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Lindsay S, Li Y, Joneja S, Hsu S. Experiences of racism and racial disparities in health care among children and youth with autism and their caregivers: a systematic review. Disabil Rehabil 2024:1-20. [PMID: 38864302 DOI: 10.1080/09638288.2024.2364823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 06/02/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE Although the health benefits of early diagnosis and therapeutic approaches for children and youth with autism spectrum disorder (ASD), racial disparities persist. This systematic review explored the experiences of racism and racial disparities in health care among children and youth with ASD and their caregivers. METHODS We conducted a systematic review, drawing on six international databases. Two reviewers screened titles, abstracts, and full texts. Thirty-seven studies met our inclusion criteria and we applied a narrative synthesis to develop themes. RESULTS Four themes were identified: (1) experiences and aspects of racism and racial disparities (i.e., language and cultural barriers, poor quality health care interactions, stereotypes and discrimination, family and community stigma, and indirect barriers); (2) racial disparities in health care (i.e., screening and referral, diagnosis, health care services, and care coordination and medication); (3) facilitators to accessing health care services; and (4) recommendations from caregivers. CONCLUSIONS This review highlights the extensive racial disparities experienced by children with autism. More research is needed to explore youth's perspectives on racism in addition to exploring potential interventions to address racial disparities and improve health equity for youth with ASD.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Yiyan Li
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Simran Joneja
- Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Shaelynn Hsu
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Faculty of Science, York University, Toronto, Canada
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Kosloski EE, Patel SD, Rollins PR. The Role of Pathways Early Autism Intervention in Improving Social Skills and Respeto for Young Hispanic Autistic Children. J Autism Dev Disord 2024:10.1007/s10803-024-06419-x. [PMID: 38842669 DOI: 10.1007/s10803-024-06419-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE We know very little about Hispanic autistic children's response to intervention as, historically, Hispanic children are underrepresented in intervention studies. Pathways parent-mediated early autism intervention is one of the few naturalistic developmental behavioral interventions (NDBIs) that is contextually and linguistically responsive to Hispanic families. However, some child-centered NDBI strategies do not align with the Hispanic caregiving value of respeto. A child exhibiting respeto demonstrates affiliative obedience by displaying deference and respect toward adults. Furthermore, theories of the ontogeny of cultural learning suggest that certain levels of social development may be necessary to learn cultural values. The current study investigates (1) the relationship between Hispanic autistic children's social skills and affiliative obedience and (2) the efficacy of Pathways in improving affiliative obedience in Hispanic children. METHODS This quasi-experimental design study used preexisting standardized test data and video recordings from 26 Hispanic participants who took part in a previous Pathways efficacy study. Recordings were coded for affiliative obedience and social connectedness. Residual change variables were used to measure progress from baseline to post-intervention, and correlation and hierarchical regression analyses were conducted to analyze the data. RESULTS We found significant positive correlations between social skills and children's affiliative obedience for baseline and change variables. In addition, we found Pathways had a significant medium-large magnitude effect on change in affiliative obedience skills. CONCLUSION This study highlights the benefits of NDBI interventions that advance social development in autistic children and support Hispanic parents in enculturating their children in the value of respeto.
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Affiliation(s)
- Erin E Kosloski
- Department of Speech, Language and Hearing, University of Texas, Dallas-Richardson, TX, USA
- Callier Center for Communication Disorders, 1966 Inwood Road, Dallas, TX, 75235, USA
| | - Siddhi D Patel
- Department of Speech, Language and Hearing, University of Texas, Dallas-Richardson, TX, USA
- Callier Center for Communication Disorders, 1966 Inwood Road, Dallas, TX, 75235, USA
| | - Pamela Rosenthal Rollins
- Department of Speech, Language and Hearing, University of Texas, Dallas-Richardson, TX, USA.
- Callier Center for Communication Disorders, 1966 Inwood Road, Dallas, TX, 75235, USA.
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Cummings KK, Greene RK, Cernasov P, Kan DDD, Parish-Morris J, Dichter G, Kinard JL. Bilingualism Predicts Affective Theory of Mind in Autistic Adults. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1785-1802. [PMID: 38701392 DOI: 10.1044/2024_jslhr-23-00431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
PURPOSE This study examined the impact of bilingualism on affective theory of mind (ToM) and social prioritization (SP) among autistic adults compared to neurotypical comparison participants. METHOD Fifty-two (25 autistic, 27 neurotypical) adult participants (ages 21-35 years) with varying second language (L2) experience, ranging from monolingual to bilingual, completed an affective ToM task. A subset of this sample also completed a dynamic eye-tracking task designed to capture differences in time spent looking at social aspects of a scene (SP). Four language groups were compared on task performance (monolingual autism and neurotypical, bilingual autism and neurotypical), followed by analyses examining the contribution of L2 experience, autism characteristics, and social face prioritization on affective ToM, controlling for verbal IQ. Finally, we conducted an analysis to identify the contribution of SP on affective ToM when moderated by autism status and L2 experience, controlling for verbal IQ. RESULTS The monolingual autism group performed significantly worse than the other three groups (bilingual autism, monolingual neurotypical, and bilingual neurotypical) on the affective ToM task; however, there were no significant differences between the bilingual autism group compared to the monolingual and bilingual neurotypical groups. For autistic individuals, affective ToM capabilities were positively associated with both verbal IQ and L2 experience but did not relate to autism characteristics or SP during eye tracking. Neurotypical participants showed greater SP during the eye-tracking task, and SP did not relate to L2 or autism characteristics for autistic individuals. SP and verbal IQ predicted affective ToM performance across autism and neurotypical groups, but this relationship was moderated by L2 experience; SP more strongly predicted affective ToM performance among participants with lower L2 experience (e.g., monolingual) and had less of an impact for those with higher L2 experience. CONCLUSION This study provides support for a bilingual advantage in affective ToM for autistic individuals. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25696083.
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Affiliation(s)
- Kaitlin K Cummings
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill
| | - Rachel K Greene
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill
| | - Paul Cernasov
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill
| | | | - Julia Parish-Morris
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, PA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Gabriel Dichter
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill
- Carolina Institute for Developmental Disabilities, School of Medicine, The University of North Carolina at Chapel Hill
- Department of Psychiatry, The University of North Carolina at Chapel Hill
| | - Jessica L Kinard
- Carolina Institute for Developmental Disabilities, School of Medicine, The University of North Carolina at Chapel Hill
- Division of Speech and Hearing Sciences, The University of North Carolina at Chapel Hill
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Fan SJS, Chen SP. Does culture play a role? A pilot study on Western services for a Chinese-Canadian family with children with Autism spectrum disorder. Disabil Rehabil 2024; 46:2584-2592. [PMID: 37382677 DOI: 10.1080/09638288.2023.2227566] [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: 11/23/2022] [Accepted: 06/15/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE Autism spectrum disorder (ASD) affects one in 66 children in Canada, and its symptoms may be particularly challenging for parents from a Chinese background. Further, when working with Chinese families, Western-educated service providers may experience difficulty in applying culturally relevant and family-centered care. This study examined the experiences of one Chinese-Canadian family as they receive intervention services for their two children with ASD. MATERIALS AND METHODS This pilot, single-case design, qualitative case study included semi-structured interviews with the parents, grandparents, as well as three service providers' views. RESULTS Three major themes emerged from the data in the form of tensions: (1) within the family members; (2) within the therapeutic relationships, and (3) in addressing culture in therapy. CONCLUSIONS Results suggested that although the family identified key cultural differences, service providers did not sufficiently address these within the therapeutic relationship, and the need for culturally-relevant and family-centered care was not fulfilled.
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Affiliation(s)
- Shu Jun Selina Fan
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Shu-Ping Chen
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
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Weitlauf AS, Miceli A, Vehorn A, Dada Y, Pinnock T, Harris JW, Hine J, Warren Z. Screening, Diagnosis, and Intervention for Autism: Experiences of Black and Multiracial Families Seeking Care. J Autism Dev Disord 2024; 54:931-942. [PMID: 36626007 PMCID: PMC10330934 DOI: 10.1007/s10803-022-05861-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Despite advances in screening and awareness, Black and multiracial families continue to experience challenges when seeking an autism diagnosis for their children. METHODS We surveyed 400 Black and multiracial families of young children with autism from an existing research database in the United States about their retrospective diagnostic experiences. We gathered quantitative and qualitative data and engaged in iterative coding to understand timing and content of first concerns, families' experiences of care providers and systems, and the impact of race and culture on accessing care. RESULTS Families provided examples of early developmental concern and described provider, systemic, and cultural barriers and facilitators to care. Families also provided insight into the influence of culture and made recommendations on how the medical system could better care for Black and multiracial families of children with autism. CONCLUSIONS Results add to a growing body of literature supporting the need for culturally sensitive and accessible care related to developmental monitoring, diagnosis, and follow-up care for Black and multiracial children.
