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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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Marquis S, Lunsky Y, McGrail KM, Baumbusch J. Population Level Mental Health Diagnoses for Youth with Intellectual/Developmental Disabilities Compared to Youth without Intellectual/Developmental Disabilities. Res Child Adolesc Psychopathol 2024; 52:1147-1156. [PMID: 38329685 DOI: 10.1007/s10802-024-01174-0] [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: 01/29/2024] [Indexed: 02/09/2024]
Abstract
There is evidence in the literature that youth with intellectual/developmental disabilities (IDD) experience mental health issues to a greater extent compared to youth without IDD. In addition, transition from pediatric to adult services may be a period of increased anxiety and mental health problems for these youth. This study used a retrospective cohort design using population level administrative health data to compare mental health diagnoses between youth with IDD and youth without IDD; particularly examining the period when youth transition from pediatric health services to adult health services. In addition, this study compared the mental health of youth with various types of IDD (Down syndrome, autism, fetal alcohol syndrome and other rarer diagnoses). Results showed that at the population level youth with IDD have greater odds of anxiety/depression or psychotic illness than youth without IDD. Adjusted odds of anxiety/depression or psychotic illness also varied with age, income level, sex, and type of IDD. Youth with fetal alcohol syndrome had the greatest odds of both anxiety/depression and a psychotic illness. Odds of anxiety/depression increased from age 15-19 years old. Odds of a psychotic illness increased from age 15 to age 24 years old.
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Affiliation(s)
- Sandra Marquis
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, CAMH, 1025 Queen St West, Toronto, ON, M6J 1H4, Canada
| | - Kimberlyn M McGrail
- Centre for Health Services and Policy Research, The University of British Columbia, 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Jennifer Baumbusch
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
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Westover AN. The Future of General Psychiatry Must Include Autism Spectrum Disorder and Intellectual Disability. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024:10.1007/s40596-024-01985-9. [PMID: 38782841 DOI: 10.1007/s40596-024-01985-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
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Ames JL, Davignon MN, Hayes EA, Croen LA. Health Care for Autistic Children: A Public Health Perspective. Pediatr Clin North Am 2024; 71:111-125. [PMID: 38423712 DOI: 10.1016/j.pcl.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Autism has been the subject of large-scale public health investment. These investments are increasingly shifting toward mitigating the lifelong disability and impairment associated with autism. Key efforts include bolstering screening schedules, accelerating the path to diagnosis and early entry into evidence-based therapies, and providing preventive management of common co-occurring conditions. Enhancing their implementation will necessitate addressing neurodiversity and health equity. Pediatric primary care teams continue to be important stewards in population-level initiatives to promote autistic health. To thrive in this role, these providers will benefit from specific educational and logistical supports from the health care system.
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Affiliation(s)
- Jennifer L Ames
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Drive, Building B, Pleasanton, CA 94588, USA.
| | - Meghan N Davignon
- Kaiser Permanente Roseville Medical Center, 1600 Eureka Road, Building C, Department of Pediatric Subspecialties, Roseville, CA 95661, USA
| | - Elizabeth A Hayes
- Kaiser Permanente Oakland Medical Center, Department of Pediatrics, 275 West Macarthur Boulevard, Oakland, CA 94611, USA
| | - Lisa A Croen
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Drive, Building B, Pleasanton, CA 94588, USA
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Costa Alves J, Morais S, Ferreira de Macedo A. [Neurodevelopmental Psychiatry Consultation: A National Level Analysis]. ACTA MEDICA PORT 2023; 36:802-810. [PMID: 37609841 DOI: 10.20344/amp.19652] [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: 01/22/2023] [Accepted: 05/26/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION Neurodevelopmental disorders are characterized by delay or variation in the acquisition of abilities or skills in several domains of development: motor, social, language, and cognitive. These disorders can manifest from childhood to adulthood, and therefore continuity of care is essential throughout these various developmental periods. However, several studies show that there is limited access to adult health care in this clinical domain. METHODS A cross-sectional observational study was carried out by distributing an anonymous survey among psychiatry physicians, at a national level, in the period between October 6 and December 6, 2020. RESULTS Data was collected from 83 psychiatry physicians (43 residents and 40 specialists). At the national level, only 16.9% of psychiatric departments had a subspecialized neurodevelopment clinic. Physicians reported that they observed few patients with neurodevelopment disorders: 72.3% observed one or none per week. When there was a neurodevelopmental disorders clinic in the psychiatry department, 64.3% of physicians reported that this clinic did not include a multidisciplinary team. The transition of these patients from the pediatric/child and adolescent psychiatry department to the psychiatric department occurred through regular intrahospital transfer in 51.8% of cases, but it occurred through a specific protocol or with a transitional medical appointment in only 15.7% of cases. Finally, 88% of psychiatry physicians considered the existence of a neurodevelopmental disorders clinic in adults to be pertinent and reported not having specialized training in the field of neurodevelopment. CONCLUSION This study made it possible to identify some difficulties and barriers regarding adequate access for patients with neurodevelopmental disorders throughout the various developmental stages, from childhood to adulthood: lack of training in this clinical field, need of better communication between departments, lack of specific protocols, shortage of multidisciplinary teams, and asymmetry in the distribution of differentiated care.
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Affiliation(s)
| | - Sofia Morais
- Instituto de Psicologia Médica. Faculdade de Medicina. Universidade de Coimbra; Serviço de Psiquiatria. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - António Ferreira de Macedo
- Instituto de Psicologia Médica. Faculdade de Medicina. Universidade de Coimbra; Serviço de Psiquiatria. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
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Davis SA, Annis IE, Hughes PM, DeJong NA, Christian RB, Ruble LA, Thomas KC. Patterns of Mental Health Service Use During the Transition to Adulthood Among Autistic Adolescents and Young Adults. AUTISM IN ADULTHOOD 2023; 5:366-373. [PMID: 38116058 PMCID: PMC10726177 DOI: 10.1089/aut.2022.0088] [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: 03/29/2023]
Abstract
Background The time of transition into adulthood, especially when leaving school, is a time when many autistic adolescents and young adults (AYA) may stop receiving mental health services that they have relied on, leading to worse mental health outcomes. The purpose of this study was to describe patterns of mental health service use during transition to adulthood among autistic AYAs. Methods We performed a cross-sectional study using electronic health records from years 2015 to 2019 from one large university health care system. We included autistic individuals ages 11-27 with at least one clinical encounter annually in the cohort. Outcomes included psychotropic medications and psychotherapy received, psychotropic polypharmacy, psychiatric emergency department (ED) visits, and adverse drug events. Results Almost half of the 529 patients in the cohort received polypharmacy. The most common treatment was medication only (56.9%), followed by no treatment (22.7%), medication plus psychotherapy (18.7%), and psychotherapy only (data masked). The 17-21 age group had the highest odds of a psychiatric ED visit, whereas the 22-27 age group had the highest odds of receiving psychotropic medications and polypharmacy. Black AYA were more likely to receive psychotherapy and less likely to receive psychotropic polypharmacy than non-Hispanic Whites. Conclusion Autistic individuals may benefit from more support from the health care system for their transition into adulthood to maintain use of beneficial mental health services as they leave school and to reduce the frequency of adverse outcomes. Access to providers experienced treating the complex needs of autistic individuals is important to reduce disparities.
