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Song W, McLean KJ, Gifford J, Kissner H, Sipe R. Adverse Childhood Experiences and Health Outcomes Among Transition-Age Autistic Youth. J Autism Dev Disord 2024:10.1007/s10803-024-06401-7. [PMID: 38771506 DOI: 10.1007/s10803-024-06401-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) have been associated with poor health outcomes in the general population. However, their impact on autistic youth remains unclear. OBJECTIVE The primary objective was to understand how childhood adversity is related to the general health, mental health, and physical health of transition-age autistic youth. PARTICIPANTS AND SETTING Using data from the 2018-2021 National Survey of Children's Health, this cross-sectional study involved 2056 autistic youth aged 12-17. METHODS Logistic regression was employed to test the association between three measures of ACEs - individual ACEs, cumulative ACEs, and grouped ACEs based on contexts, and health outcomes of autistic youth. RESULTS Our study observed a high prevalence of ACEs among autistic youth, with a substantially higher proportion experiencing multiple ACEs than their neurotypical peers. Individual ACEs were significantly associated with specific health issues. Cumulative ACEs demonstrated a clear dose-response relationship with health outcomes, with higher ACE counts increasing the likelihood of experiencing poor general health, mental health conditions, and physical health issues. Moreover, grouped ACEs associated with health differently, with community-based ACEs being particularly linked to general health status, mental health conditions, and physical health conditions, while family-based ACEs correlated more with more severe mental health conditions and being overweight. CONCLUSION These findings collectively emphasize the importance of addressing ACEs as a public health concern among transition-age autistic youth, highlighting the need for targeted interventions, prevention strategies, and support services to mitigate the negative impact of ACEs on the overall well-being of this growing community.
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Affiliation(s)
- Wei Song
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA.
| | - Kiley J McLean
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Jordan Gifford
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Hailey Kissner
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Rosalind Sipe
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
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Drahota A, Sridhar A, Moskowitz LJ, Kerns CM, Soorya L, Wainer A, Cohn E, Lerner MD. Community-based care for autistic youth: community providers' reported use of treatment practices in the United States. Front Psychiatry 2023; 14:1212084. [PMID: 37791130 PMCID: PMC10544899 DOI: 10.3389/fpsyt.2023.1212084] [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: 04/25/2023] [Accepted: 08/09/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction To illustrate the landscape of community-based care for autistic youth in the United States, we identified transdisciplinary psychosocial intervention practice sets that community providers report utilizing to care for this population, and examined characteristics associated with provider-reported utilization. Methods The Usual Care for Autism Study (UCAS) Survey assessed provider demographics and provider-reported use of transdisciplinary practices for common ASD co-occurring problems: social difficulties, externalizing behaviors, and anxiety. Community practitioners (N = 701) from allied health, behavioral, education, medical, mental health and other disciplines who treat or work with autistic youth (7-22 years) participated. Results Exploratory factor analysis yielded four factors: Consequence-Based Strategies (CBS), Cognitive-Behavioral and Therapy Strategies (CBTS), Antecedent-Based Strategies (ABS), and Teaching Strategies (TS). Providers across disciplines reported utilizing ABS more often than other sets. Providers from behavioral disciplines, with less than 4-year or Master degrees, or with more experience reported the most use of ABS, CBS and CBTS. Medical and behavioral providers reported the most use of TS. Setting and child characteristics were associated with practice set use, indicating variability by disability and client socioeconomic status. Discussion Findings reflect the complexity and inconsistency of the service landscape for autistic youth across the U.S. Only by understanding the service landscape and predictors of practice utilization, can researchers, policymakers, provider groups, and the autistic community facilitate effective implementation strategy development and use to ultimately improve community-based care.
