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Lilley R, Rapaport H, Poulsen R, Yudell M, Pellicano E. Contributing to an autism biobank: Diverse perspectives from autistic participants, family members and researchers. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1719-1731. [PMID: 37882180 PMCID: PMC11191664 DOI: 10.1177/13623613231203938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
LAY ABSTRACT A lot of autism research has focused on finding genes that might cause autism. To conduct these genetic studies, researchers have created 'biobanks' - collections of biological samples (such as blood, saliva, urine, stool and hair) and other health information (such as cognitive assessments and medical histories). Our study focused on the Australian Autism Biobank, which collected biological and health information from almost 1000 Australian autistic children and their families. We wanted to know what people thought about giving their information to the Biobank and why they chose to do so. We spoke to 71 people who gave to the Biobank, including 18 autistic adolescents and young adults, 46 of their parents and seven of their siblings. We also spoke to six researchers who worked on the Biobank project. We found that people were interested in giving their information to the Biobank so they could understand why some people were autistic. Some people felt knowing why could help them make choices about having children in the future. People also wanted to be involved in the Biobank because they believed it could be a resource that could help others in the future. They also trusted that scientists would keep their information safe and were keen to know how that information might be used in the future. Our findings show that people have lots of different views about autism biobanks. We suggest researchers should listen to these different views as they develop their work.
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2
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Ahlvik-Harju C. Finding more constructive ways forward in the debate over vaccines with increased disability cultural competence. MEDICAL HUMANITIES 2023; 49:9-16. [PMID: 35487682 PMCID: PMC9985754 DOI: 10.1136/medhum-2021-012342] [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] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
The aim of this article is to study the discursive construction of disability that takes place in the vaccine-autism controversy from the 1990s to 2000s, and an attempt to develop a more holistic framework to understand vaccine decisions and their motivations. It is argued that the debate over vaccines produces knowledge and meanings about disability, and that the vaccine-autism controversy is kept alive largely because of how it reproduces stigmatising accounts of disability and autism. The suggestion is that if the stigmatising elements of disability were removed in the debate over vaccines, there would be no controversy to keep alive in the broader vaccine debate. Hence, this article is an attempt to increase disability cultural competence in the media and among health authorities and health professionals and therethrough broaden the shared understanding of what it means to be or become disabled. By investigating the driving forces for past vaccine controversies, the goal is to find more constructive ways forward in present day and future debates over vaccines.
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Affiliation(s)
- Carolin Ahlvik-Harju
- Theology, Åbo Akademi University Faculty of Arts Psychology and Theology, Turku, Finland
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3
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Pellicano E, den Houting J. Annual Research Review: Shifting from 'normal science' to neurodiversity in autism science. J Child Psychol Psychiatry 2022; 63:381-396. [PMID: 34730840 PMCID: PMC9298391 DOI: 10.1111/jcpp.13534] [Citation(s) in RCA: 118] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 12/17/2022]
Abstract
Since its initial description, the concept of autism has been firmly rooted within the conventional medical paradigm of child psychiatry. Increasingly, there have been calls from the autistic community and, more recently, nonautistic researchers, to rethink the way in which autism science is framed and conducted. Neurodiversity, where autism is seen as one form of variation within a diversity of minds, has been proposed as a potential alternative paradigm. In this review, we concentrate on three major challenges to the conventional medical paradigm - an overfocus on deficits, an emphasis on the individual as opposed to their broader context and a narrowness of perspective - each of which necessarily constrains what we can know about autism and how we are able to know it. We then outline the ways in which fundamental elements of the neurodiversity paradigm can potentially help researchers respond to the medical model's limitations. We conclude by considering the implications of a shift towards the neurodiversity paradigm for autism science.