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Affiliation(s)
- Scott A. Davis
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Asheville, North Carolina, USA
| | - Izabela E. Annis
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Asheville, North Carolina, USA
| | - Phillip M. Hughes
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Asheville, North Carolina, USA
| | - Neal A. DeJong
- Department of Pediatrics and University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Robert B. Christian
- Department of Pediatrics and University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Lisa A. Ruble
- Department of Special Education, Ball State University, Muncie, Indiana, USA
| | - Kathleen C. Thomas
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Asheville, North Carolina, USA
- Cecil G. Sheps Center for Health Services Research, Chapel Hill, North Carolina, USA
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Marquis S, Lunsky Y, McGrail KM, Baumbusch J. Population level administrative data evidence of visits to the emergency department by youth with intellectual/developmental disabilities in BC, Canada. Am J Emerg Med 2023; 69:52-57. [PMID: 37058981 DOI: 10.1016/j.ajem.2023.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/23/2023] [Accepted: 04/03/2023] [Indexed: 04/16/2023] Open
Abstract
INTRODUCTION The literature indicates that youth with intellectual/developmental disabilities (IDD) have poor health and that access to health services decreases as they transition from pediatric to adult services. At the same time their use of emergency department services increases. The objective of this study was to compare use of emergency department services by youth with IDD to youth without IDD, with particular emphasis on the transition period from pediatric to adult health care services. METHODS This research used a population level administrative health data base for the province of British Columbia Canada for 2010-2019 to examine the use of emergency departments by youth with IDD (N = 20,591) compared to a population group of youth without IDD (N = 1,293,791). Using the ten years of data, odds ratios for visits to the emergency department were calculated adjusting for sex, income and geographical area within the Province. In addition, difference-in-differences analyses were calculated for age matched subsets of the two cohorts. RESULTS Over the ten year period, 40.60% of youth with IDD visited an emergency department at least once, compared to 29.10% of youth without IDD. Youth with IDD had an odds ratio of visiting an emergency department 1.697 (1.649, 1.747) times that of youth without IDD. However, when odds were adjusted for a diagnosis of either psychotic illness or anxiety/depression, the odds for youth with IDD visiting emergency compared to youth without IDD were reduced to 1.063 (1.031, 1.096). Use of emergency services increased as youth aged. Type of IDD also affected use of emergency services. Youth with Fetal Alcohol Syndrome had the greatest odds of using emergency services compared to youth with other types of IDD. DISCUSSION The findings from this study indicate that youth with IDD have higher odds of using emergency services than youth without IDD although these increased odds appear to be largely driven by mental illness. In addition, use of emergency services increases as the youth age and transition from pediatric to adult health services. Better treatment of mental health issues within this population may reduce their use of emergency services.
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Affiliation(s)
- Sandra Marquis
- School of Nursing University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada.
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, CAMH, 1025 Queen St West, Toronto, ONT M6J 1H4, Canada.
| | - Kimberlyn M McGrail
- Centre for Health Services and Policy Research, The University of British Columbia, 201-2206 East Mall, Vancouver, BC V6T 1Z3, Canada.
| | - Jennifer Baumbusch
- School of Nursing University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada.
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Fulceri F, Gila L, Caruso A, Micai M, Romano G, Scattoni ML. Building Bricks of Integrated Care Pathway for Autism Spectrum Disorder: A Systematic Review. Int J Mol Sci 2023; 24:ijms24076222. [PMID: 37047213 PMCID: PMC10094376 DOI: 10.3390/ijms24076222] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/03/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
An integrated plan within a defined care pathway for the diagnosis, continuative interventions, and periodic redefinition of care of autistic people is essential for better outcomes. Challenges include delivering services across all domains or life stages and effective coordination between health/social care providers and services. Further, in the ‘real world’, service provision varies greatly, and in many settings is significantly weighted towards diagnosis and children’s services rather than treatment and support or adult care. This study aims to identify existing care pathways for Autism Spectrum Disorder (ASD) from referral to care management after diagnosis. The study reviewed the international literature in PubMed and PsycInfo databases and collected information on care for autistic individuals from the Autism Spectrum Disorders in Europe (ASDEU) project partners. The study found that published data mainly focused on specific components of care pathways rather than an integrated and coordinated plan of care and legislative indications. They should be aimed at facilitating access to the services for support and the inclusiveness of autistic individuals. Given the need for care addressing the complex and heterogeneous nature of ASD, effective coordination between different health/social care providers and services is essential. It is also suggested that research priority should be given to the identification of an integrated care pathway ‘model’ centered around case management, individualization, facilitation, support, continuous training and updating, and quality management.
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Cooper CM, Rosen T, Kim H, Eaton NR, Cohn E, Drahota A, Moskowitz LJ, Lerner MD, Kerns CM. Predictors of expert providers' familiarity with intervention practices for school- and transition-age youth with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:331-343. [PMID: 35722950 DOI: 10.1177/13623613221100787] [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: 02/02/2023]
Abstract
LAY ABSTRACT School-age children, adolescents, and young adults with autism spectrum disorder encounter many different types of providers in their pursuit of treatment for anxiety, behavior problems, and social difficulties. These providers may all be familiar with different types of intervention practices. However, research has not yet investigated patterns in expert providers' familiarity with different practices nor how these patterns are related to the characteristics of providers (years in practice, academic discipline, setting) and the youth (age and intellectual disability) they typically support. A panel of 53 expert transdisciplinary providers rated their familiarity with 55 intervention practices (derived from research and expert nominations) via an online Delphi poll. Advanced statistical methods were used to identify types of intervention practices with which providers were familiar, which included two approaches (cognitive and behavioral) and two strategies (engagement and accessibility). Providers who practiced outside a school setting or treated clients without intellectual disability were more familiar with cognitive approaches. Clinical psychologists, behavior analysts, and school-based providers were more familiar with behavioral approaches. Providers practicing outside school settings were also more familiar with engagement strategies, and providers with more years in practice were more familiar with accessibility strategies. These results may help families and researchers to better anticipate how services may vary depending on the types of autism spectrum disorder providers seen and work to reduce disparities in care that may result.
