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Gilmore D, Hand BN. Diabetes mellitus in privately insured autistic adults in the United States. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1785-1794. [PMID: 37886796 DOI: 10.1177/13623613231206421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
LAY ABSTRACT Diabetes is a chronic health condition that is challenging to manage. Estimates of how common diabetes is among non-autistic adults are available, but improved estimates for autistic adults are needed. The purpose of this study was to obtain improved diabetes estimates for autistic adults. We analyzed a large private health insurance claims database to estimate how common diabetes was among autistic adults, and how likely autistic adults were to have diabetes compared to non-autistic adults at 5-year age intervals throughout adulthood (e.g. 18-22, 23-27). We found that diabetes was more common among autistic adults than non-autistic adults and that autistic adults were significantly more likely than non-autistic adults to have diabetes throughout most of adulthood. Our findings suggest that autistic adults may be more likely than non-autistic adults to experience diabetes in adulthood. The development of diabetes support services and programs that accommodate autistic adults' individual needs are important for future study to promote positive diabetes outcomes for autistic adults.
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Wang J, Christensen D, Coombes SA, Wang Z. Cognitive and brain morphological deviations in middle-to-old aged autistic adults: A systematic review and meta-analysis. Neurosci Biobehav Rev 2024; 163:105782. [PMID: 38944227 DOI: 10.1016/j.neubiorev.2024.105782] [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: 01/21/2024] [Revised: 06/07/2024] [Accepted: 06/21/2024] [Indexed: 07/01/2024]
Abstract
Cognitive challenges and brain structure variations are common in autism spectrum disorder (ASD) but are rarely explored in middle-to-old aged autistic adults. Cognitive deficits that overlap between young autistic individuals and elderlies with dementia raise an important question: does compromised cognitive ability and brain structure during early development drive autistic adults to be more vulnerable to pathological aging conditions, or does it protect them from further decline? To answer this question, we have synthesized current theoretical models of aging in ASD and conducted a systematic literature review (Jan 1, 1980 - Feb 29, 2024) and meta-analysis to summarize empirical studies on cognitive and brain deviations in middle-to-old aged autistic adults. We explored findings that support different aging theories in ASD and addressed study limitations and future directions. This review sheds light on the poorly understood consequences of aging question raised by the autism community to pave the way for future studies to identify sensitive and reliable measures that best predict the onset, progression, and prognosis of pathological aging in ASD.
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Affiliation(s)
- Jingying Wang
- Neurocognitive and Behavioral Development Laboratory, Department of Applied Physiology and Kinesiology, University of Florida, PO Box 118206, Gainesville, FL 32611-8205, USA
| | - Danielle Christensen
- Neurocognitive and Behavioral Development Laboratory, Department of Applied Physiology and Kinesiology, University of Florida, PO Box 118206, Gainesville, FL 32611-8205, USA; Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, PO Box 118206, Gainesville, FL 32611-8205, USA
| | - Stephen A Coombes
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, PO Box 118206, Gainesville, FL 32611-8205, USA; Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA
| | - Zheng Wang
- Neurocognitive and Behavioral Development Laboratory, Department of Applied Physiology and Kinesiology, University of Florida, PO Box 118206, Gainesville, FL 32611-8205, USA.
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Shameem S, Luft M, Harrington M, Nahhas RW, Hatesohl M, Gentile J, Gainer D. Relationship Between Obesity and Intellectual/Developmental Disability in an Ohio Telepsychiatry Clinic: A Retrospective Review. J Autism Dev Disord 2024:10.1007/s10803-024-06432-0. [PMID: 38907779 DOI: 10.1007/s10803-024-06432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 06/24/2024]
Abstract
Co-occurring intellectual/developmental disability (IDD) and overweight/obesity (OW/OB) is an important consideration of IDD psychiatric care. The relationship between OW/OB and comorbid diagnoses of Autism Spectrum Disorder (ASD) and/or IDD remains inadequately described in existing literature. The purpose of this study is to explore these co-occurring diagnoses. Improved understanding of associated comorbidities can guide clinicians toward interventions to minimize complications associated with OW/OB. We conducted a retrospective review of adult patients of a telepsychiatry clinic with IDD or ASD defined by DSM-5. ICD-10 diagnosis of IDD or ASD, demographics, BMI, comorbidities, and current medications were recorded. Binary logistic regression was used to estimate associations between each predictor and the outcomes overweight (body mass index (BMI) ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2). Prevalence of obesity in these 412 adults was 52.4% (95% CI 47.5, 57.3). There was a significant inverse relationship between IDD severity and the odds of each outcome (p < .001). 80.3% of patients were being actively treated with an antidepressant. Patients taking an antidepressant had twice the odds of obesity (adjusted OR 2.03, 95% CI 1.23, 3.41, p = .006). These findings provide a sense of urgency for prevention of OW/OB and its associated medical sequelae. Prevalence of obesity was higher in this sample compared to the general population. The inverse relationship between IDD severity and OW/OB warrants further research examining age, caregiver involvement, and access to care as potential modifiers.