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Affiliation(s)
- Elizabeth Pellicano
- Macquarie School of EducationMacquarie UniversitySydneyNSWAustralia,Cooperative Research Centre for Living with Autism (Autism CRC)BrisbaneQldAustralia
| | - Jacquiline den Houting
- Macquarie School of EducationMacquarie UniversitySydneyNSWAustralia,Cooperative Research Centre for Living with Autism (Autism CRC)BrisbaneQldAustralia
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4
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Mezinska S, Gallagher L, Verbrugge M, Bunnik EM. Ethical issues in genomics research on neurodevelopmental disorders: a critical interpretive review. Hum Genomics 2021; 15:16. [PMID: 33712057 PMCID: PMC7953558 DOI: 10.1186/s40246-021-00317-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background Genomic research on neurodevelopmental disorders (NDDs), particularly involving minors, combines and amplifies existing research ethics issues for biomedical research. We performed a review of the literature on the ethical issues associated with genomic research involving children affected by NDDs as an aid to researchers to better anticipate and address ethical concerns. Results Qualitative thematic analysis of the included articles revealed themes in three main areas: research design and ethics review, inclusion of research participants, and communication of research results. Ethical issues known to be associated with genomic research in general, such as privacy risks and informed consent/assent, seem especially pressing for NDD participants because of their potentially decreased cognitive abilities, increased vulnerability, and stigma associated with mental health problems. Additionally, there are informational risks: learning genetic information about NDD may have psychological and social impact, not only for the research participant but also for family members. However, there are potential benefits associated with research participation, too: by enrolling in research, the participants may access genetic testing and thus increase their chances of receiving a (genetic) diagnosis for their neurodevelopmental symptoms, prognostic or predictive information about disease progression or the risk of concurrent future disorders. Based on the results of our review, we developed an ethics checklist for genomic research involving children affected by NDDs. Conclusions In setting up and designing genomic research efforts in NDD, researchers should partner with communities of persons with NDDs. Particular attention should be paid to preventing disproportional burdens of research participation of children with NDDs and their siblings, parents and other family members. Researchers should carefully tailor the information and informed consent procedures to avoid therapeutic and diagnostic misconception in NDD research. To better anticipate and address ethical issues in specific NDD studies, we suggest researchers to use the ethics checklist for genomic research involving children affected by NDDs presented in this paper. Supplementary Information The online version contains supplementary material available at 10.1186/s40246-021-00317-4.
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Affiliation(s)
- S Mezinska
- Faculty of Medicine and Institute of Clinical and Preventive Medicine, University of Latvia, Jelgavas Str.3, Riga, LV-1004, Latvia.
| | - L Gallagher
- Discipline of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute, St. James Hospital, Dublin 8, Ireland
| | - M Verbrugge
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre Rotterdam, PO Box 2400, Rotterdam, 3000, CA, The Netherlands
| | - E M Bunnik
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre Rotterdam, PO Box 2400, Rotterdam, 3000, CA, The Netherlands
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5
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Klin A, Micheletti M, Klaiman C, Shultz S, Constantino JN, Jones W. Affording autism an early brain development re-definition. Dev Psychopathol 2020; 32:1175-1189. [PMID: 32938507 PMCID: PMC7880583 DOI: 10.1017/s0954579420000802] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The national priority to advance early detection and intervention for children with autism spectrum disorder (ASD) has not reduced the late age of ASD diagnosis in the US over several consecutive Centers for Disease Control and Prevention (CDC) surveillance cohorts, with traditionally under-served populations accessing diagnosis later still. In this review, we explore a potential perceptual barrier to this enterprise which views ASD in terms that are contradicted by current science, and which may have its origins in the current definition of the condition and in its historical associations. To address this perceptual barrier, we propose a re-definition of ASD in early brain development terms, with a view to revisit the world of opportunities afforded by current science to optimize children's outcomes despite the risks that they are born with. This view is presented here to counter outdated notions that potentially devastating disability is determined the moment a child is born, and that these burdens are inevitable, with opportunities for improvement being constrained to only alleviation of symptoms or limited improvements in adaptive skills. The impetus for this piece is the concern that such views of complex neurodevelopmental conditions, such as ASD, can become self-fulfilling science and policy, in ways that are diametrically opposed to what we currently know, and are learning every day, of how genetic risk becomes, or not, instantiated as lifetime disabilities.