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Transition from child and adolescent mental health care to adult services for young people with Attention-Deficit/Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder (ASD) in Europe: Barriers and recommendations. Encephale 2022; 48:555-559. [DOI: 10.1016/j.encep.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/22/2022]
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Grosse SD, Nichols P, Nyarko K, Maenner M, Danielson ML, Shea L. Heterogeneity in Autism Spectrum Disorder Case-Finding Algorithms in United States Health Administrative Database Analyses. J Autism Dev Disord 2022; 52:4150-4163. [PMID: 34581918 PMCID: PMC9077262 DOI: 10.1007/s10803-021-05269-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 12/19/2022]
Abstract
Strengthening systems of care to meet the needs of individuals with autism spectrum disorder (ASD) is of growing importance. Administrative data provide advantages for research and planning purposes, including large sample sizes and the ability to identify enrollment in insurance coverage and service utilization of individuals with ASD. Researchers have employed varying strategies to identify individuals with ASD in administrative data. Differences in these strategies can limit the comparability of results across studies. This review describes implications of the varying strategies that have been employed to identify individuals with ASD in US claims databases, with consideration of the strengths and limitations of each approach.
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Affiliation(s)
- Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop S106-4, Atlanta, GA, 30341, USA.
| | - Phyllis Nichols
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop S106-4, Atlanta, GA, 30341, USA
| | - Kwame Nyarko
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop S106-4, Atlanta, GA, 30341, USA
| | - Matthew Maenner
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop S106-4, Atlanta, GA, 30341, USA
| | - Melissa L Danielson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop S106-4, Atlanta, GA, 30341, USA
| | - Lindsay Shea
- Policy and Analytics Center, A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA, USA
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Five-Year Trends in Pediatric Mental Health Emergency Department Visits in Massachusetts: A Population-Based Cohort Study. J Pediatr 2022; 246:199-206.e17. [PMID: 35301021 DOI: 10.1016/j.jpeds.2022.03.011] [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: 09/30/2021] [Revised: 02/21/2022] [Accepted: 03/09/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To evaluate temporal changes in pediatric emergency department (ED) visits for mental health problems in Massachusetts based on diagnoses and patient characteristics and to assess trends in all-cause pediatric ED visits. STUDY DESIGN This statewide population-based retrospective cohort study used the Massachusetts All-Payer Claims Database, which includes almost all Massachusetts residents. The study sample consisted of residents aged <21 years who were enrolled in a health plan between 2013 and 2017. Using multivariate regression, we examined temporal trends in mental health-related and all-cause ED visits in 2013-2017, with person-quarter as the unit of analysis; we also estimated differential trends by sociodemographic and diagnostic subgroups. The outcomes were number of mental health-related (any diagnosis, plus 14 individual diagnoses) and all-cause ED visits/1000 patients/quarter. RESULTS Of the 967 590 Massachusetts residents in our study (representing 14.8 million person-quarters), the mean age was 8.1 years, 48% were female, and 57% had Medicaid coverage. For this population, mental health-related (any) and all-cause ED visits decreased from 2013 to 2017 (P < .001). Persons aged 18-21 years experienced the largest declines in mental health-related (63.0% decrease) and all-cause (60.9% decrease) ED visits. Although mental health-related ED visits declined across most diagnostic subgroups, ED visits related to autism spectrum disorder-related and suicide-related diagnoses increased by 108% and 44%, respectively. CONCLUSIONS Overall rates of pediatric ED visits with mental health diagnoses in Massachusetts declined from 2013 to 2017, although ED visits with autism- and suicide-related diagnoses increased. Massachusetts' policies and care delivery models aimed at pediatric mental health may hold promise, although there are important opportunities for improvement.
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Cheak-Zamora N, Tait A, Coleman A. Assessing and Promoting Independence in Young Adults with Autism Spectrum Disorder. J Dev Behav Pediatr 2022; 43:130-139. [PMID: 34636359 DOI: 10.1097/dbp.0000000000001021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Quality of life, independence, and employment outcomes are poor for young adults with autism spectrum disorder (YA-ASD). This study explored the desires and experiences of YA-ASD as they transition into adulthood. METHODS Fifteen YA-ASD, age 18 to 25 years, were recruited from autism spectrum disorder centers, participant registries, and social media advertising. Interested individuals completed a survey and individual interview. Semistructured interview guides included questions about transition experiences, current independence, and future goals. Interview transcripts were analyzed using thematic analysis. RESULTS The desire of young adults with autism spectrum disorder for independence was shown within 4 themes. YA-ASD described their vision of adulthood along with their need for improved skills in driving, living independently, and decision-making. CONCLUSION The findings indicate YA-ASD desire to be independent but lack the specific support services to get there.
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Affiliation(s)
- Nancy Cheak-Zamora
- Department of Health Sciences, School of Health Professions, University of Missouri, Columbia, MO
| | - Andrew Tait
- Department of Biological Sciences, College of Arts and Science, University of Missouri, Columbia, MO
| | - Ann Coleman
- Department of Health Sciences, School of Health Professions, University of Missouri, Columbia, MO
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Song W, Salzer MS, Nonnemacher SL, Shea L. Lifespan service receipt and unmet needs among individuals on the autism spectrum. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:694-705. [PMID: 35320442 DOI: 10.1007/s10488-022-01192-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 01/18/2023]
Abstract
Timely data on service use and needs across the lifespan are essential to developing an effective and efficient service delivery system that is responsive to developmental issues. This study uses data from one of the largest statewide surveys conducted between 2017 and 2018 to compare service use and unmet needs among individuals on the autism spectrum across the lifespan. A statewide sample of 5792 caregivers of autistic children and adults were included in the study. Logistic regressions were conducted to compare service use and need among six age groups ranging from early childhood (0-5 years) to later adulthood (31+) while adjusting for sociodemographic characteristics. We found that the transition-age adult group (18-21 years) was less likely to receive services, including speech/language therapy, occupational therapy, one-on-one support, and social skill training, than adolescents. However, case management and mental health services increased with age. Young adults (22-30 years) were more likely to report unmet needs than both adolescents and transition-age adult groups. The use of services overall decrease and service needs increased compared to results from an earlier statewide survey that was conducting in 2009-2010. These results can be used to inform developmentally appropriate autism-related healthcare policies and service development and delivery. This study offers a more detailed look at differences between adult age subgroups that are novel. Further research is needed about the prevalence of ASD in adulthood, clinical trajectories, and outcomes in order to support autistic adults in getting the appropriate services and supports.