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Affiliation(s)
- Sana Shameem
- Boonshoft School of Medicine, Wright State University, Dayton, OH, USA.
- Department of Psychiatry, Wright State University, Dayton, OH, USA.
| | - Megan Luft
- Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | | | - Ramzi W Nahhas
- Department of Psychiatry, Wright State University, Dayton, OH, USA
- Department of Population and Public Health Sciences, Wright State University, Dayton, OH, USA
| | - Michael Hatesohl
- Department of Psychiatry, Wright State University, Dayton, OH, USA
| | - Julie Gentile
- Department of Psychiatry, Wright State University, Dayton, OH, USA
| | - Danielle Gainer
- Department of Psychiatry, Wright State University, Dayton, OH, USA
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Klein CB, Klinger LG. Aging Well and Autism: A Narrative Review and Recommendations for Future Research. Healthcare (Basel) 2024; 12:1207. [PMID: 38921321 PMCID: PMC11203987 DOI: 10.3390/healthcare12121207] [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: 05/04/2024] [Revised: 06/05/2024] [Accepted: 06/08/2024] [Indexed: 06/27/2024] Open
Abstract
With autism first recognized in the 1940s, the early cohorts of autistic children are beginning to enter older adulthood. Little is known about the experiences and outcomes of autistic older adults. In the general population, "successful aging" is a dominant model among gerontologists and is used to evaluate outcomes in older adulthood. This narrative review aims to provide a framework for understanding and supporting successful aging in older autistic adults. Using Fernández-Ballesteros' four-domain model of "aging well" we review knowledge on aging and autism by examining outcomes in health and functioning, cognitive and physical functioning, positive affect and control, and social participation and engagement. Findings indicate that outcomes in autistic older adults are generally poor, marked by increased medical conditions, low adaptive skills, elevated risk of cognitive decline, limited physical activity, high rates of mental health conditions, low quality of life, and reduced social or community participation. Patterns of challenges are similar across cognitive abilities and profiles of autistic traits. Challenges and next steps in aging and autism research are identified, and future directions for the field are discussed.
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Affiliation(s)
- Claire B. Klein
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
- UNC TEACCH Autism Program, Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Laura G. Klinger
- UNC TEACCH Autism Program, Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Chen F, Dong X, Yu Z, Zhang Y, Shi Y. The brain-heart axis: Integrative analysis of the shared genetic etiology between neuropsychiatric disorders and cardiovascular disease. J Affect Disord 2024; 355:147-156. [PMID: 38518856 DOI: 10.1016/j.jad.2024.03.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Multiple observational studies have reported substantial comorbidity between neuropsychiatric disorders and cardiovascular disease (CVD), but the underlying mechanisms remain largely unknown. METHODS Using GWAS summary datasets of 8 neuropsychiatric disorders and 6 cardiovascular diseases, an integrative analysis incorporating linkage-disequilibrium-score-regression (LDSC), Mendelian randomization (MR), functional mapping and annotation (FUMA), and functional enrichment analysis, was conducted to investigate shared genetic etiology of the brain-heart axis from the whole genome level, single-nucleotide polymorphism (SNP) level, gene level, and biological pathway level. RESULTS In LDSC analysis, 18 pairwise traits between neuropsychiatric disorders and CVD were identified with significant genetic overlaps, revealing extensive genome-wide genetic correlations. In bidirectional MR analysis, 19 pairwise traits were identified with significant causal relationships. Genetic liabilities to neuropsychiatric disorders, particularly attention-deficit hyperactivity disorder and major depressive disorder, conferred extensive significant causal effects on the risk of CVD, while hypertension seemed to be a risk factor for multiple neuropsychiatric disorders, with no significant heterogeneity or pleiotropy. In FUMA analysis, 13 shared independent significant SNPs and 887 overlapping protein-coding genes were detected between neuropsychiatric disorders and CVD. With GO and KEEG functional enrichment analysis, biological pathways of the brain-heart axis were highly concentrated in neurotransmitter synaptic transmission, lipid metabolism, aldosterone synthesis and secretion, glutathione metabolism, and MAPK signaling pathway. CONCLUSION Extensive genetic correlations and genetic overlaps between neuropsychiatric disorders and CVD were identified in this study, which might provide some new insights into the brain-heart axis and the therapeutic targets in clinical practice.