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Affiliation(s)
- Ami Klin
- Marcus Autism Center, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
- Emory Center for Translational Social Neuroscience, Atlanta, Georgia
| | - Megan Micheletti
- Department of Psychology, University of Texas at Austin, Austin, Texas
| | - Cheryl Klaiman
- Marcus Autism Center, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Sarah Shultz
- Marcus Autism Center, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - John N. Constantino
- Departments of Psychiatry and Pediatrics, Intellectual and Developmental Disabilities Research Center, Washington University School of Medicine, St Louis,MO
| | - Warren Jones
- Marcus Autism Center, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
- Emory Center for Translational Social Neuroscience, Atlanta, Georgia
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6
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Sahni LC, Boom JA, Mire SS, Berry LN, Dowell LR, Minard CG, Cunningham RM, Goin-Kochel RP. Vaccine Hesitancy and Illness Perceptions: Comparing Parents of Children with Autism Spectrum Disorder to other Parent Groups. CHILDRENS HEALTH CARE 2020; 49:385-402. [PMID: 33716379 DOI: 10.1080/02739615.2020.1740883] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Fears persist despite compelling evidence refuting associations between vaccines and autism spectrum disorder (ASD). We compared vaccine hesitancy (VH) and beliefs about illness causes among parents of children in four groups: ASD, non-ASD developmental disorders, rheumatologic conditions, and the general pediatric population. VH was 19.9% overall; parents of children with ASD reported highest VH rates (29.5%) and more frequently attributed ASD to toxins in vaccines (28.9% vs. 15.7%, p=0.004). The odds of VH were increased among parents who attributed their child's condition to diet or eating habits (aOR 4.2; 95% CI: 1.6, 11.2) and toxins found in vaccines (aOR 20, 95% CI: 7.1, 55.9). Parents who attributed the condition to chance or bad luck were less likely to be vaccine hesitant (aOR 0.1; 95% CI: 0.03, 0.5).
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Affiliation(s)
- Leila C Sahni
- Immunization Project, Texas Children's Hospital, Houston, TX
| | - Julie A Boom
- Immunization Project, Texas Children's Hospital, Houston, TX.,Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Sarah S Mire
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX
| | - Leandra N Berry
- Department of Pediatrics, Baylor College of Medicine, Houston, TX.,Autism Center, Texas Children's Hospital, Houston, TX
| | - Lauren R Dowell
- Department of Pediatrics, Baylor College of Medicine, Houston, TX.,Autism Center, Texas Children's Hospital, Houston, TX
| | - Charles G Minard
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX
| | | | - Robin P Goin-Kochel
- Department of Pediatrics, Baylor College of Medicine, Houston, TX.,Autism Center, Texas Children's Hospital, Houston, TX
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7
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Fletcher-Watson S, Larsen K, Salomone E. What do parents of children with autism expect from participation in research? A community survey about early autism studies. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2017; 23:175-186. [DOI: 10.1177/1362361317728436] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Engagement with stakeholders is an essential part of the research process. This is particularly the case for early autism research with infant cohorts and their families, where a range of ethical issues are pertinent. Here, we report on a large survey of parents who have a child on the autism spectrum (n = 1040) which specifically probed attitudes to early autism research. The large majority of parents showed positive attitudes overall, and these were associated with greater access to services, higher service quality ratings and higher rates of intellectual disability among their children. Parents valued the scientific goals of research, but half of parents also reported that an intervention component would be an essential prerequisite for them to participate in research. If enrolled in a study, parents were positive about most commonly used measures though less favourably disposed towards brain scans for children. They valued direct contact with the research team and openness in data sharing. We interpret our findings in terms of lessons for the early autism research community and for stakeholder engagement projects.
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8
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Aman MG, Findling RL, Hardan AY, Hendren RL, Melmed RD, Kehinde-Nelson O, Hsu HA, Trugman JM, Palmer RH, Graham SM, Gage AT, Perhach JL, Katz E. Safety and Efficacy of Memantine in Children with Autism: Randomized, Placebo-Controlled Study and Open-Label Extension. J Child Adolesc Psychopharmacol 2017; 27:403-412. [PMID: 26978327 PMCID: PMC5510039 DOI: 10.1089/cap.2015.0146] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Abnormal glutamatergic neurotransmission is implicated in the pathophysiology of autism spectrum disorder (ASD). In this study, the safety, tolerability, and efficacy of the glutamatergic N-methyl-d-aspartate (NMDA) receptor antagonist memantine (once-daily extended-release [ER]) were investigated in children with autism in a randomized, placebo-controlled, 12 week trial and a 48 week open-label extension. METHODS A total of 121 children 6-12 years of age with Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision (DSM-IV-TR)-defined autistic disorder were randomized (1:1) to placebo or memantine ER for 12 weeks; 104 children entered the subsequent extension trial. Maximum memantine doses were determined by body weight and ranged from 3 to 15 mg/day. RESULTS There was one serious adverse event (SAE) (affective disorder, with memantine) in the 12 week study and one SAE (lobar pneumonia) in the 48 week extension; both were deemed unrelated to treatment. Other AEs were considered mild or moderate and most were deemed not related to treatment. No clinically significant changes occurred in clinical laboratory values, vital signs, or electrocardiogram (ECG). There was no significant between-group difference on the primary efficacy outcome of caregiver/parent ratings on the Social Responsiveness Scale (SRS), although an improvement over baseline at Week 12 was observed in both groups. A trend for improvement at the end of the 48 week extension was observed. No improvements in the active group were observed on any of the secondary end-points, with one communication measure showing significant worsening with memantine compared with placebo (p = 0.02) after 12 weeks. CONCLUSIONS This trial did not demonstrate clinical efficacy of memantine ER in autism; however, the tolerability and safety data were reassuring. Our results could inform future trial design in this population and may facilitate the investigation of memantine ER for other clinical applications.