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Affiliation(s)
- Wei Song
- College of Public Health, Temple University, 1700 N. Broad St., Suite 313, 19122, Philadelphia, PA, USA.
| | - Mark S Salzer
- Temple University Collaborative on Community Inclusion of Individuals with, Psychiatric Disabilities, 1700 N. Broad St., Suite 304, 19122, Philadelphia, PA, USA
| | - Stacy L Nonnemacher
- Bureau of Supports for Autism and Special Populations, Department of Human Services, 801 Market St, 19107, Philadelphia, Pennsylvania, PA, USA
| | - Lindsay Shea
- Policy and Analytics Center, A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, 19104, Philadelphia, PA, USA
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Badgett NM, Sadikova E, Menezes M, Mazurek MO. Emergency Department Utilization Among Youth with Autism Spectrum Disorder: Exploring the Role of Preventive Care, Medical Home, and Mental Health Access. J Autism Dev Disord 2022; 53:2274-2282. [DOI: 10.1007/s10803-022-05503-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/25/2022]
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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: 17] [Impact Index Per Article: 8.5] [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
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17
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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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18
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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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19
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Parker ML, Mosley MA. Therapy outcomes for neurodiverse couples: Exploring a solution-focused approach. JOURNAL OF MARITAL AND FAMILY THERAPY 2021; 47:962-981. [PMID: 33960423 DOI: 10.1111/jmft.12526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 06/12/2023]
Abstract
The need for clinical approaches that address romantic relationship concerns of adults with autism spectrum disorder (ASD) has been essentially overlooked. There are a growing number of recommendations in the available literature to increase the availability and evaluation of treatment approaches that are appropriate for couples that include an adult with ASD. The aim of the present study was to explore clinical outcomes of a neurodiverse couple who participated in twelve sessions of solution-focused brief therapy. Our findings indicated both partners experienced improvement in the target complaints, communication and emotional awareness. On the other hand, each partner had a different trajectory of change in relationship satisfaction over the course of treatment. Directions for future research and implications for couple therapy with adults diagnosed with ASD are discussed.
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20
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Ghanouni P, Seaker L. Healthcare Services During the Transitions to Adulthood Among Individuals with ASD Aged 15-25 Years Old: Stakeholders' Perspectives. J Autism Dev Disord 2021; 52:2575-2588. [PMID: 34216328 DOI: 10.1007/s10803-021-05159-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
Although previous research has shown that the transition to adulthood may be challenging, there exists a lack of research regarding perspectives of stakeholders on the transition of individuals with Autism Spectrum Disorder (ASD). This study aimed to investigate stakeholders' experiences regarding healthcare services for youth with ASD during their transition. We involved 20 stakeholders, including 17 parents of youth with ASD as well as 3 services providers. The study yielded three major themes including: (a) accessibility and quality of care; (b) tensions and conflicts; and (c) navigation and integrated care. The findings can be used to direct change within the healthcare services towards better practices for youth with ASD and increasing the likelihood of positive health outcomes.
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Affiliation(s)
- Parisa Ghanouni
- Department of Occupational Therapy, Dalhousie University, PO Box 15000, Halifax, NS, B3H 4R2, Canada.
| | - Liam Seaker
- Department of Occupational Therapy, Dalhousie University, PO Box 15000, Halifax, NS, B3H 4R2, Canada
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21
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Menezes M, Robinson MF, Harkins C, Sadikova E, Mazurek MO. Unmet health care needs and health care quality in youth with autism spectrum disorder with and without intellectual disability. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:2199-2208. [PMID: 34030515 DOI: 10.1177/13623613211014721] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT The increase in the prevalence of autism spectrum disorder has placed greater demands on the health care system. Children and adolescents with autism spectrum disorder often experience challenges accessing high-quality physical and mental health care due to characteristic social-communication deficits and behavioral difficulties, as well as high rates of complex medical and psychiatric comorbidities. Intellectual disability commonly co-occurs with autism spectrum disorder and individuals affected by this co-occurrence may have additional impairments that compound challenges accessing health care. This study investigated the relations among co-occurring intellectual disability, unmet physical and mental health care needs, and health care quality in a large, nationally distributed sample of youth with autism spectrum disorder using structural equation modeling techniques. Co-occurring intellectual disability was significantly associated with unmet mental health care needs in children with autism. In addition, unmet mental health care needs mediated the relationship between co-occurring intellectual disability and health care quality; youth with autism spectrum disorder and co-occurring intellectual disability who had a past-year unmet mental health need had significantly poorer caregiver-reported health care quality. These findings suggest that youth with autism spectrum disorder and co-occurring intellectual disability may be more likely to experience unmet mental health care needs and receive poorer quality of care than the broader autism spectrum disorder population.
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22
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Health Care Transition Planning Among Youth with ASD and Other Mental, Behavioral, and Developmental Disorders. Matern Child Health J 2021; 24:796-804. [PMID: 31897930 DOI: 10.1007/s10995-019-02858-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To estimate the prevalence of health care transition components among youth with autism spectrum disorder (ASD) aged 12-17 using the 2016 National Survey of Children's Health (NSCH), compared to youth with other mental, behavioral, or developmental disorders (MBDDs) or youth without MBDDs. METHODS The 2016 NSCH is a nationally and state representative survey that explores issues of health and well-being among children ages 0-17. Within the NSCH, parents of a subset of youth, ages 12-17, are asked a series of questions about their youth's eventual transition into the adult health care system. The current study explores components of this transition, comparing youth diagnosed with ASD, youth with other mental, behavioral, or developmental disorders (MBDDs), and youth without MBDDs. RESULTS Approximately 1-in-4 youth with ASD had actively worked with their doctor to understand future changes to their health care, significantly less than youth with other MBDDs and youth without MBDDs. Fewer than 2-in-5 youth with ASD had met with their doctor privately or had a parent who knew how their youth would be insured when they reached adulthood. CONCLUSIONS The current analysis of a nationally representative sample of youth reveals discrepancies in the proportion of youth with ASD receiving appropriate health care transition planning compared to youth with other MBDDs and youth without MBDDs. These findings suggest the potential for barriers among youth with ASD to effectively transitioning into the adult health care system.