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Affiliation(s)
- Amy Drahota
- Department of Psychology, Michigan State University, East Lansing, MI, United States
| | - Aksheya Sridhar
- Department of Psychology, Michigan State University, East Lansing, MI, United States
| | | | - Connor M. Kerns
- Department of Psychology, University British Columbia, Vancouver, BC, Canada
| | - Latha Soorya
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Allison Wainer
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Elizabeth Cohn
- School of Nursing, Hunter College, CUNY, New York, NY, United States
| | - Matthew D. Lerner
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
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Semovski V, King C, Lapshina N, Stewart SL. A cross-sectional examination of service complexity in youths with co-occurring autism spectrum disorder and psychiatric or medical diagnoses across service sectors. Front Psychol 2023; 13:1027373. [PMID: 36817386 PMCID: PMC9930473 DOI: 10.3389/fpsyg.2022.1027373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/28/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction Autism spectrum disorder (ASD) is a heterogeneous, life-long, and complex condition. Youth diagnosed with ASD require several supports addressing core symptoms associated with the disorder, but also those resulting from co-occurring mental and physical health conditions. As a result, their care is overseen by numerous professionals spanning various service sectors, but communication between sectors is hindered due to the absence of a standardized assessment system to identify and triage youth to services. A paucity of information surrounding this population's service use lingers and a siloed delivery system persists. Methods Using archival data collected from 1,020 youth between 12 and 18 years of age, this study explored service complexity among autistic youth with and without psychiatric and medical co-occurring conditions in Ontario, Canada. In doing so, a negative binomial regression was utilized to investigate which predisposing, enabling, and need variables were associated with service complexity. Results Results revealed that experiencing financial difficulties was not associated with service complexity. However, age, sex, caregiver distress, comorbidity, intellectual disability, and evaluated health status were significant predictors. More specifically, female youth and youth with distressed caregivers had greater mental health service complexity scores. Additionally, youth diagnosed with two or more conditions in addition to ASD who required longer durations of programming, controlling for other predictors, had greater mental health service complexity scores. Yet, youth with an intellectual disability had lower service complexity scores. Discussion Clinical implications of this study are discussed to inform future investments into mental health efforts for autistic youth.
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Cleary M, West S, Hunt GE, McLean L, Hungerford C, Kornhaber R. How People with Autism Access Mental Health Services Specifically Suicide Hotlines and Crisis Support Services, and Current Approaches to Mental Health Care: A Scoping Review. Issues Ment Health Nurs 2022; 43:1093-1106. [PMID: 36041121 DOI: 10.1080/01612840.2022.2108529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
For people with autism spectrum disorder (ASD), the risk of mental illness, including suicidality, has a higher prevalence than the general population. This scoping review explored how people with ASD access suicide hotlines/crisis support services; and current approaches to delivering mental health services (MHS) to people with ASD. A search identified 28 studies meeting the selection criteria with analysis revealing four key findings. The support received by the person with ASD influenced how they accessed MHS; people often encounter barriers to accessing MHS; a separation exists between autism and MHS; and no studies on accessing or delivering MHS through crisis hotlines. The presence of such autism-specific crisis hotlines and the dearth of studies suggest a void in the existing research.
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Affiliation(s)
- Michelle Cleary
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, NSW, Australia
| | - Sancia West
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, NSW, Australia
| | - Glenn E Hunt
- Speciality of Psychiatry, Concord Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Loyola McLean
- Diploma of Psychodynamic Psychotherapy Cert ATP, Accredited AAI Coder and Trainer, Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Consultation-Liaison Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia.,Westmead Psychotherapy Program for Complex Traumatic Disorders, Western Sydney Local Health District, Parramatta, Sydney, Australia.,Western Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Catherine Hungerford
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, NSW, and School of Health, Federation University, VIC, Australia
| | - Rachel Kornhaber
- School of Nursing, University of Tasmania, Sydney, NSW, Australia
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Lerner MD, Brown CE, Sridhar A, Tschida JE, Felsman P, Libsack EJ, Kerns CM, Moskowitz LJ, Soorya L, Wainer A, Cohn E, Drahota A. Usual care for youth with autism spectrum disorder: Community-based providers' reported familiarity with treatment practices. Front Psychiatry 2022; 13:923025. [PMID: 35958649 PMCID: PMC9360540 DOI: 10.3389/fpsyt.2022.923025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine patterns and predictors of familiarity with transdisciplinary psychosocial (e.g., non-pharmacologic) practices for practitioners treating youths with autism spectrum disorder (ASD) in the United States. METHOD Practitioners (n = 701) from behavioral, education, medical, and mental health backgrounds who worked with youth (ages 7-22) with ASD completed the Usual Care for Autism Survey, which assessed provider demographics and self-reported familiarity with transdisciplinary treatment practices for the most common referral problems of ASD. We examined relations between provider-, setting-, and client-level characteristics with familiarity of key groups of the treatment practices (practice sets). Practice sets were identified using exploratory factor analysis (EFA), and demographic predictors of practice subsets were examined using generalized estimating equations (GEE). RESULTS The EFA yielded a three-factor solution: (1) environmental modifications/antecedent strategies; (2) behavior analytic strategies; and (3) cognitive strategies, with overall familiarity ranked in this order. Medical providers indicated the least familiarity across disciplines. More experience with ASD and treating those with intellectual disabilities predicted greater familiarity with only environmental modifications/antecedent strategies and behavior analytic, but not cognitive strategies. Experience treating low SES clients predicted familiarity with environmental modification and behavior analytic strategies while experience treating high SES clients predicted familiarity with behavior analytic and cognitive strategies. CONCLUSION This is the first study to identify transdisciplinary, interpretable sets of practices for treating youth with ASD based on community providers' reported familiarity. Results highlight factors associated with familiarity with practice sets, which is essential for mapping practice availability, and optimizing training and dissemination efforts for youth with ASD.