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Affiliation(s)
- Feifan Chen
- Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing 400014, China.
| | - Xinyu Dong
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
| | - Zhiwei Yu
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing 400014, China.
| | - Yihan Zhang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing 400014, China.
| | - Yuan Shi
- Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing 400014, China.
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Schendel D, Ejlskov L, Overgaard M, Jinwala Z, Kim V, Parner E, Kalkbrenner AE, Acosta CL, Fallin MD, Xie S, Mortensen PB, Lee BK. 3-generation family histories of mental, neurologic, cardiometabolic, birth defect, asthma, allergy, and autoimmune conditions associated with autism: an open-source catalogue of findings. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.11.03.23298042. [PMID: 37961212 PMCID: PMC10635276 DOI: 10.1101/2023.11.03.23298042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
The relatively few conditions and family members investigated in autism family health history limits etiologic understanding. For more comprehensive understanding and hypothesis-generation we produced an open-source catalogue of autism associations with family histories of mental, neurologic, cardiometabolic, birth defect, asthma, allergy, and autoimmune conditions. All live births in Denmark, 1980-2012, of Denmark-born parents (1,697,231 births), and their 3-generation family members were followed through April 10, 2017 for each of 90 diagnoses (including autism), emigration or death. Adjusted hazard ratios (aHR) were estimated via Cox regression for each diagnosis-family member type combination, adjusting for birth year, sex, birth weight, gestational age, parental ages at birth, and number of family member types of index person; aHRs also calculated for sex-specific co-occurrence of each disorder. We obtained 6,462 individual family history aHRS across autism overall (26,840 autistic persons; 1.6% of births), by sex, and considering intellectual disability (ID); and 350 individual co-occurrence aHRS. Results are catalogued in interactive heat maps and down-loadable data files: https://ncrr-au.shinyapps.io/asd-riskatlas/ and interactive graphic summaries: https://public.tableau.com/views/ASDPlots_16918786403110/e-Figure5. While primarily for reference material or use in other studies (e.g., meta-analyses), results revealed considerable breadth and variation in magnitude of familial health history associations with autism by type of condition, family member type, sex of the family member, side of the family, sex of the index person, and ID status, indicative of diverse genetic, familial, and non-genetic autism etiologic pathways. Careful attention to sources of autism likelihood in family health history, aided by our open data resource, may accelerate understanding of factors underlying neurodiversity.
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Affiliation(s)
- Diana Schendel
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA, USA
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- National Centre for Register-Based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
| | - Linda Ejlskov
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- National Centre for Register-Based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
| | | | - Zeal Jinwala
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA, USA
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Viktor Kim
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA, USA
| | - Erik Parner
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Amy E Kalkbrenner
- University of Wisconsin Milwaukee, Joseph J Zilber College of Public Health, Milwaukee, WI, USA
| | - Christine Ladd Acosta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M Danielle Fallin
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Current affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Sherlly Xie
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Medtronic, Mounds View, Minnesota, USA
| | - Preben Bo Mortensen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- National Centre for Register-Based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Brian K Lee
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA, USA
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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7
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Siguier PLM, Planton M, Baudou E, Chaix Y, Delage A, Rafiq M, Wolfrum M, Gérard F, Jucla M, Pariente J. Can neurodevelopmental disorders influence the course of neurodegenerative diseases? A scoping review. Ageing Res Rev 2024; 99:102354. [PMID: 38857707 DOI: 10.1016/j.arr.2024.102354] [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: 02/06/2024] [Revised: 04/30/2024] [Accepted: 05/27/2024] [Indexed: 06/12/2024]
Abstract
This scoping review aims at giving an overview of the possible influence of neurodevelopmental disorders (NDDs) on cognitive-behavioral neurodegenerative diseases (CBNDs). Based on the PRISMA-ScR checklist, it details the methods of NDDs screening, the identified NDDs-CBNDs associations, as well as the criteria and types of association. The last literature search was performed in June 2023. In the final study, 32 articles were included. Analysis first showed that NDDs were mainly detected through medical records screening. Second, the association of specific learning disorders and major or mild neurocognitive disorder due to Alzheimer's disease was the most investigated. Third, associations were mostly based on prevalence comparisons. Finally, 66 % of studies reported a positive association between NDDs and CBNDs. Notably, up to 67 % of positive associations were observed with atypical forms of certain CBNDs. Authors' interpretations suggest that NDDs could constitute a risk factor for CBNDs. However, the influence of NDDs on CBNDs still lacks evidence and biological support, possibly due to the heterogeneity of methods and criteria employed. Developing validated assessment tools for all NDDs and conducting cohort studies could be beneficial for research, and clinical practice. Indeed, this review also underlines the importance of adopting a life-span approach regarding CBNDs.