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Affiliation(s)
| | - Robert L. Findling
- Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Maryland
| | - Antonio Y. Hardan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Robert L. Hendren
- Department of Psychiatry, University of California, San Francisco, California
| | - Raun D. Melmed
- Southwest Autism Research & Resource Center, Phoenix, Arizona
| | | | - Hai-An Hsu
- Forest Research Institute, (now Allergan) Jersey City, New Jersey
| | - Joel M. Trugman
- Forest Research Institute, (now Allergan) Jersey City, New Jersey
| | - Robert H. Palmer
- Forest Research Institute, (now Allergan) Jersey City, New Jersey
| | | | - Allyson T. Gage
- Forest Research Institute, (now Allergan) Jersey City, New Jersey
| | - James L. Perhach
- Forest Research Institute, (now Allergan) Jersey City, New Jersey
| | - Ephraim Katz
- Forest Research Institute, (now Allergan) Jersey City, New Jersey
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9
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Reiff M, Bugos E, Giarelli E, Bernhardt BA, Spinner NB, Sankar PL, Mulchandani S. "Set in Stone" or "Ray of Hope": Parents' Beliefs About Cause and Prognosis After Genomic Testing of Children Diagnosed with ASD. J Autism Dev Disord 2017; 47:1453-1463. [PMID: 28229350 DOI: 10.1007/s10803-017-3067-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Despite increasing utilization of chromosomal microarray analysis (CMA) for autism spectrum disorders (ASD), limited information exists about how results influence parents' beliefs about etiology and prognosis. We conducted in-depth interviews and surveys with 57 parents of children with ASD who received CMA results categorized as pathogenic, negative or variant of uncertain significance. Parents tended to incorporate their child's CMA results within their existing beliefs about the etiology of ASD, regardless of CMA result. However, parents' expectations for the future tended to differ depending on results; those who received genetic confirmation for their children's ASD expressed a sense of concreteness, acceptance and permanence of the condition. Some parents expressed hope for future biomedical treatments as a result of genetic research.
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Affiliation(s)
- Marian Reiff
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, 3624 Market Street, Philadelphia, PA, 19104, USA. .,Counseling and Psychological Services, University of Pennsylvania, Philadelphia, PA, USA.
| | - Eva Bugos
- Mixed Methods Research Lab, University of Pennsylvania, Philadelphia, PA, USA.,Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Ellen Giarelli
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Barbara A Bernhardt
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy B Spinner
- Division of Genomic Diagnostics and the Division of Human Genetics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Pamela L Sankar
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Surabhi Mulchandani
- Division of Genomic Diagnostics and the Division of Human Genetics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
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10
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Fletcher-Watson S, Apicella F, Auyeung B, Beranova S, Bonnet-Brilhault F, Canal-Bedia R, Charman T, Chericoni N, Conceição IC, Davies K, Farroni T, Gomot M, Jones E, Kaale A, Kapica K, Kawa R, Kylliäinen A, Larsen K, Lefort-Besnard J, Malvy J, Manso de Dios S, Markovska-Simoska S, Millo I, Miranda N, Pasco G, Pisula E, Raleva M, Rogé B, Salomone E, Schjolberg S, Tomalski P, Vicente AM, Yirmiya N. Attitudes of the autism community to early autism research. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 21:61-74. [DOI: 10.1177/1362361315626577] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Investigation into the earliest signs of autism in infants has become a significant sub-field of autism research. This work invokes specific ethical concerns such as use of ‘at-risk’ language, communicating study findings to parents and the future perspective of enrolled infants when they reach adulthood. This study aimed to ground this research field in an understanding of the perspectives of members of the autism community. Following focus groups to identify topics, an online survey was distributed to autistic adults, parents of children with autism and practitioners in health and education settings across 11 European countries. Survey respondents (n = 2317) were positively disposed towards early autism research, and there was significant overlap in their priorities for the field and preferred language to describe infant research participants. However, there were also differences including overall less favourable endorsement of early autism research by autistic adults relative to other groups and a dislike of the phrase ‘at-risk’ to describe infant participants, in all groups except healthcare practitioners. The findings overall indicate that the autism community in Europe is supportive of early autism research. Researchers should endeavour to maintain this by continuing to take community perspectives into account.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Inês C Conceição