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Affiliation(s)
- Amy S Weitlauf
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Alexandra Miceli
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alison Vehorn
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yewande Dada
- Department of Pediatrics, Meharry Medical College, Nashville, TN, USA
| | - Theodora Pinnock
- Department of Pediatrics, Meharry Medical College, Nashville, TN, USA
| | - Joyce W Harris
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey Hine
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zachary Warren
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Special Education, Vanderbilt University, Nashville, TN, USA
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Martin Loya MR, Meadan H. It's our job to bridge the gap: Perspectives of bilingual autism providers on heritage language care. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241234413. [PMID: 38415610 DOI: 10.1177/13623613241234413] [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: 02/29/2024]
Abstract
LAY ABSTRACT In the United States, many people have heritage languages they speak in their homes other than English, such as Chinese or Spanish. Autistic children whose families speak different languages could benefit from support and teaching in their heritage languages. Still, caregivers have reported that it is challenging to do so. Many autism professionals make suggestions that are not based on research. To date, researchers have not examined the perspectives of the small group of bilingual professionals in the United States who provide bilingual support for autistic children. Therefore, this study explored how bilingual autism providers in the United States talked about their work, bilingualism, and the impacts their bilingual work has on autistic children and families. The bilingual providers in this study reported many positive outcomes for autistic children when they can learn and use their heritage languages and some negative outcomes when providers cannot communicate in the same language. Recommendations from this study highlight the need to recruit more bilingual providers in the field of autism.
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Pang RCC, Ho MSH, Wong PWC. A Review of the Literature on the Multiple Forms of Stigmatization of Caregivers of Children with Autism Among Ethnic Minority Groups. J Racial Ethn Health Disparities 2024; 11:545-559. [PMID: 36877377 DOI: 10.1007/s40615-023-01540-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 03/07/2023]
Abstract
Multiple forms of stigmatization are experienced by caregivers of children with autism among ethnic minority (EM) groups in various countries. Such forms of stigmatization can lead to delayed assessment and services for mental health among children and caregivers. This review identified the research literature on the types of stigmatization experienced by caregivers of children with autism with an EM background. A total of 19 studies published after 2010 (i.e., 12 from the USA, 2 from the UK, 1 from Canada, and 1 from New Zealand) of caregivers of 20 ethnicities were identified and reviewed, and their reporting qualities systematically also assessed. Four main themes: (1) self-stigma, (2) social stigma, (3) stigma towards EM parents of children on the autism spectrum, and (4) service utilization stigma, and nine sub-themes were identified. The discrimination experienced by caregivers were extracted, synthesized, and further discussed. While the reporting quality of the studies included is good, the depth of the understanding of this under-researched yet important phenomenon is very limited. The multiple forms of stigmatization experiences are complex, and it may be difficult to disentangle whether the causes of stigmatization were autism and/or EM related, and the types of stigmatization can vary enormously among different ethnic groups in different societies. More quantitative studies are needed to quantify the impacts of multiple forms of stigmatization on families of children with autism in EM groups so that more socially inclusive support for caregivers with an EM background in host countries can be developed.
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Affiliation(s)
| | - Mimi S H Ho
- Department of Special Education and Counselling, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, Hong Kong
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Troxel M, Kraper C, Verbalis A, Safer-Lichtenstein J, Seese S, Ratto A, Myrick Y, Armour AC, Pugliese CE, Strang JF, Ba C, Martucci J, Biel MG, Jackson V, Hardy KK, Mandell D, Goode TD, Anthony BJ, Kenworthy L, Anthony LG. Reaching "The Other Half": Teacher Referral Increases Inclusivity in Intervention Research for Neurodivergent School-Age Children. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024:1-14. [PMID: 38270579 DOI: 10.1080/15374416.2024.2303723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVE Researchers employed two recruitment strategies in a school-based comparative effectiveness trial for students with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) or autism. This study assessed the: 1) effectiveness of school-based referrals for identifying students meeting diagnostic criteria and 2) impact of eliminating requirements for existing diagnoses on recruitment, sample characteristics, and intervention response. METHOD Autistic students and students with ADHD in schools serving underresourced communities were recruited for an executive functioning (EF) intervention trial over 2 years. In Year 1, school staff nominated students with previous diagnoses. In Year 2, school staff nominated students demonstrating EF challenges associated with ADHD or autism; previous diagnosis was not required. Study staff then confirmed diagnoses. RESULTS More students were included in Year 2 (N = 106) than Year 1 (N = 37). In Year 2, 96% of students referred by school staff met diagnostic criteria for ADHD or autism, 53% of whom were not previously diagnosed. Newly identified students were less likely than previously diagnosed students to be receiving services and, for those with ADHD, were more likely to speak primarily Spanish at home. Previously diagnosed and newly identified students did not differ on other demographic variables or intervention response. Caregivers of previously diagnosed students reported more symptoms than caregivers of newly identified students for both diagnostic groups. Previously diagnosed students with ADHD had more researcher-rated symptoms than newly identified students. CONCLUSIONS Recruitment for an intervention study using behavior-based referrals from school staff enhanced enrollment without compromising the sample's diagnostic integrity and engaged children who otherwise would have been excluded.
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Affiliation(s)
- Mary Troxel
- Department of Psychiatry, University of Colorado School of Medicine, and Pediatric Mental Health Institute, Children's Hospital of Colorado
| | - Catherine Kraper
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Alyssa Verbalis
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Jonathan Safer-Lichtenstein
- Department of Psychiatry, University of Colorado School of Medicine, and Pediatric Mental Health Institute, Children's Hospital of Colorado
| | - Sydney Seese
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Allison Ratto
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Yetta Myrick
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - A Chelsea Armour
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Cara E Pugliese
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - John F Strang
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Caroline Ba
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Jillian Martucci
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Matthew G Biel
- Department of Psychiatry, Georgetown University Medical Center
| | - Vivian Jackson
- Center for Child and Human Development, Georgetown University
| | - Kristina K Hardy
- Center for Autism Spectrum Disorders, Children's National Hospital
- Center for Child and Human Development, Georgetown University
| | - David Mandell
- Center for Mental Health, Department of Psychiatry, University of Pennsylvania, School of Medicine
| | - Tawara D Goode
- Center for Child and Human Development, Georgetown University
- National Center for Cultural Competence, Department of Pediatrics, Georgetown University Medical Center
| | - Bruno J Anthony
- Department of Psychiatry, University of Colorado School of Medicine, and Pediatric Mental Health Institute, Children's Hospital of Colorado
- Department of Psychiatry, Georgetown University Medical Center
- Center for Child and Human Development, Georgetown University
| | - Lauren Kenworthy
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Laura Gutermuth Anthony
- Department of Psychiatry, University of Colorado School of Medicine, and Pediatric Mental Health Institute, Children's Hospital of Colorado
- Center for Autism Spectrum Disorders, Children's National Hospital
- National Center for Cultural Competence, Department of Pediatrics, Georgetown University Medical Center
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White SW, Schall C, Santos JD, Maddox BB, Hillier A, Klinger L, Pugliese C. Promoting Quality of Life: Suggestions for Mental Health Care Providers Working with Young Autistic Adults. AUTISM IN ADULTHOOD 2023; 5:347-355. [PMID: 38116052 PMCID: PMC10726189 DOI: 10.1089/aut.2022.0106] [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
There is a growing population of autistic adults in need of supports from a service delivery system that, at present, fails to accommodate their needs adequately and equitably. Unfortunately, there is a shortage of trained behavioral health service providers to meet the needs of young autistic adults. Quality of life (QoL), or one's perception of, and satisfaction with, life in relation to held goals and expectations, has been identified as a key outcome of interest by autistic self-advocates. By supporting autistic clients to hone their strengths and interests, integrate various aspects of their identity, identify goals, and connect to appropriate resources, providers can promote clients' self-knowledge and self-determination, in the service of improving QoL. In this Perspectives article, we offer concrete recommendations to mental health providers, including those who do not specialize in autism, with the goal of supporting implementation of evidence-based strategies that improve QoL and promote self-determination among young autistic clients.
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Affiliation(s)
- Susan W. White
- Center for Youth Development and Intervention, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Carol Schall
- Autism Center for Education, Rehabilitation Research and Training Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jin Delos Santos
- Project REACH, College of Staten Island at the City University of New York, Staten Island, New York, USA
| | - Brenna B. Maddox
- TEACCH Autism Program, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ashleigh Hillier
- Department of Psychology, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Laura Klinger
- TEACCH Autism Program, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cara Pugliese
- Center for Autism Spectrum Disorders, Children's National Hospital, Washington, District of Columbia, USA
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Lo A, Lowery LA, Kuhlthau K, Parker RA, Chan J, Haddad F, Radom-Aizik S, Gehricke JG. Effects of physical exercise, LEGO, and Minecraft activities on anxiety in underserved children with autism: Study design and methodological strategies. MethodsX 2023; 11:102332. [PMID: 37649622 PMCID: PMC10463252 DOI: 10.1016/j.mex.2023.102332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/16/2023] [Indexed: 09/01/2023] Open
Abstract
Anxiety is a common comorbidity for individuals with ASD, and there is some preliminary data about the efficacy of physical exercise to alleviate anxiety. However, we are not aware of any studies that have compared the effects of a physical exercise program on anxiety in underserved children with ASD using a randomized controlled research design. This paper describes a method to evaluate and compare the efficacy of an 8-week physical exercise intervention with a sedentary play intervention to alleviate anxiety in young children with autism spectrum disorders (ASD) from underserved backgrounds. We assessed anxiety and its physical symptoms using the parent-rated Child Behavior Checklist DSM-5 anxiety (CBCL DSM-5) subscale, the child-rated Screen for Childhood Anxiety Related Emotional Disorder (SCARED), the parent-rated Child's Sleep Habits Questionnaire (CSHQ), and salivary cortisol. We also utilized the Physical Activity Questionnaire for Older Children (PAQ-C) to assess physical activity level and identify compounds. Unique components of this study include: •Implementation of novel physical exercise and sedentary play interventions that have been designed for children with ASD.•Recruitment of predominantly underserved and non-English speaking families.