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Affiliation(s)
- Perrine L M Siguier
- Toulouse NeuroImaging Center, UMR1214, Toulouse University III, Inserm, CHU PURPAN - Pavillon BAUDOT, Place du Dr Joseph Baylac, 31024 TOULOUSE cedex 3, France; Laboratoire de Neuropsycholinguistique, EA4156, University of Toulouse II, 5 allée Antonio Machado, 31058 TOULOUSE cedex 9, France.
| | - Mélanie Planton
- Toulouse NeuroImaging Center, UMR1214, Toulouse University III, Inserm, CHU PURPAN - Pavillon BAUDOT, Place du Dr Joseph Baylac, 31024 TOULOUSE cedex 3, France; Department of Neurology, Neuroscience Centre, Toulouse-Purpan University Hospital, Place du Dr Baylac, TSA 40 031, 31059 Toulouse cedex 9, France
| | - Eloise Baudou
- Toulouse NeuroImaging Center, UMR1214, Toulouse University III, Inserm, CHU PURPAN - Pavillon BAUDOT, Place du Dr Joseph Baylac, 31024 TOULOUSE cedex 3, France; Neuropediatric Department, Toulouse-Purpan University Hospital, 330 avenue de Grande Bretagne - TSA 70034 - 31059 Toulouse cedex 9, France
| | - Yves Chaix
- Toulouse NeuroImaging Center, UMR1214, Toulouse University III, Inserm, CHU PURPAN - Pavillon BAUDOT, Place du Dr Joseph Baylac, 31024 TOULOUSE cedex 3, France; Neuropediatric Department, Toulouse-Purpan University Hospital, 330 avenue de Grande Bretagne - TSA 70034 - 31059 Toulouse cedex 9, France
| | - Alix Delage
- MéD@tAS Unit, Clinical Investigation Centre INSERM 1436, Department of Medical and Clinical Pharmacology, Toulouse University Hospital, 37 Allées Jules Guesde, Toulouse 31000, France
| | - Marie Rafiq
- Department of Neurology, Neuroscience Centre, Toulouse-Purpan University Hospital, Place du Dr Baylac, TSA 40 031, 31059 Toulouse cedex 9, France
| | - Marie Wolfrum
- Department of Neurology, Neuroscience Centre, Toulouse-Purpan University Hospital, Place du Dr Baylac, TSA 40 031, 31059 Toulouse cedex 9, France
| | - Fleur Gérard
- Department of Neurology, Neuroscience Centre, Toulouse-Purpan University Hospital, Place du Dr Baylac, TSA 40 031, 31059 Toulouse cedex 9, France
| | - Mélanie Jucla
- Laboratoire de Neuropsycholinguistique, EA4156, University of Toulouse II, 5 allée Antonio Machado, 31058 TOULOUSE cedex 9, France
| | - Jérémie Pariente
- Toulouse NeuroImaging Center, UMR1214, Toulouse University III, Inserm, CHU PURPAN - Pavillon BAUDOT, Place du Dr Joseph Baylac, 31024 TOULOUSE cedex 3, France
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Bloemert H, Sizoo BB, Verhoeven EWM, Beekman A, van Meijel B. Recovery of adults with autism spectrum disorder during intensive inpatient treatment: a qualitative study. Front Psychiatry 2024; 15:1383138. [PMID: 38911701 PMCID: PMC11190818 DOI: 10.3389/fpsyt.2024.1383138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/24/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Although some adults with autism spectrum disorder (ASD) require intensive and specialized ASD treatment, there is little research on how these adults experience the recovery process. Recovery is defined as the significant improvement in general functioning compared to the situation prior to treatment. Methods This qualitative study describes the recovery process from the perspective of adults on the autism spectrum during intensive inpatient treatment. Semi-structured interviews (n = 15) were carried out and analyzed according to the principles of grounded theory. Results Our results indicate that, given the specific characteristics of autism, therapeutic interventions and goal-oriented work cannot be carried out successfully, and the recovery process cannot begin, if no good working relationship has been established, and if care is not organized in ways that a person on the autism spectrum finds clear and predictable.