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23
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Fombonne E, Green Snyder L, Daniels A, Feliciano P, Chung W. Psychiatric and Medical Profiles of Autistic Adults in the SPARK Cohort. J Autism Dev Disord 2020; 50:3679-3698. [PMID: 32096123 DOI: 10.1007/s10803-020-04414-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study examined lifetime medical and psychiatric morbidity reported by caregivers of 2917 autistic adults participating in the US research cohort SPARK. Participants were 78.4% male, 47.3% had intellectual disability, and 32.1% had persistent language impairments. Childhood language disorders (59.7%), speech/articulation problems (32.8%), sleep (39.4%) and eating problems (29.4%), motor delays (22.8%) and history of seizure (15.5%) were the most frequently reported clinical features. Over two thirds (67.2%) had been diagnosed with at least one psychiatric disorder (anxiety disorders: 41.1%; ADHD: 38.7%). Compared to verbally fluent participants, those with language impairments had lower frequencies of almost all psychiatric disorders. Female sex and older age were associated with higher medical and psychiatric morbidity.
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Affiliation(s)
- Eric Fombonne
- Departments of Psychiatry, Pediatrics & Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
| | | | | | | | - Wendy Chung
- The Simons Foundation, New York, NY, USA
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
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24
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Weiss JA, Lai JKY, Lee V, Lunsky Y. Predictors of Changes in Daily Activity in Transition-Age Autistic Youth. Autism Res 2020; 14:324-332. [PMID: 32902130 DOI: 10.1002/aur.2371] [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: 02/06/2020] [Revised: 06/04/2020] [Accepted: 07/21/2020] [Indexed: 11/06/2022]
Abstract
Transitioning into adulthood is fraught with challenges for autistic youth. A greater understanding of the facilitators of community involvement in school and employment during this period is warranted. The current study examines changes in service need and receipt, and the stability of accessing daily structured activities, for autistic young adults over their transition period compared to adolescents and adults that did not enter the transition period. Baseline caregiver survey data were taken from the Canadian Autism Spectrum Disorders Alliance National Autism Needs Assessment Survey in 2014, and caregivers (n = 304) completed the same set of questions in 2017 about sociodemographic factors, clinical need, service receipt and typical weekday activities. Three cohorts were compared: (1) pretransition age youth, (2) transition-age youth, and (3) young adults who were past transition age. Results suggest that transition-age youth were found to have a unique set of priority service needs compared to pre transition-age adolescent and to adult groups, and both transition-age and adult groups had lower levels of priority service receipt compared to pretransition-age adolescents. The transition-age group experienced the greatest loss of structured weekday activity between time points, and were more likely than pretransition-age adolescents to not have structured weekday activities at Time 2. A recovery of structured daily activity was not observed in young adults. Our results highlight the tumultuous nature of the transition period for autistic youth, which continues into adulthood, and the urgent need for supports during this time. LAY SUMMARY: This research highlights that autistic young people who are transitioning to adulthood are at greatest risk of losing structured weekday activities, and that once in adulthood, many continue to struggle to obtain meaningful community engagement. These results can help guide the design of adolescent and young adult transition programs.
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Affiliation(s)
- Jonathan A Weiss
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Jonathan K Y Lai
- Canadian Autism Spectrum Disorder Alliance, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Vivian Lee
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Cheak-Zamora N, Petroski G, La Manna A, Beversdorf D, Farmer J. Validation of the Health-Related Independence for Young Adults with Autism Spectrum Disorder Measure- Caregiver Version. J Autism Dev Disord 2020; 51:2036-2046. [PMID: 32892234 DOI: 10.1007/s10803-020-04690-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Little is known about Young adults with Autism Spectrum Disorder (YA-ASD) health, healthcare and safety needs. This study describes the validation of a health care transition measure for YA-ASD, the Health-Related Independence (HRI). We collected data from caregivers (n = 490) at five Autism Treatment Network sites and compared the psychometric properties of HRI to the gold standard (STARx) and other validated measures. A Confirmatory Factor Analysis and item culling resulted in 30 items addressing six subscales. Content, criterion, and construct validity and internal consistency indicated high validity and reliability for the scale and subscales. HRI is a validated caregiver-report measure of YA-ASD's self-management, safety, and transition skills. This novel measure will be a useful tool in clinics, intervention development, and research.
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Affiliation(s)
- Nancy Cheak-Zamora
- Department of Health Professions, School of Health Professions, University of Missouri, 510 Clark Hall, Columbia, MO, 65211, USA.
| | - Greg Petroski
- Department of Health Management and Informatics, School of Medicine, University of Missouri, Columbia, USA
| | - Anna La Manna
- Department of Social Work, University of Missouri, Columbia, USA
| | - David Beversdorf
- Department of Radiology, Neurology and Psychology, School of Medicine, University of Missouri, Columbia, USA
| | - Janet Farmer
- School of Health Professions, University of Missouri, Columbia, USA
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26
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Sandercock RK, Lamarche EM, Klinger MR, Klinger LG. Assessing the convergence of self-report and informant measures for adults with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:2256-2268. [PMID: 32744068 PMCID: PMC7541713 DOI: 10.1177/1362361320942981] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Self-report measures are widely used for research and clinical assessment of adults with autism spectrum disorder. However, there has been little research examining the convergence of self- and informant-report in this population. This study examined agreement between 40 pairs of adults with autism spectrum disorder and their caregivers on measures of symptom severity, daily living skills, quality of life, and unmet service needs. In addition, this study examined the predictive value of each reporter for objective independent living and employment outcomes. Caregiver and self-report scores were significantly positively correlated on all measures (all r’s >0.50). Results indicated that there were significant differences between reporter ratings of daily living skills, quality of life, and unmet service needs, but no significant differences between ratings of symptom severity. Combining caregiver-report and self-report measures provided significantly higher predictive value of objective outcomes than measures from a single reporter. These findings indicate that both informants provide valuable information and adults with autism spectrum disorder should be included in reporting on their own symptoms and experiences. Given that two reporters together were more predictive of objective outcomes; however, a multi-informant assessment may be the most comprehensive approach for evaluating current functioning and identifying service needs in this population.