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Biosystems and Integrative Sciences Institute, Portugal
| | | | | | - Marie Gomot
- Université François-Rabelais de Tours, France
| | | | | | | | | | | | | | | | | | | | | | | | - Natercia Miranda
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Biosystems and Integrative Sciences Institute, Portugal
| | | | | | | | - Bernadette Rogé
- Université Jean Jaurès Toulouse, Institut Universitaire de France (IUF), France
| | | | | | | | - Astrid M Vicente
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Biosystems and Integrative Sciences Institute, Portugal
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11
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Reiff M, Giarelli E, Bernhardt BA, Easley E, Spinner NB, Sankar PL, Mulchandani S. Parents' perceptions of the usefulness of chromosomal microarray analysis for children with autism spectrum disorders. J Autism Dev Disord 2016; 45:3262-75. [PMID: 26066358 DOI: 10.1007/s10803-015-2489-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Clinical guidelines recommend chromosomal microarray analysis (CMA) for all children with autism spectrum disorders (ASDs). We explored the test's perceived usefulness among parents of children with ASD who had undergone CMA, and received a result categorized as pathogenic, variant of uncertain significance, or negative. Fifty-seven parents participated in a semi-structured telephone interview, and 50 also completed a survey. Most parents reported that CMA was helpful for their child and family. Major themes regarding perceived usefulness were: medical care, educational and behavioral interventions, causal explanation, information for family members, and advancing knowledge. Limits to utility, uncertainties and negative outcomes were also identified. Our findings highlight the importance of considering both health and non-health related utility in genomic testing.
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Affiliation(s)
- Marian Reiff
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Penn Tower Room 1112, Philadelphia, PA, 19104, USA.
| | - Ellen Giarelli
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Barbara A Bernhardt
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Penn Tower Room 1112, Philadelphia, PA, 19104, USA
| | - Ebony Easley
- Mixed Methods Research Lab, University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy B Spinner
- Division of Genomic Diagnostics and Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Pamela L Sankar
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Surabhi Mulchandani
- Division of Genomic Diagnostics and Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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12
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Hens K, Peeters H, Dierickx K. The ethics of complexity. Genetics and autism, a literature review. Am J Med Genet B Neuropsychiatr Genet 2016; 171B:305-16. [PMID: 26870917 DOI: 10.1002/ajmg.b.32432] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 02/04/2016] [Indexed: 11/10/2022]
Abstract
It is commonly believed that the etiology of autism is at least partly explained through genetics. Given the complexity of autism and the variability of the autistic phenotype, genetic research and counseling in this field are also complex and associated with specific ethical questions. Although the ethics of autism genetics, especially with regard to reproductive choices, has been widely discussed on the public fora, an in depth philosophical or bioethical reflection on all aspects of the theme seems to be missing. With this literature review we wanted to map the basic questions and answers that exist in the bioethical literature on autism genetics, research, counseling and reproduction, and provide suggestions as to how the discussion can proceed. We found 19 papers that fitted the description of "bioethics literature focusing on autism genetics," and analyzed their content to distill arguments and themes. We concluded that because of the complexity of autism, and the uncertainty with regard to its status, more ethical reflection is needed before definite conclusions and recommendations can be drawn. Moreover, there is a dearth of bioethical empirical studies querying the opinions of all parties, including people with autism themselves. Such empirical bioethical studies should be urgently done before bioethical conclusions regarding the aims and desirability of research into autism genes can be done. Also, fundamental philosophical reflection on concepts of disease should accompany research into the etiology of autism.