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Affiliation(s)
- Hendrikje Bloemert
- Center for Developmental Disorders, Dimence Institute for Mental Health, Deventer, Netherlands
- Department of Nursing, Inholland University of Applied Sciences, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Universitair Medische Centra (UMC; VUmc), Amsterdam, Netherlands
| | - Bram B. Sizoo
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | | | - Aartjan Beekman
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Universitair Medische Centra (UMC; VUmc), Amsterdam, Netherlands
| | - Berno van Meijel
- Department of Nursing, Inholland University of Applied Sciences, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Universitair Medische Centra (UMC; VUmc), Amsterdam, Netherlands
- Parnassia Psychiatric Institute, Parnassia Academy, The Hague, Netherlands
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Beasant L, Realpe A, Douglas S, Kenny L, Rai D, Mills N. Autistic adults' views on the design and processes within randomised controlled trials: The APRiCoT study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1540-1550. [PMID: 37882480 PMCID: PMC11134970 DOI: 10.1177/13623613231202432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
LAY ABSTRACT Large randomised controlled trials are used to test healthcare treatments. Yet there are no large randomised controlled trials on effective treatments for common mental health issues affecting autistic adults. The purpose of this study was to learn what autistic adults think about randomised controlled trials in preparation for a randomised controlled trial testing a medication for anxiety. This means we wanted to know their opinions about the way randomised controlled trials are done, such as how people are chosen to be in the study and how the study is carried out. We did this by talking to 49 autistic adults individually and asking them questions. We found that most of the people we talked to were okay with the way randomised controlled trials are done. They thought it was fair and they liked that it was based on evidence. However, some autistic people might find it hard to take part in randomised controlled trials. Some people did not like the uncertainty of not knowing what treatment they would receive in a randomised controlled trial. Others felt too vulnerable and may have had bad experiences with healthcare in the past. We found that it is important to involve autistic people early on and at every stage when designing a clinical trial. Care about how clear and precise the study communication is will build trust and improve access to research. Our study indicates that it is possible to conduct large randomised controlled trials with and for autistic people. This can ultimately contribute to the improvement of healthcare outcomes for this population.
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Affiliation(s)
| | - Alba Realpe
- University of Bristol, UK
- Bristol NIHR Biomedical Research Centre, UK
| | | | | | - Dheeraj Rai
- University of Bristol, UK
- Bristol NIHR Biomedical Research Centre, UK
- Avon and Wiltshire Mental Health Partnership NHS Trust, UK
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10
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Thiel T, Riedelbauch S, Gaigg S, Roessner V, Ring M. The impact of depressive and anxious symptoms on quality of life in adults on the autism spectrum. Autism Res 2024; 17:1161-1174. [PMID: 38783834 DOI: 10.1002/aur.3144] [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] [Received: 07/24/2022] [Accepted: 04/19/2024] [Indexed: 05/25/2024]
Abstract
Quality of life (QoL) is lower in adults on the autism spectrum (AS) compared with typically developing (TD) adults. In this context, recent studies have examined the role of depression and anxiety in reducing QoL in AS adults. The aim of this study was to (1) replicate these findings of lower QoL and (2) assess the negative influence of depressive and anxious symptoms on QoL in an adult AS (N = 86) and TD (N = 87) German sample with a broad age range (18-70 years). For this, we used questionnaires that have been validated for the AS and TD population: the World Health Organization Quality of Life Brief Version, the Autism-Specific QoL items, and the Hospital Anxiety and Depression Scale. We replicated previous findings and extended them to autism-specific QoL. Our AS sample had lower QoL compared with the TD adults. However, depressive symptoms were the largest contributor to lower QoL in both samples, more so than group membership and anxious symptoms. We conclude that interventions to improve QoL in AS adults should specifically target depressive symptoms and for this, improvements to the diagnostic process and treatment of depression in AS are necessary.