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27
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Leibson C, Weaver A, Myers S, Long K, Ransom J, Voigt R, Katusic S. Objective Estimates of Direct-Medical Costs Among Persons Aged 3 to 38 Years With and Without Research-Defined Autism Spectrum Disorder Ascertained During Childhood: A Population-Based Birth-Cohort Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:595-605. [PMID: 32389225 PMCID: PMC7224581 DOI: 10.1016/j.jval.2019.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/25/2019] [Accepted: 12/22/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Accurate estimates of autism spectrum disorder (ASD)-associated medical costs are essential for predicting future care needs, allocating resources, identifying best practices, and modeling cost-effectiveness. Most existing studies have either employed subjective cost data or ascertained ASD using self-reported or International Classification of Diseases-coded diagnoses. Such ascertainment is especially problematic for identifying milder ASD among older individuals never diagnosed with ASD. METHODS This 1976 through 2000 population-based birth-cohort study was set in Olmsted County, Minnesota. ASD cases and age- and sex-matched unaffected controls were identified by applying uniform operational research criteria for ASD (using the guidelines of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision) after rigorous review of provider-linked medical and public, private, or home school records available for all members from birth to a maximum age of 21 years. Medical cost estimates for the 901 case-control pairs used line-item provider-linked billing data (including all payers) from 2003 through 2014 (ages 3-38 years). Outpatient pharmaceutical costs were unavailable. Temporal changes in diagnostic criteria, clinical practice, public awareness, and access were addressed by separating analyses into 5-year age group and 4-year calendar period cells. Unadjusted and adjusted (age and age plus co-occurring conditions) cost estimates were provided for cases, controls, and case-control differences. Additional factors (co-occurring conditions, percentage hospitalized, intellectual disability) were investigated using unadjusted descriptive analyses. RESULTS Cell sample sizes ranged from 93 to 402 for age groups 3 through 19 years and from 45 to 395 for age groups 20 through 38 years. Unadjusted, age-adjusted, and fully adjusted medical costs were significantly higher for cases versus controls in 100% of cells for age groups 3 through 19 years and in 50% (unadjusted), 38% (age adjusted), and 12% (fully adjusted) of cells for age groups 20 through 38 years. CONCLUSIONS These unique estimates can help inform the construction of cost-effectiveness models; decisions by payers, providers, and policy makers; and predictions of lifetime costs.
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Affiliation(s)
- Cynthia Leibson
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN, USA.
| | - Amy Weaver
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Scott Myers
- Geisinger Autism & Developmental Medicine Institute, Lewisburg, PA, USA
| | - Kirsten Long
- K Long Health Economics Consulting LLC, St Paul, MN, USA
| | - Jeanine Ransom
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Robert Voigt
- Meyer Center for Developmental Pediatrics, Baylor College, of Medicine, Houston, TX, USA
| | - Slavica Katusic
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
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Mazurek MO, Stobbe G, Loftin R, Malow BA, Agrawal MM, Tapia M, Hess A, Farmer J, Cheak-Zamora N, Kuhlthau K, Sohl K. ECHO Autism Transition: Enhancing healthcare for adolescents and young adults with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:633-644. [PMID: 31581793 DOI: 10.1177/1362361319879616] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024]
Abstract
Transition-age youth and young adults with autism spectrum disorder have complex healthcare needs, yet the current healthcare system is not equipped to adequately meet the needs of this growing population. Primary care providers lack training and confidence in caring for youth and young adults with autism spectrum disorder. The current study developed and tested an adaptation of the Extension for Community Healthcare Outcomes model to train and mentor primary care providers (n = 16) in best-practice care for transition-age youth and young adults with autism spectrum disorder. The Extension for Community Healthcare Outcomes Autism Transition program consisted of 12 weekly 1-h sessions connecting primary care providers to an interdisciplinary expert team via multipoint videoconferencing. Sessions included brief didactics, case-based learning, and guided practice. Measures of primary care provider self-efficacy, knowledge, and practice were administered pre- and post-training. Participants demonstrated significant improvements in self-efficacy regarding caring for youth/young adults with autism spectrum disorder and reported high satisfaction and changes in practice as a result of participation. By contrast, no significant improvements in knowledge or perceived barriers were observed. Overall, the results indicate that the model holds promise for improving primary care providers' confidence and interest in working with transition-age youth and young adults with autism spectrum disorder. However, further refinements may be helpful for enhancing scope and impact on practice.
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Affiliation(s)
| | | | | | | | | | | | - Amy Hess
- Nationwide Children's Hospital, USA
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Schwartz JK, Agrawal M, Treminio I, Espinosa S, Rodriguez M, Richard L. Caregivers’ perspectives on health-care transition in autism. ADVANCES IN AUTISM 2020. [DOI: 10.1108/aia-07-2019-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Adults with autism spectrum disorder (ASD) experience significant health-care disparities across physical and mental health domains resulting in poorer health and quality of life. Poor transitions to adult care negatively impact the health of adults with ASD. Current research focuses on personal factors in research samples that lack diversity. The purpose of this study is to examine the lived health-care experiences of geographically and ethnically diverse young adults with ASD in adult care settings in the USA to understand provider and system-level factors affecting their health.
Design/methodology/approach
Nine caregivers of young adults with ASD participated in key informant interviews describing their experiences in navigating the health-care system. Data were analyzed using a grounded theory approach.
Findings
The data indicated that limited quantity of services, poor quality of services, and high cost of services had a negative effect on the health of adults with ASD. Issues cascaded to become more complex.
Practical implications
Practical implications for payors, providers, persons with ASD and their families are discussed in this paper.
Originality/value
To the best of the authors’ knowledge, this study answers the call to better understand system-level factors affecting the health of geographically and ethnically diverse people with ASD.
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Tunesi S, Bosio M, Russo AG. Do autistic patients change healthcare services utilisation through the transition age? An Italian longitudinal retrospective study. BMJ Open 2019; 9:e030844. [PMID: 31727653 PMCID: PMC6886997 DOI: 10.1136/bmjopen-2019-030844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES This paper aims to provide an estimate of the prevalence rate of autism spectrum disorder (ASD) in 8-year-olds in 2017 based on administrative databases and to investigate the change in healthcare service use during the healthcare transition age of 18. DESIGN This research is based on a longitudinal retrospective cohort study. SETTING The data is drawn from the Italian Administrative Healthcare Database (2010-2017). PARTICIPANTS We identified 5607 ASD patients; 331 ASD patients from 2012 to 2015 in the calendar year of their 18th birthday were selected and their health service utilisation during a 5-year period-ranging from 2 years preceding and succeeding their 18th year-were investigated. INTERVENTIONS None. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence, incidence and proportion of ASD patients receiving specific healthcare services were included in the outcome measures. RESULTS Prevalence of ASD at age 8 was 5.4/1000. Global access to health and social services was lower both before and after age 18 (46.5% at 16; 68.0% at 18; 54.1% at 20). The percentage of patients receiving a neuropsychiatric consultation decreased after age 18 (30.8% at 18; 5.4% at 20). Community mental health services (CMHS) utilisation rate increased above 18 years of age. Regarding psychiatric visits, for both outpatient and CMHS, an increase was observed from 17.8% at age 18 to 25.4% at age 20. The utilisation of rehabilitation services decreased with age, dropping from 17.8% at age 16 to 1.8% at age 20. Psychiatric outpatient services remained stable across ages at about 14%. CONCLUSION Our findings suggest that ASD patients changed clinical reference services with age from neuropsychiatric and rehabilitative services towards psychiatric and community-based services as they transitioned from paediatric to adult healthcare services.