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Affiliation(s)
- Angelina Lo
- University of California, Irvine, School of Medicine. 1001 Health Sciences Rd, Irvine, CA 92617, USA
| | - Lea Ann Lowery
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri. 205 Portland Street, Columbia, MO 65211, USA
| | - Karen Kuhlthau
- Massachusetts General Hospital (MGH), Harvard University. 125 Nashua Street 8th Floor Boston, MA 02114, USA
| | - Robert A. Parker
- Massachusetts General Hospital (MGH), Harvard University. 125 Nashua Street 8th Floor Boston, MA 02114, USA
| | - James Chan
- Massachusetts General Hospital (MGH), Harvard University. 125 Nashua Street 8th Floor Boston, MA 02114, USA
| | - Fadia Haddad
- Pediatric Exercise & Genomics Research Center, Department of Pediatrics, University of California, Irvine. 101 Academy, Suite 150, Irvine, CA 92617, USA
| | - Shlomit Radom-Aizik
- Pediatric Exercise & Genomics Research Center, Department of Pediatrics, University of California, Irvine. 101 Academy, Suite 150, Irvine, CA 92617, USA
| | - Jean-G. Gehricke
- The Center for Autism & Neurodevelopmental Disorders, Department of Pediatrics, University of California, Irvine, 2500 Red Hill Ave #100, Santa Ana, CA 92705, USA
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11
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Kantor J, Smrčková A, de Goumoëns V, Munn Z, Svobodová Z, Klugar M. Experience of having a sibling with autism spectrum disorder: a systematic review protocol. JBI Evid Synth 2023; 21:2406-2412. [PMID: 37789814 DOI: 10.11124/jbies-23-00069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVE This qualitative systematic review aims to understand the experiences of neurotypical siblings of a person with autism spectrum disorder. INTRODUCTION Autism spectrum disorder influences communication and social interaction with other people and has a significant impact on family relationships. The experiences of siblings range from the positive, such as development of increased empathy and ability to cope with challenges, to experiences that are more negative, such as a higher risk of bullying. In many countries, neurotypical siblings are marginalized and don't receive adequate support to cope with the increased challenges. INCLUSION CRITERIA This review will consider qualitative studies exploring the experiences of siblings of a person with autism spectrum disorder. There will be no limitations regarding age, gender, sex, or length of relationship with the sibling. We will consider studies from all countries and contexts. METHODS This study will be conducted according to the JBI methodology for qualitative reviews. A 3-step search strategy will be used to find published and unpublished studies from the following sources: MEDLINE, CINAHL, APA PsycINFO, Scopus, SocINDEX, Web of Science, Embase, ERIC, ProQuest Dissertations and Theses, Open Dissertations, and Google Scholar (first 100 records). There will be no search limitations on the publication period or language, but only studies with an English-language abstract/title will be considered for inclusion. Screening, data extraction, and data synthesis will be conducted by 2 independent reviewers.
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Affiliation(s)
- Jiří Kantor
- Institute of Special Educational Studies, Faculty of Education, Palacký University Olomouc, Olomouc, Czech Republic
- Center of Evidence-based Education and Arts Therapies: A JBI Affiliated Group, Palacký University Olomouc, Czech Republic
| | - Alžběta Smrčková
- Institute of Special Educational Studies, Faculty of Education, Palacký University Olomouc, Olomouc, Czech Republic
- Center of Evidence-based Education and Arts Therapies: A JBI Affiliated Group, Palacký University Olomouc, Czech Republic
| | - Véronique de Goumoëns
- La Source School of Nursing, HES-SO, University of Applied Sciences and Arts, Western Switzerland, Lausanne, Switzerland
- Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST) a JBI Centre of Excellence, Lausanne, Switzerland
| | - Zachary Munn
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Zuzana Svobodová
- Center of Evidence-based Education and Arts Therapies: A JBI Affiliated Group, Palacký University Olomouc, Czech Republic
- Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| | - Miloslav Klugar
- Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Czech GRADE Network; Institute of Health Information and Statistics of the Czech Republic (IHIS-CR), Prague, Czech Republic
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Burke MM, Cheung WC, Kim J. Understanding the Effectiveness and Feasibility of a Family Navigator Program for Parents of Children With Autism. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2023; 61:426-439. [PMID: 37770053 PMCID: PMC10637767 DOI: 10.1352/1934-9556-61.5.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/27/2023] [Indexed: 10/03/2023]
Abstract
Systems navigation can be difficult, especially for low-resourced families (i.e., families who are "low income" or meet one of the following indicators: mother has a high school diploma or less; primary caregiver is unemployed; or the family receives governmental assistance). Navigators may help families access services; however, the training of navigators is unclear. The purpose of this study was to determine the effectiveness and feasibility of Supporting Parents to Access and Navigate Services (SPANS), a program to develop navigators. Altogether, 19 low-resourced parents of children with autism participated in SPANS. Participants demonstrated significantly improved knowledge about autism services and perceived advocacy for other families and systemic change. There was high attendance, low attrition, high acceptability, and high fidelity. Implications are discussed.
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Affiliation(s)
| | | | - Julianna Kim
- Department of Special Education, University of Maryland
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13
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Ellis J(M. Imagining Neurodivergent Futures from the Belly of the Identity Machine: Neurodiversity, Biosociality, and Strategic Essentialism. AUTISM IN ADULTHOOD 2023; 5:225-235. [PMID: 37663441 PMCID: PMC10468558 DOI: 10.1089/aut.2021.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Several critiques have emerged of the neurodiversity paradigm and of claims made by activists in the Neurodiversity Movement. These critiques include concerns that the Neurodiveristiy movement downplays the differences between Autistic people. In this article, I argue that the neurodiversity paradigm is a strategically adopted response to current realities. Sometimes, it is strategically necessary to appeal to existing narratives about Autism, or to emphasize solidarity within the Autistic community over the autism spectrum's internal diversity. At times, this can lead activists to neglect a more nuanced articulation of the Neurodiversity paradigm, which allows for the diversity of our community while still calling for solidarity in the face of shared experiences of discrimination. I compare this strategy with strategies of strategic essentialism utilized in the Indigenous Rights movement in Canada. I also explore the ways in which discourses of ableism and racism have historically been intertwined. Both Autistic people and Indigenous people represent diverse communities that must grapple with externally imposed identities to access legal rights, and both identities have been denigrated as mentally inferior by non-Autistic and colonial powers. I conclude that it is sometimes necessary to employ these types of strategies to secure needed resources and protections. I call for both scholars and advocates to take a more intersectional approach to understanding how strategic essentialism is being deployed within the Neurodiversity Movement.
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Rollins PR, Rangel-Uribe C, Rojas R, Brantley S. Examining Cultural and Linguistic Sensitivity of Pathways Early Autism Intervention with Hispanic Families. J Autism Dev Disord 2023:10.1007/s10803-023-06003-9. [PMID: 37142911 PMCID: PMC10159226 DOI: 10.1007/s10803-023-06003-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE This research aimed to evaluate evidence of Pathways parent-mediated early autism intervention as a culturally and linguistically sensitive intervention (CLSI) for Hispanic families with autistic children. METHODS We used Bernal et al.'s ecologically valid (EV) framework to evaluate current practice and Hispanic parents' perceptions of Pathways 1 ½ years after completing the intervention. Both quantitative and qualitative methods were used. Nineteen parents were contacted, of which 11 completed a semi-structured interview about their experience with Pathways. RESULTS On average, the group that completed the interview was less educated, had more monolingual Spanish speakers, and rated their general experience with the intervention slightly more positively than those who did not agree to complete the interview. A review of Pathways's current practices through the lens of the EV framework suggested that Pathways was a CLSI for Hispanic participants in the domains of context, methods, language, and persons. Parental interviews echoed these strengths. However, Pathways did less well balancing evidence-based intervention strategies for autistic children with the heritage value of respeto. CONCLUSION Pathways demonstrated strengths regarding cultural and linguistic sensitivity for Hispanic families with young autistic children. Future work with our community stakeholder group will integrate heritage and majority culture perspectives to strengthen Pathways as a CLSI.
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Affiliation(s)
- Pamela Rosenthal Rollins
- Department of Speech, Language and Hearing, Callier Center for Communication Disorders, University of Texas at Dallas-Richardson, 1966 Inwood Road, Dallas, TX, 75235, USA.
| | - Cristina Rangel-Uribe
- Department of Speech, Language and Hearing, Callier Center for Communication Disorders, University of Texas at Dallas-Richardson, 1966 Inwood Road, Dallas, TX, 75235, USA
| | - Raúl Rojas
- Department of Speech-Language-Hearing: Sciences and Disorders, University of Kansas, Lawrence, KS, 66045, USA
| | - Sara Brantley
- Department of Speech, Language and Hearing, Callier Center for Communication Disorders, University of Texas at Dallas-Richardson, 1966 Inwood Road, Dallas, TX, 75235, USA
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The Impacts of the COVID-19 Pandemic on Therapy Utilization Among Racially/Ethnically and Socio-Economically Diverse Autistic Children. J Autism Dev Disord 2023; 53:918-933. [PMID: 36757541 PMCID: PMC9909136 DOI: 10.1007/s10803-023-05905-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 02/10/2023]
Abstract
PURPOSE The purpose of current study was to evaluate change in hours of Applied Behavior Analysis (ABA) therapy utilization for autistic children during the year prior to the COVID-19 pandemic, the first three months of the pandemic (crisis phase), and the following 9 months of the pandemic (mitigation phase). Additionally, this study aimed to evaluate if change in therapy utilization differed based on child race, ethnicity, and primary payer of services. Finally, we aimed to identify potential mechanisms of ABA therapy disruption by interpreting findings using an extended version of Donabedian's structure-process-outcome model. METHODS Retrospective clinical data on client demographics and therapy utilization (n = 283) were collected from ABA clinics in California and analyzed with four piecewise growth multi-level models. RESULTS We found that therapy utilization dropped during the first three months of the pandemic (-10.65 h/month; p < .001) and increased during the following 9 months (2.39 h/month; p < .001). Moderator analyses revelated that Asian, Non-Latinx and school-district funded children had significantly different trajectories of change in therapy utilization compared to white, non-Latinx participants and private insurance funded participants, respectively. CONCLUSION Findings suggest that utilization of ABA therapy was disrupted for a full year following the onset of the COVID-19 pandemic and that child race/ethnicity and primary payer influenced the degree to which autistic children were impacted by service disruption. These findings have implications for autistic children who lost therapy access during key developmental periods and for the ABA care delivery system.