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Affiliation(s)
- Tobias Thiel
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Medizinische Fakultät, TU Dresden, Dresden, Germany
| | - Saskia Riedelbauch
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Medizinische Fakultät, TU Dresden, Dresden, Germany
| | - Sebastian Gaigg
- Autism Research Group, Department of Psychology, City, University of London, London, UK
| | - Veit Roessner
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Medizinische Fakultät, TU Dresden, Dresden, Germany
| | - Melanie Ring
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Medizinische Fakultät, TU Dresden, Dresden, Germany
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McLean KJ, Haas M, Koenig J, Horvath M, Vigil M, Werner NE, Bishop L. "I'm dealing with a health care system that doesn't get it": Barriers and facilitators to inclusive healthcare for autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1382-1393. [PMID: 38469707 PMCID: PMC11132937 DOI: 10.1177/13623613241236380] [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: 03/13/2024]
Abstract
LAY ABSTRACT Research has suggested that autistic adults may have a bigger chance of having mental health and physical health conditions such as depression, anxiety, sleep disorders, diabetes, obesity, and heart problems than adults without autism. Unfortunately, the unique healthcare needs of autistic adults are often overlooked, so it is not clear why autistic adults have worse health or what can be done to improve it. This study wants to find out the challenges autistic adults experience in taking care of their health and in going to different doctors. Researchers interviewed autistic adults across the country about their healthcare experiences. The interviewed autistic adults told the researchers about the barriers (things that did not help) and facilitators (things that did help) that impacted whether they received the care they needed. The researchers then organized what they learned from the autistic adults into a model called the Systems Engineering Initiative for Patient Safety model of work system and patient safety. This model explains how different parts of a healthcare system (person, tasks, technology and tools, environment, and organization) interact with one another and impact the healthcare experiences and outcomes of the patients in their care, like autistic adults. Overall, this study advocates for a systems-level approach to improving the healthcare experiences of autistic adults and their health outcomes.
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Affiliation(s)
| | - Meghan Haas
- Sandra Rosenbaum School of Social Work University of Wisconsin-Madison, USA
| | - Jamie Koenig
- Sandra Rosenbaum School of Social Work University of Wisconsin-Madison, USA
- Waisman Center, USA
| | - Megan Horvath
- Sandra Rosenbaum School of Social Work University of Wisconsin-Madison, USA
| | - Mariah Vigil
- Sandra Rosenbaum School of Social Work University of Wisconsin-Madison, USA
| | - Nicole E Werner
- Department of Health and Wellness Design, Indiana University Bloomington, USA
| | - Lauren Bishop
- Sandra Rosenbaum School of Social Work University of Wisconsin-Madison, USA
- Waisman Center, USA
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12
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Pineo T. Have you considered autism? J Hosp Med 2024; 19:542-544. [PMID: 38268425 DOI: 10.1002/jhm.13270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 01/26/2024]
Affiliation(s)
- Thomas Pineo
- University of Pittsburgh Medical Center, UPMC Community Osteopathic, Harrisburg, Pennsylvania, USA
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Pineo T. Clinical progress note: Caring for hospitalized Autistic adults. J Hosp Med 2024; 19:520-523. [PMID: 38372081 DOI: 10.1002/jhm.13307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 02/20/2024]
Affiliation(s)
- Thomas Pineo
- Division of Hospital Medicine, University of Pittsburgh Medical Center, Harrisburg, Pennsylvania, USA
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Jin T, Huang W, Pang Q, Cao Z, Xing D, Guo S, Zhang T. Genetically identified mediators associated with increased risk of stroke and cardiovascular disease in individuals with autism spectrum disorder. J Psychiatr Res 2024; 174:172-180. [PMID: 38640796 DOI: 10.1016/j.jpsychires.2024.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/08/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
Growing evidence suggested that individuals with autism spectrum disorder (ASD) associated with stroke and cardiovascular disease (CVD). However, the causal association between ASD and the risk of stroke and CVD remains unclear. To validate this, we performed two-sample Mendelian randomization (MR) and two-step mediation MR analyses, using relevant genetic variants sourced from the largest genome-wide association studies (GWASs). Two-sample MR evidence indicated causal relationships between ASD and any stroke (OR = 1.1184, 95% CI: 1.0302-1.2142, P < 0.01), ischemic stroke (IS) (OR = 1.1157, 95% CI: 1.0237-1.2160, P = 0.01), large-artery atherosclerotic stroke (LAS) (OR = 1.2902, 95% CI: 1.0395-1.6013, P = 0.02), atrial fibrillation (AF) (OR = 1.0820, 95% CI: 1.0019-1.1684, P = 0.04), and heart failure (HF) (OR = 1.1018, 95% CI: 1.0007-1.2132, P = 0.05). Additionally, two-step mediation MR suggested that type 2 diabetes mellitus (T2DM) partially mediated this effect (OR = 1.14, 95%CI: 1.02-1.28, P = 0.03). The mediated proportion were 10.96% (95% CI: 0.58%-12.10%) for any stroke, 11.77% (95% CI: 10.58%-12.97%) for IS, 10.62% (95% CI: 8.04%-13.20%) for LAS, and 7.57% (95% CI: 6.79%-8.36%) for HF. However, no mediated effect was observed between ASD and AF risk. These findings have implications for the development of prevention strategies and interventions for stroke and CVD in patients with ASD.
