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Mulé CM, Sliwinski SK, Israel R, Lavelle TA. Developmental Behavioral Pediatrician Perspectives on Decision-Making in Early Treatment Planning for Children with Autism Spectrum Disorder. J Dev Behav Pediatr 2022; 43:71-79. [PMID: 34654040 DOI: 10.1097/dbp.0000000000001002] [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] [Received: 10/02/2020] [Accepted: 07/23/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Providers of children with autism spectrum disorder (hereafter "autism") report higher levels of shared decision-making during initial diagnostic and treatment planning visits than observed. The goal of this study was to qualitatively explore this discrepancy by investigating provider perceptions of the parent-provider decision-making process in early treatment planning and the role for parents in this process. METHODS We conducted semistructured qualitative interviews with developmental behavioral pediatricians (DBPs; n = 15) to investigate how they approach early treatment planning with parents. We analyzed participant characteristics using descriptive statistics. Interviews were audio-recorded, transcribed, and independently coded by 2 researchers until consensus was reached. Analyses were conducted using a modified grounded theory framework. RESULTS DBPs reported that their primary role during early treatment planning was to provide diagnostic clarification and that parents' primary role was to learn as much as they can about autism. Most DBPs wanted treatment planning to be collaborative, and perceived that parents had the same preference but might not have the knowledge or skills to effectively participate. DBPs identified additional barriers that influence the extent to which they engage parents in the collaborative decision-making and provided recommendations for enhancing the process. CONCLUSION DBPs are proponents of collaborative treatment planning between parents and providers; however, there are many obstacles that prevent this. Strategies such as decision tools or aids and larger systemic reforms are necessary to support DBPs and parents in this process.
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Affiliation(s)
- Christina M Mulé
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Golisano Children's Hospital, University of Rochester, Rochester, NY
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Tufts Children's Hospital, Tufts University School of Medicine, Boston, MA
| | | | - Rebecca Israel
- Master of Public Health Program, Tufts University School of Medicine, Boston, MA
| | - Tara A Lavelle
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
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Mulé CM, Lavelle TA, Sliwinski SK, Wong JB. Shared Decision-Making During Initial Diagnostic and Treatment Planning Visits for Children with Autism Spectrum Disorder. J Dev Behav Pediatr 2021; 42:363-373. [PMID: 33443970 PMCID: PMC8204856 DOI: 10.1097/dbp.0000000000000903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Although shared decision-making (SDM) can improve patient engagement, adherence, and outcomes, evidence on the use of SDM within the context of autism spectrum disorder (ASD) initial diagnosis and treatment planning remains limited. The goal of this study was to objectively assess the occurrence of SDM in these visits and to compare this assessment with parent and provider perceptions of SDM in the same encounter. METHODS After audio-recording and transcribing initial clinical visits between parents (n = 22) and developmental behavioral pediatricians (n = 6) discussing the diagnosis of ASD and treatment options, we used the OPTION5 Item scale to assess the occurrence of SDM. Afterward, parents and providers completed the OPTION5 Item, and parents also participated in a semistructured qualitative interview. Analysis consisted of descriptive statistics for OPTION5 Item scores and a modified grounded theory framework for interviews. RESULTS Low levels of SDM were observed, with 41% of visits having no elements of SDM. On average, visits scored 1.1 of a possible 20 points on the OPTION5 Item scale for SDM. By contrast, parents and providers indicated on the OPTION5 Item scale that providers made a "moderate" to "skilled" effort to engage parents in SDM. Qualitative interviews with parents were consistent with their OPTION5 Item ratings. CONCLUSION The level of SDM determined by parent and provider reports was higher than the level of SDM determined by objective observation using a standard validated rating method. The findings reinforce the need for further research into barriers and facilitators of SDM methods and outcomes within ASD.