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Affiliation(s)
- Kristien Hens
- Department of Philosophy, University of Antwerp, Antwerpen, Belgium
| | - Hilde Peeters
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Kris Dierickx
- Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
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13
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Dawson G, Rice CE. The Complex Etiology of Autism Presents Challenges in Risk Communication. Pediatrics 2016; 137:e20152703. [PMID: 26738887 DOI: 10.1542/peds.2015-2703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2015] [Indexed: 11/24/2022] Open
Affiliation(s)
- Geraldine Dawson
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina; and
| | - Catherine E Rice
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia
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14
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Sarrett JC, Rommelfanger KS. Commentary: Attention to Eyes Is Present but in Decline in 2-6-Month-Old Infants Later Diagnosed with Autism. Front Public Health 2015; 3:272. [PMID: 26697420 PMCID: PMC4672052 DOI: 10.3389/fpubh.2015.00272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/23/2015] [Indexed: 12/15/2022] Open
Affiliation(s)
- Jennifer C Sarrett
- Center for the Study of Human Health, Emory University Atlanta , Atlanta, GA , USA
| | - Karen S Rommelfanger
- Center for Ethics Neuroethics Program, Emory University Atlanta , Atlanta, GA , USA ; Department of Neurology, Emory University Atlanta , Atlanta, GA , USA ; Department of Psychiatry and Behavioral Sciences, Emory University Atlanta , Atlanta, GA , USA
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15
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Ozonoff S. Editorial: Early detection of mental health and neurodevelopmental disorders: the ethical challenges of a field in its infancy. J Child Psychol Psychiatry 2015; 56:933-5. [PMID: 26257104 DOI: 10.1111/jcpp.12452] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The signs of many mental health and neurodevelopmental conditions first appear in childhood and diagnosis can reliably be made by school age for most. Such conditions can be chronically disabling and confer significant long-term impairment. Determining early risk signs and first emerging symptoms of disorder is imperative to enhance early detection and to identify targets and ideal time points for prevention and intervention efforts. This Special Issue of JCPP focuses on the prospect of earlier identification of conditions that are traditionally diagnosed later in childhood. Ten invited empirical articles cover topics related to the science of early detection. Several are focused on prediction of later diagnosis, of functional impairment, and of future service utilization, while others cover instrument development and topics related to screening. The papers span the conditions of ADHD, ASD, dyslexia, mood dysregulation, disruptive behavior disorders, and anxiety disorders. This Editorial provides an overview of the invited contributions and the perspectives they provide on the ethical challenges and choices of a field still in its infancy.
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Gidaya NB, Lee BK, Burstyn I, Yudell M, Mortensen EL, Newschaffer CJ. In utero exposure to selective serotonin reuptake inhibitors and risk for autism spectrum disorder. J Autism Dev Disord 2015; 44:2558-67. [PMID: 24803368 DOI: 10.1007/s10803-014-2128-4] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We investigated whether there is an association between increased risk for autism spectrum disorders (ASD) and selective serotonin reuptake inhibitors (SSRIs) used during pregnancy. This study used Denmark's health and population registers to obtain information regarding prescription drugs, ASD diagnosis, and health and socioeconomic status. There were 1.5 % of cases and 0.7 % of controls exposed to SSRIs during the pregnancy period, and higher effect estimates observed with longer use. We found evidence that in utero exposure to SSRIs increases a child's risk associated with ASD. These results, while adding to the limited knowledge on prenatal pharmacological exposures as potential ASD risk factors, need to be balanced against the benefits of indicated medication use by pregnant mothers.
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Affiliation(s)
- Nicole B Gidaya
- Drexel University, School of Public Health, Nesbitt Hall, 3215 Market Street, Philadelphia, PA, 19104, USA,
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Pellicano E, Dinsmore A, Charman T. Views on researcher-community engagement in autism research in the United Kingdom: a mixed-methods study. PLoS One 2014; 9:e109946. [PMID: 25303222 PMCID: PMC4193852 DOI: 10.1371/journal.pone.0109946] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 09/13/2014] [Indexed: 01/28/2023] Open
Abstract
There has been a substantial increase in research activity on autism during the past decade. Research into effective ways of responding to the immediate needs of autistic people is, however, less advanced, as are efforts at translating basic science research into service provision. Involving community members in research is one potential way of reducing this gap. This study therefore investigated the views of community involvement in autism research both from the perspectives of autism researchers and of community members, including autistic adults, family members and practitioners. Results from a large-scale questionnaire study (n = 1,516) showed that researchers perceive themselves to be engaged with the autism community but that community members, most notably autistic people and their families, did not share this view. Focus groups/interviews with 72 participants further identified the potential benefits and remaining challenges to involvement in research, especially regarding the distinct perspectives of different stakeholders. Researchers were skeptical about the possibilities of dramatically increasing community engagement, while community members themselves spoke about the challenges to fully understanding and influencing the research process. We suggest that the lack of a shared approach to community engagement in UK autism research represents a key roadblock to translational endeavors.
