
Abstract
INTRODUCTION People on the autism spectrum often experience poorer health than the general population despite higher engagement with the health services. This suggests a disparity in the accessibility of appropriate healthcare for autistic individuals. To improve access, barriers the autism community experience in healthcare first need to be identified. This paper aimed to: 1) develop and evaluate a caregiver-report tool; 2) identify barriers to physical healthcare for autistic individuals; and 3) identify potential contributing factors. METHODS A previously established taxonomy of barriers to healthcare for autistic individuals informed the development of the tool; this was then distributed to caregivers of autistic adults and children. Exploratory factor analysis (EFA) assessed validity and reliability of the tool. Multiple Regressions were performed to identify predictors of barriers. RESULTS In total, caregivers of 194 autistic children or adults participated in the study. The EFA produced four factors: 1) patient-level barriers; 2) healthcare provider-level (HCP) barriers; 3) healthcare system-level barriers; and 4) barriers related to managing healthcare. The greatest barriers included difficulties with identifying/reporting symptoms (endorsed by 62.4% of participants); difficulties handling the waiting area (60.3% of participants); and a lack of HCP knowledge regarding autism (52.1% of participants). Autism severity, general adjustment problems, anxiety, age and having unmet needs predicted the frequency and/or severity of barriers. CONCLUSIONS A tool that allows assessment of patient-, HCP-, and system-level barriers to healthcare was developed and evaluated. Patient-level barriers appear to occur frequently and pose substantial challenges. This tool will help identify areas most in need of intervention and support intervention evaluation.
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Affiliation(s)
- C Walsh
- Department of General Practice, School of Medicine, National University of Ireland Galway, Ireland
| | - S Lydon
- School of Medicine, National University of Ireland Galway, Ireland
| | - A Hehir
- School of Medicine, National University of Ireland Galway, Ireland
| | - P O'Connor
- Department of General Practice, School of Medicine, National University of Ireland Galway, Ireland
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A Systematic Review of the Perceived Barriers and Facilitators to Accessing Psychological Treatment for Mental Health Problems in Individuals on the Autism Spectrum. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2020. [DOI: 10.1007/s40489-020-00226-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Engelhard MM, Berchuck SI, Garg J, Henao R, Olson A, Rusincovitch S, Dawson G, Kollins SH. Health system utilization before age 1 among children later diagnosed with autism or ADHD. Sci Rep 2020; 10:17677. [PMID: 33077796 PMCID: PMC7572401 DOI: 10.1038/s41598-020-74458-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/28/2020] [Indexed: 01/02/2023] Open
Abstract
Children with autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD) have 2-3 times increased healthcare utilization and annual costs once diagnosed, but little is known about their utilization patterns early in life. Quantifying their early health system utilization could uncover condition-specific health trajectories to facilitate earlier detection and intervention. Patients born 10/1/2006-10/1/2016 with ≥ 2 well-child visits within the Duke University Health System before age 1 were grouped as ASD, ADHD, ASD + ADHD, or No Diagnosis using retrospective billing codes. An additional comparison group was defined by later upper respiratory infection diagnosis. Adjusted odds ratios (AOR) for hospital admissions, procedures, emergency department (ED) visits, and outpatient clinic encounters before age 1 were compared between groups via logistic regression models. Length of hospital encounters were compared between groups via Mann-Whitney U test. In total, 29,929 patients met study criteria (ASD N = 343; ADHD N = 1175; ASD + ADHD N = 140). ASD was associated with increased procedures (AOR = 1.5, p < 0.001), including intubation and ventilation (AOR = 2.4, p < 0.001); and outpatient specialty care, including physical therapy (AOR = 3.5, p < 0.001) and ophthalmology (AOR = 3.1, p < 0.001). ADHD was associated with increased procedures (AOR = 1.41, p < 0.001), including blood transfusion (AOR = 4.7, p < 0.001); hospital admission (AOR = 1.60, p < 0.001); and ED visits (AOR = 1.58, p < 0.001). Median length of stay was increased after birth in ASD (+ 6.5 h, p < 0.001) and ADHD (+ 3.8 h, p < 0.001), and after non-birth admission in ADHD (+ 1.1 d, p < 0.001) and ASD + ADHD (+ 2.4 d, p = 0.003). Each condition was associated with increased health system utilization and distinctive patterns of utilization before age 1. Recognizing these patterns may contribute to earlier detection and intervention.
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Affiliation(s)
- Matthew M Engelhard
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Rd, Durham, NC, 27705, USA.
| | - Samuel I Berchuck
- Department of Statistical Science, Duke University, Durham, NC, USA
- Duke Forge, Duke University School of Medicine, Durham, NC, USA
| | - Jyotsna Garg
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Ricardo Henao
- Duke Forge, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Andrew Olson
- Duke Forge, Duke University School of Medicine, Durham, NC, USA
| | | | - Geraldine Dawson
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Rd, Durham, NC, 27705, USA
- Duke Center for Autism and Brain Development and Duke Institute for Brain Sciences, Durham, NC, USA
| | - Scott H Kollins
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Rd, Durham, NC, 27705, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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Abstract
Autism spectrum disorder (ASD) is a condition characterized by impaired social communication as well as restricted and repetitive behaviors. It is considered a neurodevelopmental disorder because it is associated with neurologic changes that may begin in prenatal or early postnatal life, alters the typical pattern of child development, and produces chronic signs and symptoms that usually manifest in early childhood and have potential long-term consequences. In past decades, autism was conceptualized as a strictly defined set of behaviors, usually accompanied by intellectual impairment. Today, it is recognized as a spectrum, ranging from mild to severe, in which behaviors vary substantially and the majority of children who fall on the spectrum have average to above average intellectual ability. Here, the authors discuss the risk factors for ASD, its epidemiology, common concurrent conditions, evaluation, diagnosis, treatments, and outcomes.
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Affiliation(s)
- Deborah Christensen
- Deborah Christensen is an epidemiologist at the Centers for Disease Control and Prevention, Atlanta. Jennifer Zubler is a pediatric consultant at Eagle Global Scientific, San Antonio, TX. Contact author: Deborah Christensen, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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