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Affiliation(s)
- Christina M. Mulé
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Floating Hospital for Children at Tufts Medical Center, Tufts University School of Medicine, Boston, MA
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Golisano Children's Hospital, University of Rochester, Rochester, NY
| | - Tara A. Lavelle
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Samantha K. Sliwinski
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Floating Hospital for Children at Tufts Medical Center, Tufts University School of Medicine, Boston, MA
| | - John B. Wong
- Division of Clinical Decision Making, Tufts Medical Center, Tufts University School of Medicine, Boston, MA
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Huffman LC, Hubner LM, Hansen RL. Autism-Focused Online Training in Shared Decision-Making: A Randomized Controlled Trial. J Dev Behav Pediatr 2021; 42:173-181. [PMID: 33759846 DOI: 10.1097/dbp.0000000000000882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This medical education quasi-randomized controlled trial (quasi-RCT), involving 97 developmental-behavioral pediatrics fellows across the United States, examined differential effects of 2 autism-focused, online, interactive case-based trainings on shared decision-making (SDM). METHODS An intervention case provided direct teaching about SDM, addressing autism treatment options. A comparison case focused on evidence-based practice (EBP) related to medication use in autism with no specific SDM teaching. Measured outcomes included self-reported SDM and attitudes toward concordance in medication-prescribing. RESULTS After the intervention, both groups showed significantly increased SDM, but not medication-prescribing concordance (controlling for trainee level, autism patient numbers, and past SDM training). CONCLUSION This quasi-RCT presents evidence that knowledge of SDM in care of children with autism can be enhanced by online case-based training focused either indirectly on evidence-based practice or directly on SDM. Consistent online SDM training can be provided to all trainees, irrespective of the location.
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Affiliation(s)
- Lynne C Huffman
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Lauren M Hubner
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Robin L Hansen
- Department of Pediatrics, and Director of the Center for Excellence in Developmental Disabilities, University of California Davis, Sacramento, CA
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Quebles I, Solomon O, Smith KA, Rao SR, Lu F, Azen C, Anaya G, Yin L. Racial and Ethnic Differences in Behavioral Problems and Medication Use Among Children With Autism Spectrum Disorders. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 125:369-388. [PMID: 32936891 PMCID: PMC8423191 DOI: 10.1352/1944-7558-125.5.369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/14/2020] [Indexed: 06/03/2023]
Abstract
We examined racial and ethnic differences in the prevalence of behavioral problems measured by the Child Behavioral Checklist (CBCL), sleep disturbances measured by the Child Sleep Habits Questionnaire (CSHQ), and medication use among children with Autism Spectrum Disorders (ASD). We analyzed data from the Autism Treatment Network (ATN) dataset for 2,576 children ages 6 to 18 years of age diagnosed with ASD. Multivariable logistic regression accounting for age, gender, Diagnostic and Statistical Manual of Mental Disorders (4th Edition - Text Revision), diagnosis (Autistic Disorder, PDD-NOS, Asperger's Disorder), and parents' education did not show any racial or ethnic differences in behavioral challenges, conduct problems, or sleep disturbances for any of the groups, but Black children had lower odds of Total Problem Behaviors and Asian children had lower odds of Hyperactivity compared to White children. As a group, children from racial and ethnic minorities had lower odds of Total Problem Behaviors and Conduct Problems compared to White children. Hispanic children had lower odds of medication use for Behavioral Challenges, Total Problem Behaviors, Hyperactivity, and Conduct Problems. Asian children had lower odds of medication use for Behavioral Challenges, Total Problem Behaviors, and Hyperactivity; and had close to lower odds in medication use for Conduct Problems. Black children had lower odds for medication use for Total Problem Behaviors only. As a group, children from racial and ethnic minorities had lower odds for medication use for Behavioral Challenges, Total Problem Behaviors, Hyperactivity, and Conduct problems, but not for Sleep Disturbances. While these results are consistent with previous studies showing that White children are significantly more likely to receive psychotropic medication compared to children from racial and ethnic minority groups, we found no such differences for sleep challenges, suggesting that they are more consistently identified and equitably treated than other behavioral problems associated with ASD. We draw upon Andersen's (1995) Behavioral Model of Healthcare Use to suggest predisposing, enabling, and needs factors that may contribute to this pattern of racial and ethnic differences in the use of medications among children ASD.