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Tekola B, Kinfe M, Girma Bayouh F, Hanlon C, Hoekstra RA. The experiences of parents raising children with developmental disabilities in Ethiopia. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:539-551. [PMID: 35757938 DOI: 10.1177/13623613221105085] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
LAY ABSTRACT The experiences of parents raising children with developmental disabilities have been widely researched, although most of this research comes from Western, high-income countries. In comparison, little is known about the lived experiences of parents of children with developmental disabilities in low- and middle-income countries and in Africa in particular. We interviewed 14 mothers and 4 fathers in Addis Ababa and the rural town of Butajira to explore what life is like for parents caring for children with developmental disabilities in Ethiopia. Cultural and religious beliefs played a role in the types of delays or differences in their child's development that parents noticed early and the kinds of support they sought. Parents experienced stigma and lack of understanding from others. Their experiences regarding some of the challenges they faced such as lack of appropriate services varied based on where they lived (urban or rural). Single mothers especially were faced with multiple struggles including poverty, stigma, and lack of social support. Implications for future research and interventions that aim to increase knowledge about developmental disabilities, tackle stigma and improve the lives of children and their families are discussed.
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17
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Tang Yan C, Bachour A, Pérez CJ, Ansaldo LP, Santiago D, Jin Y, Li Z, Mok YS, Weng Y, Martinez LS. Partnering with immigrant families to promote language justice and equity in education. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 70:433-457. [PMID: 35621207 DOI: 10.1002/ajcp.12604] [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: 07/27/2021] [Revised: 04/01/2022] [Accepted: 04/15/2022] [Indexed: 06/15/2023]
Abstract
Despite US federal legislation mandates institutions to provide meaningful access and participation to students and families in educational settings, culturally and linguistically diverse (CLD) families and caregivers of children in special education experience cultural and linguistic barriers. A Community Advisory Team (CAT) of parents, advocates, community interpreters and translators, researchers, and teachers explored CLD families' experiences and advocacy efforts. Critical bifocality and circuits of dispossession, privilege, and resistance informed the documentation of inequities and resistance to understand the linkages of structural arrangements of power. Focus groups with families (n = 21) speakers of Spanish, Portuguese, and Cantonese were conducted. Findings indicate perceived discrimination, poor and inadequate interpretation and translation services impact children's access to special education services, hinder family's communication with schools and reduce the perceptions of schools as trustworthy institutions. Families advocate relentlessly for their children and recommend schools listen to families and hire culturally and linguistically competent interpreters and translators. Community psychologists can make significant contributions to promote language justice in education settings through participatory approaches to inquiry that value CLD families' knowledge and expertise.
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Affiliation(s)
| | - Angélica Bachour
- Parent Advocate, Community Interpreter and Translator, CAT Member, Chelsea, Massachusetts, USA
| | - Consuelo J Pérez
- Artist, Parent Advocate, Community Interpreter and Translator, CAT Member, Somerville, Massachusetts, USA
| | - Loreto P Ansaldo
- MST, CI, Community Interpreter and Translator, Teacher, CAT Member, Boston, Massachusetts, USA
| | - Diana Santiago
- Esq., Senior Attorney, Massachusetts Advocates for Children (MAC), CAT Member, Boston, Massachusetts, USA
| | - Yichen Jin
- Boston University School of Social Work, Boston, Massachusetts, USA
| | - Zihui Li
- Parent Educator, Community Interpreter and Translator, Quincy, Massachusetts, USA
| | - Yu S Mok
- Community Interpreter and Translator, Malden, Massachusetts, USA
| | - Yanyi Weng
- MSW, LCSW, Social Worker, Boston, Massachusetts, USA
| | - Linda S Martinez
- Boston University School of Social Work, Boston, Massachusetts, USA
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18
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Weitlauf AS, Vehorn A, Miceli A, Pinnock T, Dada Y, Hine J, Warren Z. Black Families' Experiences of Developmental Screening: Review of Well-Child Visits to Inform Enhanced Autism Spectrum Disorder Risk Assessment. J Dev Behav Pediatr 2022; 43:503-510. [PMID: 36443922 PMCID: PMC9713582 DOI: 10.1097/dbp.0000000000001129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Black families face barriers to early diagnosis of autism spectrum disorder (ASD). Most work emphasizes systemic delays to diagnosis rather than how existing screening procedures may affect identification. Our goal was to examine pediatric care visits in which screening was most likely to occur to document behaviors of parents and providers. METHODS We examined 18- to 36-month primary care visits in our electronic health record system (n = 99) of thirty-nine 4- and 8-year-old Black children later diagnosed with ASD. We extracted qualitative and quantitative data and engaged in consensus coding. We captured whether formal screening occurred, the content of concerns of parents and providers, and referral patterns for follow-up care or evaluation. RESULTS Consistent with existing work, we found differences in parent and provider concerns and discrepancies in referral rates. Parents often endorsed concerns about language, sleeping or eating habits, behavior, or motor skills rather than ASD, but specific mention of ASD as a concern increased over time. Referrals for follow-up care were more likely when providers, not parents alone, expressed concerns about patient development. CONCLUSION Pediatric providers cannot place the burden on families to raise autism concerns. Although some level of developmental risk was noted at most visits for children later diagnosed with ASD, referrals were only made when providers were also concerned, and most of these were for speech-language evaluation. Ongoing work is necessary to better understand how existing care systems interact with diverse families to inform the creation of inclusive screening practices that mitigate diagnostic delays.
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Affiliation(s)
- Amy S. Weitlauf
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alison Vehorn
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alexandra Miceli
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Theodora Pinnock
- Department of Pediatrics, Meharry Medical College, Nashville, Tennessee
| | - Yewande Dada
- Department of Pediatrics, Meharry Medical College, Nashville, Tennessee
| | - Jeffrey Hine
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Zachary Warren
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Special Education, Vanderbilt University, Nashville, Tennessee
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Mallipeddi NV, VanDaalen RA. Intersectionality Within Critical Autism Studies: A Narrative Review. AUTISM IN ADULTHOOD 2022; 4:281-289. [PMID: 36777375 PMCID: PMC9908281 DOI: 10.1089/aut.2021.0014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The aim of this narrative review was to examine intersectionality within critical autism studies. A growing body of evidence has demonstrated the importance of intersectional frameworks in highlighting the diverse experiences of marginalized communities. Many disability studies researchers investigated intersectionality to elucidate the impact of race, gender, sexuality, class, and other constructs on disability identification. Within critical autism studies, a field that emerged to challenge the deficit-laden, pathologizing autism discourses favored by the medical community, intersectionality has started to become an integral component of the literature. This review highlights intersectional frameworks utilized to explore autism in both academic and nonacademic contexts, to provide a foundation for future study. Upon analysis, we found overarching themes regarding the explicit, implicit, and descriptive approaches to intersectionality, racial and gender biases within critical autism studies, and the multidisciplinary nature of intersectionality and critical autism studies. We finish the review with recommendations for how to more fully address the experiences of all autistic people-particularly of racial, gender, and sexual minority individuals-in future study. Our recommendations include utilizing intersectionality as an analytical lens for describing previously overlooked phenomena and questioning central tenets of methodology and processes, including developing research questions, analyzing data, and writing results.
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Affiliation(s)
| | - Rachel A. VanDaalen
- Department of Psychology, University of Maryland, College Park, Maryland, USA
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20
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Wallace-Watkin C, Sigafoos J, Waddington H. Barriers and facilitators for obtaining support services among underserved families with an autistic child: A systematic qualitative review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 27:588-601. [PMID: 36081366 DOI: 10.1177/13623613221123712] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Families from underrepresented ethnic or racial groups and those with limited financial resources could experience more difficulty in accessing support services for their autistic child due to certain types of barriers. We searched academic journals, websites, and other sources for studies which looked at what barriers might be present for such families and what might help families access support services for their autistic child. The search found 18 studies. Results from each study were examined and coded into themes. Parents reported that accessibility, diversity of support services, and stigma influenced their experiences with support services. We discuss what these findings might mean for future research and for service delivery.