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Affiliation(s)
- Tianyu Jin
- Department of Rehabilitation Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Department of Neurological Rehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China; Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Wei Huang
- Drum Tower Clinical Medical College, Nanjing Medical University, Nanjing, China
| | - Qiongyi Pang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Department of Neurological Rehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Zheng Cao
- Department of Medicine and Health, University of Sydney, Sydney, Australia
| | - Dalin Xing
- Department of Rehabilitation Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Department of Neurological Rehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Shunyuan Guo
- Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Tong Zhang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Department of Neurological Rehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China.
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Westover AN. The Future of General Psychiatry Must Include Autism Spectrum Disorder and Intellectual Disability. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024:10.1007/s40596-024-01985-9. [PMID: 38782841 DOI: 10.1007/s40596-024-01985-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
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16
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Yang F, You H, Mizui T, Ishikawa Y, Takao K, Miyakawa T, Li X, Bai T, Xia K, Zhang L, Pang D, Xu Y, Zhu C, Kojima M, Lu B. Inhibiting proBDNF to mature BDNF conversion leads to ASD-like phenotypes in vivo. Mol Psychiatry 2024:10.1038/s41380-024-02595-5. [PMID: 38762692 DOI: 10.1038/s41380-024-02595-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 04/29/2024] [Accepted: 05/03/2024] [Indexed: 05/20/2024]
Abstract
Autism Spectrum Disorders (ASD) comprise a range of early age-onset neurodevelopment disorders with genetic heterogeneity. Most ASD related genes are involved in synaptic function, which is regulated by mature brain-derived neurotrophic factor (mBDNF) and its precursor proBDNF in a diametrically opposite manner: proBDNF inhibits while mBDNF potentiates synapses. Here we generated a knock-in mouse line (BDNFmet/leu) in which the conversion of proBDNF to mBDNF is attenuated. Biochemical experiments revealed residual mBDNF but excessive proBDNF in the brain. Similar to other ASD mouse models, the BDNFmet/leu mice showed reduced dendritic arborization, altered spines, and impaired synaptic transmission and plasticity in the hippocampus. They also exhibited ASD-like phenotypes, including stereotypical behaviors and deficits in social interaction. Moreover, the plasma proBDNF/mBDNF ratio was significantly increased in ASD patients compared to normal children in a case-control study. Thus, deficits in proBDNF to mBDNF conversion in the brain may contribute to ASD-like behaviors, and plasma proBDNF/mBDNF ratio may be a potential biomarker for ASD.
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Affiliation(s)
- Feng Yang
- China National Clinical Research Center for Neurological Diseases, Basic and Translational Medicine Center, Beijing Tiantan Hospital, Capital Medical University, 100070, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, 100070, Beijing, China
| | - He You
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, 100070, Beijing, China
- School of Pharmaceutical Sciences and IDG/McGovern Institute for Brain Research, Tsinghua University, 100084, Beijing, China
| | - Toshiyuki Mizui
- Core Research for Evolutional Science and Technology (CREST), Kawaguchi, 332-0012, Japan
| | - Yasuyuki Ishikawa
- Department of Systems Life Engineering, Maebashi Institute of Technology, Maebashi, 371-0816, Japan
| | - Keizo Takao
- Core Research for Evolutional Science and Technology (CREST), Kawaguchi, 332-0012, Japan
- Life Science Research Center, University of Toyama, Toyama, 930-0194, Japan
- Department of Behavioral Physiology, Graduate School of Innovative Life Science, University of Toyama, Toyama, 930-0194, Japan
| | - Tsuyoshi Miyakawa
- Core Research for Evolutional Science and Technology (CREST), Kawaguchi, 332-0012, Japan
- Division of Systems Medical Science, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Xiaofei Li
- China National Clinical Research Center for Neurological Diseases, Basic and Translational Medicine Center, Beijing Tiantan Hospital, Capital Medical University, 100070, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, 100070, Beijing, China
| | - Ting Bai
- Centre for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Kun Xia
- Centre for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Lingling Zhang
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Dizhou Pang
- Center for Child Behavioral Development, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yiran Xu
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Changlian Zhu
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Masami Kojima
- Core Research for Evolutional Science and Technology (CREST), Kawaguchi, 332-0012, Japan.