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Affiliation(s)
- Irina Quebles
- Irina Quebles, Olga Solomon, and Kathryn A. Smith, Children's Hospital Los Angeles, University of Southern California
| | - Olga Solomon
- Irina Quebles, Olga Solomon, and Kathryn A. Smith, Children's Hospital Los Angeles, University of Southern California
| | - Kathryn A Smith
- Irina Quebles, Olga Solomon, and Kathryn A. Smith, Children's Hospital Los Angeles, University of Southern California
| | - Sowmya R Rao
- Sowmya R. Rao and Frances Lu, Massachusetts General Hospital, Boston
| | - Frances Lu
- Sowmya R. Rao and Frances Lu, Massachusetts General Hospital, Boston
| | - Colleen Azen
- Colleen Azen, Grace Anaya, and Larry Yin, Children's Hospital Los Angeles, University of Southern California
| | - Grace Anaya
- Colleen Azen, Grace Anaya, and Larry Yin, Children's Hospital Los Angeles, University of Southern California
| | - Larry Yin
- Colleen Azen, Grace Anaya, and Larry Yin, Children's Hospital Los Angeles, University of Southern California
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dosReis S, N'Dri L, Ross M, Camelo Castillo W, Reeves G, Butler B. Care Management for Youth With Comorbid Developmental and Mental Health Conditions: A Discrete Choice Experiment Pilot Study. Acad Pediatr 2020; 20:241-249. [PMID: 31128382 DOI: 10.1016/j.acap.2019.05.127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/25/2019] [Accepted: 05/18/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Caregivers of a child with a coexisting cognitive/intellectual and an emotional/behavior/developmental disability have difficult decisions regarding care management options for their child. This study aimed to pilot and refine an instrument to elicit caregivers' preferences in managing their child's care needs. METHODS Subjects were 38 caregivers of a child aged 21 and younger with a coexisting cognitive/intellectual and an emotional/behavior/developmental disability. A mixed-methods design was used to develop and pilot a discrete choice experiment (DCE) to elicit care management preferences for their child. Six attributes of care management decisions were tested in the DCE: medication use, parental custody, time cost, social interactions, medication effects, and school placement. Subjects completed a paper-and-pencil survey after which a debriefing discussion was held to obtain feedback that would aid in refining the attribute descriptions. Conditional logistic regression generated mean scores for each attribute. Comments from the debriefing sessions were audio-recorded and used to modify the attribute descriptions. RESULTS The majority (84%) of subjects were aged 40 years or older and a female caregiver. Common diagnoses of the children were autism spectrum disorder (55%) and attention-deficit/hyperactivity disorder (76%). Subjects preferred using fewer medications and maintaining decision-making authority as opposed to delegating authority to a third party. Medication effects on the child's mood were more important than effects on personality or body weight. CONCLUSIONS The DCE was sensitive to caregivers' preferences for managing their child's coexisting cognitive/intellectual and emotional/behavior/developmental disability. Findings may help providers gauge treatment in a broader context of health outcomes.
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Affiliation(s)
- Susan dosReis
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore (S dosReis, WC Castillo).
| | - Laetitia N'Dri
- University of Maryland School of Pharmacy, Baltimore (L N'Dri)
| | - Melissa Ross
- Patient-Centered Research, Evidera, Bethesda (M Ross)
| | - Wendy Camelo Castillo
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore (S dosReis, WC Castillo)
| | - Gloria Reeves
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, Baltimore (G Reeves)
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Miller IT, Wiederhold BK, Miller CS, Wiederhold MD. Virtual Reality Air Travel Training with Children on the Autism Spectrum: A Preliminary Report. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2019; 23:10-15. [PMID: 31355673 DOI: 10.1089/cyber.2019.0093] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Autism spectrum disorder (ASD) is categorized by deficits in social communication and interaction, alongside repetitive, restrictive behaviors or interests (RRBIs). Previous research supports the efficacy of virtual reality (VR) to train a variety of specific skills (i.e., riding a bus or crossing the street) as well as more complex social skills, such as emotion recognition and functional communication. The present reports the implementation of a VR-based air travel functional communication activity in five children diagnosed with ASD. Using an iPhone X and Google Cardboard device, researchers delivered the VR intervention once per week for 3 weeks to each participant. During these interventions, researchers measured activity completion ability on a 4-point scale. At week 4, all children participated in a real-world air travel rehearsal at the San Diego International Airport. Parents were asked to rate their child's air travel abilities before week 1 and after week 4. All children improved their air travel skills from pre- to postintervention, reflected in both the researchers' and parents' observations. All children navigated the real-world airport under their own power. This preliminary report suggests the efficacy of VR to teach basic air travel skills to young children diagnosed with autism. Clinician observations regarding attention to the VR and strategies for helping participants accept the intervention technique are discussed. Future iterations of this program will require larger sample sizes and more robust clinical measurements-such as communication samples and physiological monitoring.
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Affiliation(s)
- Ian T Miller
- Interactive Media Institute, San Diego, California
| | - Brenda K Wiederhold
- Interactive Media Institute, San Diego, California.,Virtual Reality Medical Center, La Jolla, California
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