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21
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Diemer MC, Gerstein ED, Regester A. Autism presentation in female and Black populations: Examining the roles of identity, theory, and systemic inequalities. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1931-1946. [PMID: 35899909 DOI: 10.1177/13623613221113501] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Although the prevalence of autism has been rising in recent years, disparities in diagnosis still remain. Female and Black populations in the United States are diagnosed later, are more likely to have an intellectual disability, and are excluded from research as well as services designed for autistic individuals. Autistic Black girls are effectively invisible in the current scientific literature. Intersectional theory, which looks at a person as a whole, examines models that are inclusive toward diverse gender, ability, and racial/ethnic backgrounds. This theory may be a useful approach to clinical and research work with autism so that practitioners may be most effective for the whole population of autistic people. The authors recommend research focusing on inclusion of autistic populations with intellectual disability and research studies that include evaluations as part of the procedure. Clinically, the authors recommend a focus on screening all young children for autism and improving provider knowledge in working with diverse autistic populations.
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22
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Brown HM, Dwyer PSR, Gassner DL, Kapp SK, Ne′eman A, Ryan JG, Waisman TC, Williams ZJ. The Autism Intervention Research Network on Physical Health Autistic Researcher Review Board. Pediatrics 2022; 149:e2020049437F. [PMID: 35363294 PMCID: PMC9069212 DOI: 10.1542/peds.2020-049437f] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 01/29/2023] Open
Affiliation(s)
- Heather M. Brown
- Department of Educational Psychology, Faculty of Education, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick S. R. Dwyer
- Center for Mind and Brain, University of California Davis, Davis, California
- Department of Psychology, University of California Davis, Davis, California
| | - Dena L. Gassner
- School of Social Work, Adelphi University, Garden City, New York
- Department of Health Sciences, Towson University, Towson, Maryland
| | - Steven K. Kapp
- Department of Psychology, University of Portsmouth, Portsmouth, United Kingdom
| | - Ari Ne′eman
- Harvard University, Cambridge, Massachusetts
| | - Jacalyn G. Ryan
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - TC Waisman
- University of Calgary, Calgary, Alberta, Canada
| | - Zachary J. Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, Tennessee
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, Tennessee
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Turnock A, Langley K, Jones CR. Understanding Stigma in Autism: A Narrative Review and Theoretical Model. AUTISM IN ADULTHOOD 2022; 4:76-91. [PMID: 36605561 PMCID: PMC8992913 DOI: 10.1089/aut.2021.0005] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The experience of stigma by autistic people is relatively understudied, despite contributing to a range of poor outcomes and having an overarching impact on well-being. The current review of the literature synthesizes research to determine what is currently known and presents a theoretical model of autism stigma. Autism stigma is primarily influenced by a public and professional understanding of autism in combination with interpretation of visible autistic traits. Moderating factors include the quality and quantity of contact with autistic people, cultural factors, sex and gender, individual differences, and diagnostic disclosure. Stigma can reduce well-being as well as increase the presence of camouflaging behaviors, which mask autistic traits. Caregivers of autistic people can experience stigma by association, that is, affiliate stigma, which can impact their own well-being. A variety of interventions and approaches to reduce stigma are discussed, including "autism friendly" spaces, positive media representation, educational and psychosocial training for the public and professionals, as well as cultural and systemic shifts that foster inclusivity and recognize neurodiversity.
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Affiliation(s)
- Alice Turnock
- School of Medicine, Cardiff University, University Hospital of Wales, Cardiff, United Kingdom
| | - Kate Langley
- Wales Autism Research Centre, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Catherine R.G. Jones
- Wales Autism Research Centre, School of Psychology, Cardiff University, Cardiff, United Kingdom.,Address correspondence to: Catherine R.G. Jones, PhD, School of Psychology, Cardiff University, Park Place, Cardiff CF10 3AT, United Kingdom
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Jones M, Falkmer M, Milbourn B, Tan T, Bölte S, Girdler S. The Core Elements of Strength-Based Technology Programs for Youth on the Autism Spectrum: A Systematic Review of Qualitative Evidence. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022. [DOI: 10.1007/s40489-022-00302-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AbstractStrength-based programs that incorporate technology have gained increasing popularity as an approach to improve outcomes for individuals with autism spectrum disorder (ASD). Despite this, the core elements of strength-based technology programs remain poorly described. This study aimed to identify the core elements of strength-based technology programs for youth with ASD through a systematic review of the literature. Electronic databases were searched for qualitative studies delivering strength-based technology-driven interventions to youth on the spectrum. Ten of the 874 studies identified met the criteria. Qualitative analysis revealed three core elements of strength-based technology programs for this population: mutual respect, demonstrating skills, and interests. The findings underpin the design of future strength-based technology programs for youth with ASD.
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Zeng W, Magaña S, Lopez K, Xu Y, Marroquín JM. Revisiting an RCT study of a parent education program for Latinx parents in the United States: Are treatment effects maintained over time? AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:499-512. [PMID: 34320853 PMCID: PMC8795242 DOI: 10.1177/13623613211033108] [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: 02/03/2023]
Abstract
LAY ABSTRACT Background: We conducted a follow-up investigation of a two-site randomized controlled trial in the United States. We examined whether the treatment effects in a culturally tailored parent education program for Latinx families of children with autism spectrum disorder were maintained over time.Methods: Using linear mixed models, we compared differences in parent and child outcomes across three timepoints: baseline, 4 months after baseline (Time 2), and 8 months after baseline (T3). Parent outcomes included family empowerment, self-reported confidence in, and frequency of using evidence-based strategies. Child outcomes included parent-reported challenging behaviors, social communication impairments, and the number of services received. Participants were 109 Latina mothers (intervention = 54, control = 55) of children with autism spectrum disorder.Results: After intervention at both Time 2 and Time 3 in both sites, mothers in the intervention groups reported significantly greater confidence in and frequency of using evidence-based strategies, and that their child received significantly more services. We also found that there were treatment differences across the two study sites in several outcomes.Implications: The intervention for Latinx parents of children with autism spectrum disorder was efficacious and could be maintained, and that site-specific policy and service differences may need to be examined in future research to inform dissemination and implementation.
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Affiliation(s)
- Weiwen Zeng
- Steve Hicks School of Social Work, University of Texas at Austin, TX, USA
| | - Sandy Magaña
- Steve Hicks School of Social Work, University of Texas at Austin, TX, USA
| | - Kristina Lopez
- School of Social Work, Arizona State University, AZ, USA
| | - Yue Xu
- Department of Disability and Human Development, University of Illinois at Chicago, IL, USA
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Cascio MA, Racine E. Autism service preferences of parents/guardians and autistic adults in five countries. Autism Res 2022; 15:570-585. [PMID: 35040590 DOI: 10.1002/aur.2667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 10/26/2021] [Accepted: 12/16/2021] [Indexed: 01/14/2023]
Abstract
Scholars and activists debate whether people on the autism spectrum should access autism-specific services or general/inclusive/mainstream services. This article presents quantitative results from a mixed-methods survey of autistic adults and parents/guardians of autistic people in Canada, France, Germany, Italy, and the United States. Respondents reported categories of services used (autism-specific, mixed-disability, or general/inclusive/mainstream), satisfaction, and overall service preference. Most respondents preferred autism-specific services, followed by different categories of services for different service types. Demographic factors had little influence on overall service preferences. No significant differences were found between adults' and parents/guardians' overall service preferences. For parents/guardians, using autism-specific services was associated with a preference for autism-specific services. There were significant associations between the services respondents reported having previously used and their overall service preference. Parents/guardians in Italy and France reported lower satisfaction with many services. These results suggest that a preference for autism-specific services pervades different groups. While most respondents did endorse autism-specific services, the strong secondary preference for different service categories encourages providers and policy makers to attend to diverse needs. While satisfaction was generally middling to high, there remain areas for improvement, especially in general job training services. General services can use a Universal Design approach and collaborate with autism-specific and mixed-disability services to increase accessibility to diverse populations. The influence of previous service use on preferences suggests that providers can leverage strengths of existing services, leverage and create connections, and ask users about previous experiences to better address their expectations. LAY SUMMARY: This study asked autistic adults and parents/guardians of autistic people what they think about autism services. Most parents/guardians and adults liked services that focus on autism, but many parents/guardians and adults liked them for some things and not others. All services can ask people about services they used in the past and learn from the strengths of good services through Universal Design and working with other services.
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Affiliation(s)
- M Ariel Cascio
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, Quebec, Canada.,Department of Medicine (Division of Experimental Medicine), Department of Neurology and Neurosurgery, Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, Quebec, Canada.,Department of Medicine (Division of Experimental Medicine), Department of Neurology and Neurosurgery, Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada.,Département de médicine, Département de médecine sociale et préventive, Université de Montréal, Montréal, Quebec, Canada
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Benevides TW, Tao S, Becker A, Verstreate K, Shea L. Occupational Therapy Service Delivery Among Medicaid-Enrolled Children and Adults on the Autism Spectrum and With Other Intellectual Disabilities. Am J Occup Ther 2022; 76:23165. [PMID: 35030249 DOI: 10.5014/ajot.2022.049202] [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] Open
Abstract
IMPORTANCE Rates of occupational therapy service utilization among people with autism spectrum disorder (ASD) or intellectual disability (ID) have not been explored in population-based samples. OBJECTIVE To describe occupational therapy services delivered to Medicaid-eligible persons younger than age 65 yr identified as having ASD, ID, or both and to evaluate demographic factors associated with occupational therapy service utilization in this population. DESIGN Retrospective, case-control, cohort study using claims records from Medicaid Analytic eXtract files (2009-2012). SETTING Data from all 50 states and Washington, DC. PARTICIPANTS Beneficiaries identified as having ASD only, ASD+ID, or ID only who were younger than age 18 yr (N = 664,214) and ages 18-64 yr (N = 702,338). Outcomes and Measures: We analyzed Current Procedural Terminology® and Healthcare Common Procedure Coding System procedure codes, Medicaid Statistical Information System type of service codes, and Center for Medicare & Medicaid Services provider specialty codes. RESULTS Only 3.7% to 6.3% of eligible adult beneficiaries received occupational therapy; in contrast, 20.5% to 24.2% of children received occupational therapy. Significant predictors of service use varied by group; however, differences by race-ethnicity, eligibility on the basis of poverty, and geographic location were observed. Among children, the most frequent billing code was for "therapeutic activities" (43%-60%); among adults, it was "community/work reintegration training" (29%-39%). CONCLUSIONS AND RELEVANCE Billed procedure code patterns do not consistently reflect the unique occupational focus that occupational therapy providers deliver to people with developmental disabilities. Disparities in occupational therapy receipt warrant further attention to understand the social and structural factors affecting service delivery. What This Article Adds: Occupational therapy services paid for by Medicaid are used more frequently by children with ASD and ID than by adults with these diagnoses. Greater understanding of the intersectional factors that drive service delivery and disparities is needed.