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Affiliation(s)
- Matthew D Lerner
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Cynthia E Brown
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States.,School of Graduate Psychology, Pacific University, Hillsboro, OR, United States
| | - Aksheya Sridhar
- Department of Psychology, Michigan State University, Lansing, MI, United States
| | - Jessica E Tschida
- Department of Psychology, Michigan State University, Lansing, MI, United States
| | - Peter Felsman
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States.,Department of Social Work, Northern Michigan University, Marquette, MI, United States
| | - Erin J Libsack
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Connor M Kerns
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | - Lauren J Moskowitz
- Department of Psychology, St. John's University, Queens, NY, United States
| | - Latha Soorya
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, United States
| | - Allison Wainer
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, United States
| | - Elizabeth Cohn
- Hunter-Bellevue School of Nursing, City University of New York, New York, NY, United States
| | - Amy Drahota
- Department of Psychology, Michigan State University, Lansing, MI, United States
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Service Use Among Transition-Age Youth with Autism Spectrum Disorder. J Autism Dev Disord 2021; 52:1051-1065. [PMID: 33864557 DOI: 10.1007/s10803-021-04999-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
This study explored predictors of service use among 174 transition-age youth (age 16-30) with an Autism Spectrum Disorder using Andersen's (J Health Soc Behav 36(1):1-10, 1995) healthcare utilization model. Family caregivers were interviewed about past 6-month use of 15 services. On average, youth used 6.1 and needed 3.2 additional services. Greater service use was associated with two predisposing (caregiver college educated, caregiver not married/partnered), two enabling (youth has Medicaid waiver, youth in high school), and one need factor (lower adaptive functioning). Use of specific services was most strongly related to enabling (Medicaid waiver, in high school) and need factors (lower adaptive functioning, comorbid mental health diagnosis). Findings provide a snapshot of the "service cliff" faced by families and highlight the need for additional research.
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Cummings MR, Dubovsky SL, Ehrlich I, Kandefer S, Van Cleve J, Yin Y, Cranwell V, Gordon J, Youngs M. Preliminary Assessment of a Novel Continuum-of-Care Model for Young People With Autism Spectrum Disorders. Psychiatr Serv 2020; 71:1313-1316. [PMID: 32988326 DOI: 10.1176/appi.ps.201900574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Because of limited intermediate-care services, patients with autism spectrum disorders (ASDs) are increasingly being treated in emergency departments (EDs) and psychiatric hospitals. To address this growing problem, the authors developed a mobile outreach program, called Access to Psychiatry through Intermediate Care (APIC), for young (≤26 years) patients with ASD at risk for involvement with emergency medical services or the legal system. In its initial year, the average program duration per patient was 264.5 days. Clinical and Family Distress Scale scores indicated significant improvements for participating patients and caretakers. In the first year, among 40 patients with sufficient data for comparison, 13 (33%) went to the ED, and lengths of stay decreased up to 77% from pre- to postintervention. Given a cost per APIC-enrolled patient of $1,700, the net saving for the cost of ED treatment was $2,260-$2,559 per patient. The feasibility and cost-effectiveness of the APIC model has attracted additional state and county funding.