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Affiliation(s)
- Sara Tunesi
- Epidemiology Unit, Agency for Health Protection of Milan, Milan, Italy
| | - Marco Bosio
- Agency for Health Protection of Milan, Milan, Italy
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31
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Shields MC, Akobirshoev I, Dembo RS, Mitra M. Self-Injurious Behavior Among Adults With ASD: Hospitalizations, Length of Stay, and Costs of Resources to Deliver Care. Psychiatr Serv 2019; 70:457-464. [PMID: 30841844 DOI: 10.1176/appi.ps.201800318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Research on hospitalizations related to self-injurious behavior and ideation among adults with autism spectrum disorder (ASD) is limited. This study compared admissions, average length of stay, and costs of resources to deliver care for such hospitalizations between adults with and without ASD. METHODS The 2014 Healthcare Cost and Utilization Project National Inpatient Sample was used to compare 5,341 discharge records for adults with ASD and 16,023 records for adults without ASD, matched on age and gender in a 1:3 ratio. Hierarchical logistic and linear regressions accounted for clustering by hospital. Covariates included gender, race-ethnicity, age, region, comorbidities, number of procedures, and insurance. RESULTS Among hospitalized adults, those with ASD were twice as likely as those without ASD to have a hospitalization related to self-injurious behavior and ideation. Among hospital stays for self-injurious behavior and ideation, adults with ASD had average lengths of stay that were 2.14 days longer (95% confidence interval [CI]=1.20-3.08) compared with adults without ASD. Among adults with a hospitalization related to self-injurious behavior and ideation, unadjusted average costs for those with ASD were 36.8% higher than for adults without ASD. After the analysis accounted for covariates and length of stay, adults with ASD still had 7.48% (95% CI=1.05%-14.32%) higher costs. CONCLUSIONS Adults with ASD were twice as likely as adults without ASD to have a hospitalization related to self-injurious behavior and ideation. Among adults with such a hospitalization, those with ASD had longer stays and, even after the analysis accounted for length of stay, higher costs.
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Affiliation(s)
- Morgan C Shields
- Lurie Institute for Disability Policy (Shields, Akobirshoev, Dembo, Mitra) and Institute for Behavioral Health (Shields), Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Ilhom Akobirshoev
- Lurie Institute for Disability Policy (Shields, Akobirshoev, Dembo, Mitra) and Institute for Behavioral Health (Shields), Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Robert S Dembo
- Lurie Institute for Disability Policy (Shields, Akobirshoev, Dembo, Mitra) and Institute for Behavioral Health (Shields), Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Monika Mitra
- Lurie Institute for Disability Policy (Shields, Akobirshoev, Dembo, Mitra) and Institute for Behavioral Health (Shields), Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
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Hand BN, Boan AD, Bradley CC, Charles JM, Carpenter LA. Emergency department utilization and monetary charges in adolescents with autism spectrum disorder, intellectual disability, and a population comparison group. Autism Res 2019; 12:1129-1138. [PMID: 31081200 DOI: 10.1002/aur.2124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 01/12/2023]
Abstract
Adolescents with autism spectrum disorder (ASD) and/or intellectual disability (ID) may utilize the emergency department (ED) more frequently than individuals in the general population. This study compared ED utilization and charges during adolescence among four groups of individuals: ASD-only, ASD + ID, ID-only, and a population comparison (PC) group. ED visits occurring during age 12-17 years were examined to identify non, low, and high utilizers. Logistic regression was used to compare groups on the odds of having at least one ED visit during adolescence. Generalized linear models were used to compare groups on number of ED visits and total charges, stratified by low and high ED utilization. Descriptive examination of presenting diagnoses was performed. Individuals with ID, with or without co-occurring ASD, were significantly more likely to have at least one ED visit during adolescence. Among high ED utilizers, the ID-only group had the most frequent ED visits but had significantly lower charges than the ASD-only group. Individuals with ASD-only and ASD + ID differed from the ID-only and PC groups in presenting diagnoses. No differences between groups in number of ED visits or charges were observed among low utilizers. ID, with or without ASD, increased the odds of visiting the ED during adolescence. Adolescents with ID-only had the most frequent ED visits, but individuals with ASD-only had the highest ED charges and tended to be seen for psychiatric concerns. Further research is warranted to better characterize and meet the healthcare needs of individuals with ASD and/or ID during adolescence. Autism Res 2019, 12: 1129-1138. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Frequent emergency department (ED) visits strain medical resources and are costlier than primary and urgent care. Our findings show that adolescents with intellectual disability (ID) may use the ED frequently for nonurgent conditions. Adolescents with autism spectrum disorder, without ID, use the ED less frequently but incur higher charges. Further research is needed to understand how to meet the unique needs of these populations in primary care to prevent overuse of the ED.
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Affiliation(s)
| | - Andrea D Boan
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Jane M Charles
- Medical University of South Carolina, Charleston, South Carolina
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Straus J, Coburn S, Maskell S, Pappagianopoulos J, Cantrell K. Medical Encounters for Youth With Autism Spectrum Disorder: A Comprehensive Review of Environmental Considerations and Interventions. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2019; 13:1179556519842816. [PMID: 31065222 PMCID: PMC6488780 DOI: 10.1177/1179556519842816] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 03/13/2019] [Indexed: 11/30/2022]
Abstract
Approximately 1 in 59 youth are currently diagnosed with autism spectrum disorder
(ASD), a neurodevelopmental disorder. In comparison to typically developing
peers, youth with ASD encounter hospitalization at higher rates due to their
heightened health care needs. While visiting the hospital is a stressor for
youth with neurotypical needs, the experience contains unique challenges for
those with ASD. This systematic literature review highlights research that
considers the psychosocial impact of the hospital environment on the coping and
adjustment of youth with ASD. Specifically, the review focuses on
recommendations and interventions that may be used by health care professionals
while supporting this population as they encounter the health care system.
Ninety-six articles were identified as meeting inclusion and exclusion criteria.
The findings suggest that practicing clinicians should implement a wide variety
of interventions for youth with ASD including diversion techniques, comfort
positions, and picture schedules. Although there are published evidence-based
interventions for supporting youth with ASD in the hospital, most clinicians
lack ASD-specific training. This article concludes with recommendations for
future research.