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Affiliation(s)
- Teal W Benevides
- Teal W. Benevides, PhD, MS, OTR/L, is Associate Professor, Department of Occupational Therapy, College of Allied Health Sciences, Augusta University, Augusta, GA;
| | - Sha Tao
- Sha Tao, MPH, is Data Analyst, A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA
| | - Alec Becker
- Alec Becker, MAS, is Data Analyst, A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA
| | - Kate Verstreate
- Kate Verstreate, MPH, is Data Analyst, A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA
| | - Lindsay Shea
- Lindsay Shea, DrPH, MS, is Associate Professor, A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA
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Calleja S, Kingsley J, Amirul Islam FM, McDonald R. Barriers to Accessing Healthcare: Perspectives from Autistic Adults and Carers. QUALITATIVE HEALTH RESEARCH 2022; 32:267-278. [PMID: 34906008 DOI: 10.1177/10497323211050362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Autistic adults have higher health needs compared to most, yet they continue to experience barriers to accessing appropriate healthcare. Presently, no qualitative research exists exploring these barriers which impact overall physical and mental health. We conducted a qualitative analysis in Victoria (Australia) of the perceived experiences of healthcare access for autistic adults (n = 9) and primary caregivers of autistic adults (n = 7). Specifically, a three-staged phenomenological approach was applied involving: (i) a communicative checklist, (ii) a health status survey and (iii) face-to-face interviews. Elements such as support, responsibilities and protective factors exhibited by caregivers, may impact healthcare access for autistic adults. Results indicate the need for further research exploring interdependent factors that impact healthcare access by caregivers, so evidence-based interventions can be developed to support caregivers in the future.
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Affiliation(s)
- Shenae Calleja
- Faculty of Health, Arts and Design, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Jonathan Kingsley
- Faculty of Health, Arts and Design, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
- Centre of Urban Transitions, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Fakir M Amirul Islam
- Faculty of Health, Arts and Design, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Rachael McDonald
- Faculty of Health, Arts and Design, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
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Rivera-Figueroa K, Marfo NYA, Eigsti IM. Parental Perceptions of Autism Spectrum Disorder in Latinx and Black Sociocultural Contexts: A Systematic Review. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 127:42-63. [PMID: 34979034 PMCID: PMC8740628 DOI: 10.1352/1944-7558-127.1.42] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 03/30/2021] [Indexed: 05/15/2023]
Abstract
Parents of children with autism spectrum disorder (ASD) face challenges in accessing diagnostic and treatment services; these challenges vary by race, ethnicity, and culture. This systematic review examines parental perceptions of ASD within Latinx and Black American communities. Findings indicate that interconnections with family and religious groups promoted positive coping and describe positive impacts of having a child with ASD. Relative to White families, community members reported reduced access to information and more inaccurate beliefs about ASD, higher levels of ASD-related stigma, and more negative experiences with healthcare providers, which serve to exacerbate healthcare disparities. Conclusions are limited by an underrepresentation of minority groups in research. We call for efforts to address the specific needs of racial and ethnic minorities.
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Affiliation(s)
- Karla Rivera-Figueroa
- Karla Rivera-Figueroa, Nana Yaa A. Marfo, and Inge-Marie Eigsti, University of Connecticut
| | - Nana Yaa A Marfo
- Karla Rivera-Figueroa, Nana Yaa A. Marfo, and Inge-Marie Eigsti, University of Connecticut
| | - Inge-Marie Eigsti
- Karla Rivera-Figueroa, Nana Yaa A. Marfo, and Inge-Marie Eigsti, University of Connecticut
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Beauchamp MLH, Amorim K, Wunderlich SN, Lai J, Scorah J, Elsabbagh M. Barriers to access and utilization of healthcare services for minority-language speakers with neurodevelopmental disorders: A scoping review. Front Psychiatry 2022; 13:915999. [PMID: 36090362 PMCID: PMC9453304 DOI: 10.3389/fpsyt.2022.915999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/11/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Minority-language speakers in the general population face barriers to accessing healthcare services. This scoping review aims to examine the barriers to healthcare access for minority-language speakers who have a neurodevelopmental disorder. Our goal is to inform healthcare practitioners and policy makers thus improving healthcare services for this population. INCLUSION CRITERIA Information was collected from studies whose participants include individuals with a neurodevelopmental disorder (NDD) who are minority-language speakers, their family members, and healthcare professionals who work with them. We examined access to healthcare services across both medical and para-medical services. METHOD Searches were completed using several databases. We included all types of experimental, quasi-experimental, observational and descriptive studies, as well as studies using qualitative methodologies. Evidence selection and data extraction was completed by two independent reviewers and compared. Data extraction focused on the barriers to accessing and to utilizing healthcare for minority-language speakers with NDDs. The search process and ensuing results were fully reported using a diagram from the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review. RESULTS Following the database search, a total of 28 articles met our final selection criteria and two articles were hand-picked based on our knowledge of the literature, for a total of 30 articles. These studies revealed that minority-language speakers with NDDs and their families experience several barriers to accessing and utilizing healthcare services. These barriers, identified at the Systems, Provider and Family Experience levels, have important consequences on children's outcomes and families' well-being. DISCUSSION While our review outlined several barriers to access and utilization of healthcare services for minority-language speakers with NDDs and their families, our findings give rise to concrete solutions. These solutions have the potential to mitigate the identified barriers, including development and implementation of policies and guidelines that support minority-language speakers, practitioner training, availability of referral pathways to appropriate services, access to tools and other resources such as interpretation services, and partnership with caregivers. Further research needs to shift from describing barriers to examining the efficacy of the proposed solutions in mitigating and eliminating identified barriers, and ensuring equity in healthcare for minority-language speakers with NDDs.
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Affiliation(s)
| | - Kaela Amorim
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | | | - Jonathan Lai
- Autism Alliance of Canada and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Julie Scorah
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Mayada Elsabbagh
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
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Missing from the Narrative: A Seven-Decade Scoping Review of the Inclusion of Black Autistic Women and Girls in Autism Research. Behav Anal Pract 2021; 15:1093-1105. [PMID: 36605161 PMCID: PMC9745006 DOI: 10.1007/s40617-021-00654-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 01/09/2023] Open
Abstract
The intersectional experiences of Black autistic women and girls (BAWG) are missing from medical and educational research on autism spectrum disorder (ASD). Understanding the intersectional experiences of BAWG is important due to the rising prevalence of autism in Black children and girls (Centers for Disease Control and Prevention (CDC), 2020) and the concurrent lack of availability of culturally relevant autism-related interventions (Maenner et al., 2020; West et al., 2016). Intersectionality is the study of the overlapping discrimination produced by systems of oppression (Collins, 2019; Crenshaw, 1989, 1991) and allows the researcher to simultaneously address race and disability in special education (Artiles, 2013). In this scoping review, the authors used the PRISMA-ScR checklist (Tricco et al., 2018) and Arskey and O'Malley's (2005) framework to investigate the degree to which autism-related research (ARR) has included the intersectional experiences of BAWG. Utilizing narrative synthesis, strengths and gaps across the current body of literature are identified in order to set new directions for intersectional ARR. Overall, the authors found that across a 77-year period, three studies foregrounded BAWG and none addressed intersectionality as measured through criteria advanced by García and Ortiz (2013). These results reveal the scholarly neglect BAWG face in ARR, discourse, policy, and practice. A future agenda including research, practice, and policy priorities is identified and discussed.
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Maddox BB, Dickson KS, Stadnick NA, Mandell DS, Brookman-Frazee L. Mental Health Services for Autistic Individuals Across the Lifespan: Recent Advances and Current Gaps. Curr Psychiatry Rep 2021; 23:66. [PMID: 34402984 PMCID: PMC8961310 DOI: 10.1007/s11920-021-01278-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW This synthesis of recent mental health services research with autistic individuals presents significant advances, current gaps, and recommendations for improving mental healthcare for this population. RECENT FINDINGS Recent advances include improved understanding of co-occurring mental health conditions among autistic individuals, a growing evidence base for interventions to address them, the development and implementation of new service models to support mental health for this population, and a substantial increase in mental health services and implementation research focused on autism. Ongoing challenges include a lack of mental health interventions designed for community implementation with autistic individuals, limited workforce capacity, complex and disconnected service systems, and racial, ethnic, and socioeconomic disparities in accessibility and quality of mental health services. Despite the advances in our understanding of mental health needs and mental health services for autistic individuals, several critical gaps remain. We encourage future efforts to develop and test interventions that can be used in community settings, train and incentivize the workforce to provide them, realign policies and funding with best practice, and embrace an equity-focused approach to autism research and care.