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Affiliation(s)
- Michael R Cummings
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo (Cummings, Dubovsky, Kandefer, Van Cleve, Cranwell, Gordon, Youngs); Department of Economics (Ehrlich, Yin) and School of Management (Ehrlich), State University of New York at Buffalo, Buffalo; Departments of Psychiatry and Medicine, University of Colorado, Aurora (Dubovsky). Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Steven L Dubovsky
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo (Cummings, Dubovsky, Kandefer, Van Cleve, Cranwell, Gordon, Youngs); Department of Economics (Ehrlich, Yin) and School of Management (Ehrlich), State University of New York at Buffalo, Buffalo; Departments of Psychiatry and Medicine, University of Colorado, Aurora (Dubovsky). Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Isaac Ehrlich
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo (Cummings, Dubovsky, Kandefer, Van Cleve, Cranwell, Gordon, Youngs); Department of Economics (Ehrlich, Yin) and School of Management (Ehrlich), State University of New York at Buffalo, Buffalo; Departments of Psychiatry and Medicine, University of Colorado, Aurora (Dubovsky). Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Sevie Kandefer
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo (Cummings, Dubovsky, Kandefer, Van Cleve, Cranwell, Gordon, Youngs); Department of Economics (Ehrlich, Yin) and School of Management (Ehrlich), State University of New York at Buffalo, Buffalo; Departments of Psychiatry and Medicine, University of Colorado, Aurora (Dubovsky). Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Janell Van Cleve
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo (Cummings, Dubovsky, Kandefer, Van Cleve, Cranwell, Gordon, Youngs); Department of Economics (Ehrlich, Yin) and School of Management (Ehrlich), State University of New York at Buffalo, Buffalo; Departments of Psychiatry and Medicine, University of Colorado, Aurora (Dubovsky). Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Yong Yin
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo (Cummings, Dubovsky, Kandefer, Van Cleve, Cranwell, Gordon, Youngs); Department of Economics (Ehrlich, Yin) and School of Management (Ehrlich), State University of New York at Buffalo, Buffalo; Departments of Psychiatry and Medicine, University of Colorado, Aurora (Dubovsky). Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Victoria Cranwell
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo (Cummings, Dubovsky, Kandefer, Van Cleve, Cranwell, Gordon, Youngs); Department of Economics (Ehrlich, Yin) and School of Management (Ehrlich), State University of New York at Buffalo, Buffalo; Departments of Psychiatry and Medicine, University of Colorado, Aurora (Dubovsky). Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Joshua Gordon
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo (Cummings, Dubovsky, Kandefer, Van Cleve, Cranwell, Gordon, Youngs); Department of Economics (Ehrlich, Yin) and School of Management (Ehrlich), State University of New York at Buffalo, Buffalo; Departments of Psychiatry and Medicine, University of Colorado, Aurora (Dubovsky). Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Margaret Youngs
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo (Cummings, Dubovsky, Kandefer, Van Cleve, Cranwell, Gordon, Youngs); Department of Economics (Ehrlich, Yin) and School of Management (Ehrlich), State University of New York at Buffalo, Buffalo; Departments of Psychiatry and Medicine, University of Colorado, Aurora (Dubovsky). Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
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McLennan JD, Bahadur A, Cobigo V, Hrycko S, Fulford C. Cross-sector service use patterns among children with developmental disabilities in a district in Canada. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:546-555. [PMID: 33070429 DOI: 10.1111/jar.12821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a lack of information about cross-sector service use by children with developmental disabilities despite their need for services from multiple sectors. METHODS Responses to service use questions from a parent-completed survey on school-aged children who attended clinics specific for those with developmental disabilities at a Canadian children's hospital were examined. RESULTS School meetings were the most common of three professional meeting types attended in the last 12 months (64.9%) for the sample of 205 children. Recreational services were the most common of five service types received in the same time period (79.0%). Using ordinal logistic regression models, a higher number of behavioural difficulties was the only variable consistently related to indices of more meeting types (school, physician, other) attended and more service types received (recreation, respite, etc.). CONCLUSIONS The service relationship with behavioural problems, and not socio-demographic variables, is consistent with a needs-based oriented delivery system.
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Affiliation(s)
- John D McLennan
- Children's Hospital of Eastern Ontario-Research Institute, Ottawa, ON, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Virginie Cobigo
- Children's Hospital of Eastern Ontario-Research Institute, Ottawa, ON, Canada.,School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Sophia Hrycko
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Casey Fulford
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
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