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Affiliation(s)
- Jolie Straus
- Department of Child Study and Human Development, Tufts University, Medford, MA, USA
| | - Sarah Coburn
- Department of Child Study and Human Development, Tufts University, Medford, MA, USA
| | - Stephanie Maskell
- Department of Child Study and Human Development, Tufts University, Medford, MA, USA
| | | | - Kathryn Cantrell
- Department of Child Study and Human Development, Tufts University, Medford, MA, USA
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Zablotsky B, Maenner MJ, Blumberg SJ. Geographic Disparities in Treatment for Children with Autism Spectrum Disorder. Acad Pediatr 2019; 19:740-747. [PMID: 30858082 PMCID: PMC6732019 DOI: 10.1016/j.acap.2019.02.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/08/2019] [Accepted: 02/10/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Geographic differences may provide insight into what factors influence the likelihood that a child is diagnosed with autism spectrum disorder (ASD) in the United States; yet, there have been few nationally representative surveys that have explored this topic. The current study expands the limited literature by analyzing regional differences in ASD prevalence, service utilization, and the presence of unmet needs within a nationally representative sample of children. METHODS Data were drawn from the 2014-2016 National Health Interview Survey (NHIS), a nationally representative household survey of the noninstitutionalized US population. Children 3 to 17 years of age were included in the analytic sample. Prevalence estimates accounted for the complex survey design of the NHIS, and differences between geographic regions were compared using logistic/linear regressions with and without adjustment for child/family characteristics. RESULTS The prevalence of ASD was highest in the Northeast (3.0%), followed by the Midwest (2.4%), South (2.4%), and West (2.3%). A significant difference was found between the Northeast and West (P < .05); however, after accounting for child and family characteristics, this difference was no longer significant. Children with ASD in the Northeast were the most likely to have seen a specialist in the past year. Approximately 1 in 8 children with ASD experienced at least 1 unmet need, but there were no differences found by geographic region. CONCLUSIONS Although differences in prevalence were not significant after adjustment, service utilization differences remained. It appears that children with ASD in the Northeast utilize the greatest number of specialty services when compared to children with ASD from other parts of the country.
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Affiliation(s)
- Benjamin Zablotsky
- National Center for Health Statistics (B Zablotsky and SJ Blumberg), Hyattsville, Md.
| | - Matthew J. Maenner
- National Center on Birth Defects and Developmental Disabilities, 1600 Clifton Road, Atlanta, GA, 30329
| | - Stephen J. Blumberg
- National Center for Health Statistics, 3311 Toledo Road, Hyattsville, MD, 20782
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Zhang W, Eshghi M. Brief Report: Regional Variations in Characteristics of ASD Hospitalizations in the U.S. J Autism Dev Disord 2018; 49:1289-1297. [PMID: 30443701 DOI: 10.1007/s10803-018-3826-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Regional differences in ASD inpatient care remain understudied. We used the Nationwide Inpatient Sample to examine contributory causes and potential determinants associated with regional variations in ASD hospitalizations. We performed univariate and multivariate analyses to identify differences in ASD hospitalizations across four U.S. Census Bureau-defined regions. Our results revealed considerable variations in ASD hospitalizations across U.S. regions. Compared with patients in the Northeast, those in the Midwest, South, and West were less likely to be hospitalized for ASD. Significant differences were observed among regions with regard to the effect of health insurance type, hospital length of stay, hospital bed size, hospital location and teaching status on ASD hospitalizations. The region-specific analysis provides direction for further investigation.
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Affiliation(s)
- Wanqing Zhang
- Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, 321 S. Columbia Street, Chapel Hill, NC, 27599-7122, USA.
| | - Marziye Eshghi
- Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, 321 S. Columbia Street, Chapel Hill, NC, 27599-7122, USA.,Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
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White PH, Cooley WC, Boudreau ADA, Cyr M, Davis BE, Dreyfus DE, Forlenza E, Friedland A, Greenlee C, Mann M, McManus M, Meleis AI, Pickler L. Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home. Pediatrics 2018; 142:peds.2018-2587. [PMID: 30348754 DOI: 10.1542/peds.2018-2587] [Citation(s) in RCA: 421] [Impact Index Per Article: 70.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Risk and vulnerability encompass many dimensions of the transition from adolescence to adulthood. Transition from pediatric, parent-supervised health care to more independent, patient-centered adult health care is no exception. The tenets and algorithm of the original 2011 clinical report, "Supporting the Health Care Transition from Adolescence to Adulthood in the Medical Home," are unchanged. This updated clinical report provides more practice-based quality improvement guidance on key elements of transition planning, transfer, and integration into adult care for all youth and young adults. It also includes new and updated sections on definition and guiding principles, the status of health care transition preparation among youth, barriers, outcome evidence, recommended health care transition processes and implementation strategies using quality improvement methods, special populations, education and training in pediatric onset conditions, and payment options. The clinical report also includes new recommendations pertaining to infrastructure, education and training, payment, and research.
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Affiliation(s)
- Patience H. White
- Got Transition/The National Alliance to Advance Adolescent Health and Department of Medicine and Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia; and
| | - W. Carl Cooley
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
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Understanding Service Usage and Needs for Adults with ASD: The Importance of Living Situation. J Autism Dev Disord 2018; 49:556-568. [DOI: 10.1007/s10803-018-3729-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Eklund H, Findon J, Cadman T, Hayward H, Murphy D, Asherson P, Glaser K, Xenitidis K. Needs of Adolescents and Young Adults with Neurodevelopmental Disorders: Comparisons of Young People and Parent Perspectives. J Autism Dev Disord 2018; 48:83-91. [PMID: 28894999 PMCID: PMC5760588 DOI: 10.1007/s10803-017-3295-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
This study used the Camberwell Assessment of Need for adults with Developmental and Intellectual Disabilities (CANDID) to examine the social, physical health and mental health needs of 168 young people (aged 14-24 years) with neurodevelopmental disorders and compared young person and parent ratings of need. Agreement was poor in 21 out of 25 domains. Parents consistently reported higher levels of need than young people in the majority of domains although young people with ADHD reported significantly more needs in physical health, eyesight/hearing, seizures, other mental health problems and safety of others than their parents. Both parent and young person perspectives of needs are necessary to ensure that needs that are predictive of current or future poor outcomes are not missed.
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Affiliation(s)
- Hanna Eklund
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - James Findon
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Tim Cadman
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Hannah Hayward
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Declan Murphy
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Philip Asherson
- MRC Social Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Karen Glaser
- Department of Social Sciences, Health and Medicine, Institute of Gerontology, King's College London, Strand, London, WC2R 2LS, UK
| | - Kiriakos Xenitidis
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
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