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Affiliation(s)
- Brenna B Maddox
- Department of Psychiatry, TEACCH Autism Program, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
| | - Kelsey S Dickson
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Child and Family Development, San Diego State University, San Diego, CA, USA
| | - Nicole A Stadnick
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Dissemination and Implementation Science Center, University of California San Diego Altman Clinical and Translational Research Institute, San Diego, CA, USA
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Dissemination and Implementation Science Center, University of California San Diego Altman Clinical and Translational Research Institute, San Diego, CA, USA
- Rady Children's Hospital, San Diego, CA, USA
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Wagner S, Rubin IL, Singh JS. Underserved and Undermeasured: a Mixed-Method Analysis of Family-Centered Care and Care Coordination for Low-Income Minority Families of Children with Autism Spectrum Disorder. J Racial Ethn Health Disparities 2021; 9:1474-1487. [PMID: 34231160 DOI: 10.1007/s40615-021-01086-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/02/2021] [Accepted: 06/09/2021] [Indexed: 10/20/2022]
Abstract
This study examined how a racially and socioeconomically diverse group of caregivers of children with autism spectrum disorder (ASD) responds to national standard measures of family-centered care (FCC) and care coordination (CC) and what aspects of quality care are missing from these measures. Based on survey and interview data collected from 70 caregivers who have a child with ASD that receive services at a community-based autism clinic located in Atlanta, GA, we compared proportions of answers to FCC and CC questions to national and state representative data using chi-square analyses and contextualized our findings through a thematic analysis of qualitative interviews. Compared to national- and state-level data, the Atlanta autism clinic data had a higher percentage of participants who identified as Black, relied on public health insurance, and lived below 200% of the federal poverty line. The Atlanta autism clinic responses were significantly more positive in four measures of FCC but significantly less effective in two CC measures, including a lower reported percentage who received CC and greater reported percentage who needed extra help. Qualitative data revealed a range of positive meanings and challenges associated with FCC and identified areas of help needed beyond CC, including physical and mental health care and emotional connection, especially for low-income single Black female caregivers. Our mixed-method approach identified strengths in FCC, barriers to CC, and suggestions for developing more pragmatic questions in national surveys that address experiences of quality-of-care among low-income, racial minority families of children with ASD.
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Affiliation(s)
- Stephanie Wagner
- Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA.,Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - I Leslie Rubin
- Department of Pediatrics, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA.,The Rubin Center for Autism and Developmental Pediatrics, 750 Hammond Drive, Bldg. 1, Suite 100, Atlanta, GA, 30328, USA
| | - Jennifer S Singh
- School of History and Sociology, Georgia Institute of Technology, 221 Bobby Dodd Way, Atlanta, GA, 30332-225, USA.
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Inclusion and Rigor in Qualitative Autism Research: A Response to Van Schalkwyk and Dewinter (2020). J Autism Dev Disord 2021; 51:1802-1804. [PMID: 32737669 DOI: 10.1007/s10803-020-04634-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Benevides TW, Carretta HJ, Rust G, Shea L. Racial and ethnic disparities in benefits eligibility and spending among adults on the autism spectrum: A cohort study using the Medicare Medicaid Linked Enrollees Analytic Data Source. PLoS One 2021; 16:e0251353. [PMID: 34032811 PMCID: PMC8148358 DOI: 10.1371/journal.pone.0251353] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/24/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Research on children and youth on the autism spectrum reveal racial and ethnic disparities in access to healthcare and utilization, but there is less research to understand how disparities persist as autistic adults age. We need to understand racial-ethnic inequities in obtaining eligibility for Medicare and/or Medicaid coverage, as well as inequities in spending for autistic enrollees under these public programs. METHODS We conducted a cross-sectional cohort study of U.S. publicly-insured adults on the autism spectrum using 2012 Medicare-Medicaid Linked Enrollee Analytic Data Source (n = 172,071). We evaluated differences in race-ethnicity by eligibility (Medicare-only, Medicaid-only, Dual-Eligible) and spending. FINDINGS The majority of white adults (49.87%) were full-dual eligible for both Medicare and Medicaid. In contrast, only 37.53% of Black, 34.65% Asian/Pacific Islander, and 35.94% of Hispanic beneficiaries were full-dual eligible for Medicare and Medicare, with most only eligible for state-funded Medicaid. Adjusted logistic models controlling for gender, intellectual disability status, costly chronic condition, rural status, county median income, and geographic region of residence revealed that Black beneficiaries were significantly less likely than white beneficiaries to be dual-eligible across all ages. Across these three beneficiary types, total spending exceeded $10 billion. Annual total expenditures median expenditures for full-dual and Medicaid-only eligible beneficiaries were higher among white beneficiaries as compared with Black beneficiaries. CONCLUSIONS Public health insurance in the U.S. including Medicare and Medicaid aim to reduce inequities in access to healthcare that might exist due to disability, income, or old age. In contrast to these ideals, our study reveals that racial-ethnic minority autistic adults who were eligible for public insurance across all U.S. states in 2012 experience disparities in eligibility for specific programs and spending. We call for further evaluation of system supports that promote clear pathways to disability and public health insurance among those with lifelong developmental disabilities.
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Affiliation(s)
- Teal W. Benevides
- Department of Occupational Therapy, College of Allied Health Sciences, Augusta University, Augusta, GA, United States of America
| | - Henry J. Carretta
- College of Medicine, Florida State University, Tallahassee, FL, United States of America
| | - George Rust
- College of Medicine, Florida State University, Tallahassee, FL, United States of America
| | - Lindsay Shea
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA, United States of America
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36
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Dallman AR, Artis J, Watson L, Wright S. Systematic Review of Disparities and Differences in the Access and Use of Allied Health Services Amongst Children with Autism Spectrum Disorders. J Autism Dev Disord 2021; 51:1316-1330. [PMID: 32683545 DOI: 10.1007/s10803-020-04608-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Individuals with autism spectrum disorder (ASD) often benefit from allied health services such as occupational therapy, speech and language pathology, and applied behavioral analysis. While there is consistent evidence of disparities in access and use of medical services (e.g. dentistry), no such systematic review has examined disparities and differences in allied health use amongst children with ASD. In this systematic review, we examine disparities and differences in service access and use for children with ASD. Our findings suggest that children who are older, have less severe ASD symptoms, are from minority groups, and those from particular geographic regions are less likely to receive allied health services. Limitations and future directions are discussed.
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Affiliation(s)
- Aaron R Dallman
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, 200 N. Greensboro St., D-12, Carrboro, NC, 27510, USA.
| | - Jonet Artis
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, 200 N. Greensboro St., D-12, Carrboro, NC, 27510, USA
| | - Linda Watson
- Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarah Wright
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Spain D, Mason D, J Capp S, Stoppelbein L, W White S, Happé F. "This may be a really good opportunity to make the world a more autism friendly place": Professionals' perspectives on the effects of COVID-19 on autistic individuals. RESEARCH IN AUTISM SPECTRUM DISORDERS 2021; 83:101747. [PMID: 36570074 PMCID: PMC9760644 DOI: 10.1016/j.rasd.2021.101747] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/15/2021] [Accepted: 02/21/2021] [Indexed: 05/05/2023]
Abstract
BACKGROUND The COVID-19 (C-19) pandemic affects everyone. Autistic individuals may be at increased risk of experiencing difficulties coping with the impact of C-19 (e.g. due to unexpected changes to usual activities and routines, and the general sense of uncertainty). This preliminary study gathered the perspectives of health and social care professionals, and researchers, about: (1) vulnerability factors for coping with the pandemic; (2) the impact of the pandemic; (3) service provision during the pandemic; and (4) interventions to support reintegration during and post the pandemic. METHOD We conducted an online survey, comprising Likert-scale and free text responses. Quantitative data were analysed descriptively, and qualitative data thematically. RESULTS Thirty-seven participants, working in clinical, education and academic settings with autistic individuals, completed the survey. C-19 had substantially impacted service provision, causing major disruption or loss of services. Thematic analysis indicated six overarching themes: (1) vulnerability factors for coping with C-19 and lockdown; (2) positive and negative impact of lockdown (for autistic individuals, families and professionals); (3) public health response to C-19; (4) service provision during the pandemic; (5) inequalities; and (6) looking to the future. CONCLUSIONS Professionals, across disciplines and settings, must now work together with autistic individuals and their families, to understand the impact of these extraordinary circumstances and develop ways everyone can be supported more effectively.
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Affiliation(s)
- Debbie Spain
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
- South London & Maudsley NHS Foundation Trust, United Kingdom
| | - David Mason
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Simone J Capp
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | | | - Susan W White
- Center for Youth Development and Intervention, University of Alabama, United States
| | - Francesca Happé
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
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Samadi SA, McConkey R, Abdollahi-Boghrabadi G, Pourseid-Mohammad M. Developmental Signs of Autism Spectrum Disorder in Iranian Pre-Schoolers. J Pediatr Nurs 2021; 58:e69-e73. [PMID: 33536153 DOI: 10.1016/j.pedn.2021.01.006] [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: 10/22/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Early identification and intervention is recommended for developmental disabilities such as autism spectrum disorders (ASD). Various screening tools are available, but most were developed in affluent English speaking countries. DESIGN AND METHODS In order to identify possible early signs of ASD within Iranian society, parents of 623 children in an age range from 3 to 7 years of age at risk of ASD, were interviewed about the signs that alerted their concerns. Also two screening instruments were developed and tested with the parents using items derived from the Gilliam Autism Rating Scale (GARS2). One focused on autistic behaviors and the second on developmental indicators. RESULTS Using both tools, 93% of the children who were identified as likely to have ASD based on a full GARS assessment were identified using the two screening tools. PRACTICE IMPLICATIONS These assessments might be used in initial screening for ASD by early year's personnel or public health professionals with Iranian parents of toddlers who have concerns about their child's development.