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Affiliation(s)
- Elizabeth Pellicano
- Centre for Research in Autism and Education (CRAE), Department of Psychology and Human Development, Institute of Education, University of London, London, United Kingdom
| | - Adam Dinsmore
- Centre for Research in Autism and Education (CRAE), Department of Psychology and Human Development, Institute of Education, University of London, London, United Kingdom
- Wellcome Trust, Strategic Planning & Policy Unit, London, United Kingdom
| | - Tony Charman
- Department of Psychology, King's College London, Institute of Psychiatry, London, United Kingdom
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Elsabbagh M, Yusuf A, Prasanna S, Shikako-Thomas K, Ruff CA, Fehlings MG. Community engagement and knowledge translation: progress and challenge in autism research. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2014; 18:771-81. [PMID: 25128332 DOI: 10.1177/1362361314546561] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The last decade has seen significant growth in scientific understanding and public awareness of autism. There is still a long road ahead before this awareness can be matched with parallel improvements in evidence-based practice. The process of translating evidence into community care has been hampered by the seeming disconnect between the mainstream scientific research agenda and the immediate priorities of many communities. The need for community engagement in the process of translating knowledge into impact has been recognized. However, there remains little consensus or empirical data regarding the process of such engagement and how to measure its impact. We shed light on a number of engagement models and tools, previously advocated in health research, as they apply to autism research. Furthermore, we illustrate the utility of such tools in supporting identification of knowledge gaps and priorities, using two community-based case studies. The case studies illustrate that information generated from research is indeed relevant and critical for knowledge users in the community. Simple and systematic methods can support the translation and uptake of knowledge in diverse communities, therefore enhancing engagement with research and bridging research findings with immediate community needs.
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Affiliation(s)
| | | | | | | | - Crystal A Ruff
- Toronto Western Hospital, Canada University of Toronto, Canada
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Cuccaro ML, Czape K, Alessandri M, Lee J, Deppen AR, Bendik E, Dueker N, Nations L, Pericak-Vance M, Hahn S. Genetic testing and corresponding services among individuals with autism spectrum disorder (ASD). Am J Med Genet A 2014; 164A:2592-600. [DOI: 10.1002/ajmg.a.36698] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 06/27/2014] [Indexed: 01/04/2023]
Affiliation(s)
- Michael L. Cuccaro
- Dr. John T. McDonald Department of Human Genetics; Hussman Institute for Human Genomics; University of Miami Miller School of Medicine; Miami Florida
| | - Kayla Czape
- Dr. John T. McDonald Department of Human Genetics; Hussman Institute for Human Genomics; University of Miami Miller School of Medicine; Miami Florida
| | | | - Joycelyn Lee
- Dr. John T. McDonald Department of Human Genetics; Hussman Institute for Human Genomics; University of Miami Miller School of Medicine; Miami Florida
| | - Abigail Rupchock Deppen
- Dr. John T. McDonald Department of Human Genetics; Hussman Institute for Human Genomics; University of Miami Miller School of Medicine; Miami Florida
| | - Elise Bendik
- Dr. John T. McDonald Department of Human Genetics; Hussman Institute for Human Genomics; University of Miami Miller School of Medicine; Miami Florida
| | - Nicole Dueker
- Dr. John T. McDonald Department of Human Genetics; Hussman Institute for Human Genomics; University of Miami Miller School of Medicine; Miami Florida
| | - Laura Nations
- Carolina Institute for Intellectual Disabilities; University of North Carolina School of Medicine; Chapel Hill North Carolina
| | - Margaret Pericak-Vance
- Dr. John T. McDonald Department of Human Genetics; Hussman Institute for Human Genomics; University of Miami Miller School of Medicine; Miami Florida
| | - Susan Hahn
- Dr. John T. McDonald Department of Human Genetics; Hussman Institute for Human Genomics; University of Miami Miller School of Medicine; Miami Florida
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