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Affiliation(s)
| | - Roy McConkey
- Institute of Nursing and Health Research, Ulster University, Iran
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Kulage KM, Goldberg J, Usseglio J, Romero D, Bain JM, Smaldone AM. How has DSM-5 Affected Autism Diagnosis? A 5-Year Follow-Up Systematic Literature Review and Meta-analysis. J Autism Dev Disord 2020; 50:2102-2127. [PMID: 30852784 DOI: 10.1007/s10803-019-03967-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We conducted a 5-year follow-up systematic review and meta-analysis to determine change in frequency of autism spectrum disorder (ASD) diagnosis since diagnostic and statistical manual 5 (DSM-5) publication and explore the impact of Social Communication Disorder (SCD). For 33 included studies, use of DSM-5 criteria suggests decreases in diagnosis for ASD [20.8% (16.0-26.7), p < 0.001], DSM-IV-TR Autistic Disorder [10.1% (6.2-16.0), p < 0.001], and Asperger's [23.3% (12.9-38.5), p = 0.001]; pervasive developmental disorder-not otherwise specified decrease was not significant [46.1% (34.6-58.0), p = 0.52]. Less than one-third [28.8% (13.9-50.5), p = 0.06] of individuals diagnosed with DSM-IV-TR but not DSM-5 ASD would qualify for SCD. Findings suggest smaller decreases in ASD diagnoses compared to earlier reviews. Future research is needed as concerns remain for impaired individuals without a diagnosis.
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Affiliation(s)
- Kristine M Kulage
- Columbia University School of Nursing, 630 West 168th Street, Box 6, New York, NY, 10032, USA.
| | - Johanna Goldberg
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - John Usseglio
- Augustus C. Long Health Sciences Library, Columbia University Irving Medical Center, 701 West 168th Street, New York, NY, 10032, USA
| | - Danielle Romero
- Lucile Packard Children's Hospital at Stanford, 770 Welch Road, Palo Alto, CA, 94304, USA
| | - Jennifer M Bain
- Department of Neurology, Division of Child Neurology, Columbia University Vagelos College of Physicians and Surgeons, 180 Fort Washington Avenue, 5th Floor, New York, NY, 10032, USA
| | - Arlene M Smaldone
- Columbia University School of Nursing, 630 West 168th Street, Box 6, New York, NY, 10032, USA
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Long KA, Gordillo M, Orsmond GI. Improving the Validity and Generalizability of Adult Autism Research Through Incorporating Family and Cultural Contexts. AUTISM IN ADULTHOOD 2020; 2:177-184. [PMID: 32959029 DOI: 10.1089/aut.2019.0061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The relatively nascent empirical knowledge base regarding autism in adulthood provides an opportunity to adopt a contextual approach that conceptualizes autism features, outcomes, and supportive services as interactions between the characteristics of the condition and contextual factors across the life course. Although a contextual approach encompasses many aspects of a person's identity and social ecology, we focus here on the closely interrelated family and cultural contexts, which have been poorly integrated into adult autism research. We argue that designing studies with a priori attention to context (e.g., family and culture) will improve the relevance and comprehensiveness of findings, which in turn will improve construct validity and provide a more accurate understanding of autism-related outcomes in adulthood. Similarly, designing and/or selecting measures that have been validated with culturally and linguistically diverse samples will improve the utility of findings and reduce spurious or null effects. More contextually informed methodologies will lead to improved generalizability and practical applications of findings. We offer concrete guidance regarding how to increase the social ecological perspective within adult autism research as it relates to study conceptualization, methodology, and measurement.
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Affiliation(s)
- Kristin A Long
- Department of Psychological & Brain Sciences and Boston University, Boston, Massachusetts, USA
| | - Monica Gordillo
- Department of Psychological & Brain Sciences and Boston University, Boston, Massachusetts, USA
| | - Gael I Orsmond
- Department of Occupational Therapy, Boston University, Boston, Massachusetts, USA
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Making Autism Research Inclusive by Attending to Intersectionality: a Review of the Research Ethics Literature. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2020. [DOI: 10.1007/s40489-020-00204-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Psychoeducational Interventions for Adults With Level 3 Autism Spectrum Disorder: A 50-Year Systematic Review. Cogn Behav Neurol 2020; 32:139-163. [PMID: 31517698 PMCID: PMC6749978 DOI: 10.1097/wnn.0000000000000201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
There is face validity to the expectation that adults with level 3 autism spectrum disorder (ASD–3) will benefit from a range of psychoeducational interventions. This paper reviews the empirical evidence supporting the effectiveness of these interventions, many of which are currently used in clinical settings. We reviewed 56 peer-reviewed studies of psychoeducational interventions for adults with ASD–3, written in English and since 1968, that met our criteria. The reviewing team included educators, clinicians, researchers, and a biostatistician. The available literature was limited, and most, if not all, of the studies presented some significant methodological limitations. When using Cochrane’s criteria to assess seven key outcome domains—activities of daily living, aggressive/destructive behaviors, emotional functioning, language/communication skills, self-injurious behaviors, stereotypy/mannerisms, and vocational skills—we found only moderately reliable evidence to support the effectiveness of interventions designed to improve emotional functioning in adults with ASD–3. The reliability of evidence relevant to the six other outcome domains was rated as low or very low. Based on this review, we suggest directions for future study of interventions for adults with ASD–3, including topics, subpopulations, and approaches that should be explored. We also propose some crucial changes in how future studies regarding this population should be designed, analyzed, and documented, while balancing clinical considerations with scientific/educational utility.
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Tupou J, Waddington H, van der Meer L, Sigafoos J. Effects of a low-intensity Early Start Denver Model-based intervention delivered in an inclusive preschool setting. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2020; 68:107-121. [PMID: 35309698 PMCID: PMC8928834 DOI: 10.1080/20473869.2019.1707434] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 06/14/2023]
Abstract
The Early Start Denver Model (ESDM) is a promising early intervention for promoting improved social, cognitive, and communication outcomes for young children with autism spectrum disorder (ASD). However, most studies evaluating group-based delivery of this program have used 15-25 h per week of intervention in specialized ESDM preschools with low child-teacher ratios. Thus, the positive results from such studies might not be obtained when this intervention model is evaluated in more typical inclusive preschool settings. In this study, a low-intensity version of the ESDM was delivered to three young children with ASD in their regular inclusive preschool by a certified therapist who did not typically work at any of the preschools. The intervention procedures were implemented for 3 h per week over an 8- to 10-week period. Data were gathered on children's levels of participation, imitation, and communication from weekly 10-min video recordings. The effects of the intervention were evaluated using a multiple probe across participants design with 3 weekly follow-up probes, 3 weeks after the intervention ended. All participants showed improvement in active participation, imitation and either intentional vocalizations or spontaneous functional utterances. These results were generally maintained at follow-up. This low-intensity version of the ESDM would seem effective for use in real-world preschool environments.
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Affiliation(s)
- Jessica Tupou
- School of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Hannah Waddington
- School of Education, Victoria University of Wellington, Wellington, New Zealand
| | | | - Jeff Sigafoos
- School of Education, Victoria University of Wellington, Wellington, New Zealand
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Franz L, Dawson G. Implementing early intervention for autism spectrum disorder: a global perspective. PEDIATRIC MEDICINE (HONG KONG, CHINA) 2019; 2:44. [PMID: 31535090 PMCID: PMC6750262 DOI: 10.21037/pm.2019.07.09] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Lauren Franz
- Centre for Autism Research in Africa, Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Duke Global Health.Institute, Duke University, Durham, NC, USA
| | - Geraldine Dawson
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Duke Institute for Brain Sciences, Duke University, Durham, NC, USA
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Stahmer AC, Dababnah S, Rieth SR. Considerations in implementing evidence-based early autism spectrum disorder interventions in community settings. PEDIATRIC MEDICINE (HONG KONG, CHINA) 2019; 2:18. [PMID: 31565699 PMCID: PMC6764452 DOI: 10.21037/pm.2019.05.01] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Evidence-based practices (EBPs) in early intervention for autism spectrum disorder (ASD) have the potential to improve children's developmental trajectories and address family needs. However, the successful use of EBPs in community early intervention settings requires careful attention to the context in which services are delivered. Implementation science, and specifically the Exploration, Preparation, Implementation, and Sustainment (EPIS) Model, provides a framework to examine context across multiple levels and identify barriers and facilitators to community EBP use. This article identifies several considerations most relevant for early intervention in ASD at the outer and inner context levels, as well as bridging and innovation factors. Outer context considerations include the policies and funding streams surrounding service delivery, the role of advocacy in shaping the service landscape, the availability of appropriate specialists to provide services, and family cultural characteristics. Inner context factors include the individual characteristics of both the children receiving the service as well as the provider delivering the service, in addition to the leadership and organizational climate surrounding the use of a particular EBP. We also discuss considerations of the specific innovation (in this case, EBP early interventions) to be deployed, as well as bridging factors.
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