- Biomedical Department of Applied Bioscience, College of Bioscience and Chemistry, Kanazawa Institute of Technology (KIT), Ishikawa, 924-0838, Japan.
| | - Bai Lu
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, 100070, Beijing, China.
- School of Pharmaceutical Sciences and IDG/McGovern Institute for Brain Research, Tsinghua University, 100084, Beijing, China.
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17
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Zhao T, Huang CQ, Zhang YH, Zhu YY, Chen XX, Wang T, Shao J, Meng XH, Huang Y, Wang H, Wang HL, Wang B, Xu DX. Prenatal 1-Nitropyrene Exposure Causes Autism-Like Behavior Partially by Altering DNA Hydroxymethylation in Developing Brain. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024:e2306294. [PMID: 38757379 DOI: 10.1002/advs.202306294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 03/13/2024] [Indexed: 05/18/2024]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder, characterized by social communication disability and stereotypic behavior. This study aims to investigate the impact of prenatal exposure to 1-nitropyrene (1-NP), a key component of motor vehicle exhaust, on autism-like behaviors in a mouse model. Three-chamber test finds that prenatal 1-NP exposure causes autism-like behaviors during the weaning period. Patch clamp shows that inhibitory synaptic transmission is reduced in medial prefrontal cortex of 1-NP-exposed weaning pups. Immunofluorescence finds that prenatal 1-NP exposure reduces the number of prefrontal glutamate decarboxylase 67 (GAD67) positive interneurons in fetuses and weaning pups. Moreover, prenatal 1-NP exposure retards tangential migration of GAD67-positive interneurons and downregulates interneuron migration-related genes, such as Nrg1, Erbb4, and Sema3F, in fetal forebrain. Mechanistically, prenatal 1-NP exposure reduces hydroxymethylation of interneuron migration-related genes through inhibiting ten-eleven translocation (TET) activity in fetal forebrain. Supplement with alpha-ketoglutarate (α-KG), a cofactor of TET enzyme, reverses 1-NP-induced hypohydroxymethylation at specific sites of interneuron migration-related genes. Moreover, α-KG supplement alleviates 1-NP-induced migration retardation of interneurons in fetal forebrain. Finally, maternal α-KG supplement improves 1-NP-induced autism-like behaviors in weaning offspring. In conclusion, prenatal 1-NP exposure causes autism-like behavior partially by altering DNA hydroxymethylation of interneuron migration-related genes in developing brain.
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Affiliation(s)
- Ting Zhao
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, 230022, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, China
| | - Cheng-Qing Huang
- School of Food and Bioengineering, Hefei University of Technology, Hefei, 230009, China
| | - Yi-Hao Zhang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, 230022, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, China
| | - Yan-Yan Zhu
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, 230022, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, China
| | - Xiao-Xi Chen
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, 230022, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, China
| | - Tao Wang
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, China
| | - Jing Shao
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, China
| | - Xiu-Hong Meng
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, China
| | - Yichao Huang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, 230022, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, China
| | - Hua Wang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, 230022, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, China
| | - Hui-Li Wang
- School of Food and Bioengineering, Hefei University of Technology, Hefei, 230009, China
| | - Bo Wang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, 230022, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, China
| | - De-Xiang Xu
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, 230022, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, China
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18
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Moore HL, Freeston M, Rodgers J, Cassidy S. A Measurement Invariance Analysis of the Anxiety Scale for Autism-Adults in a Sample of Autistic and Non-Autistic Men and Women. J Autism Dev Disord 2024:10.1007/s10803-024-06260-2. [PMID: 38740697 DOI: 10.1007/s10803-024-06260-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 05/16/2024]
Abstract
The Anxiety Scale for Autism-Adults (ASA-A) captures the autistic anxiety experience, but we do not know whether it is structurally equivalent for men and women, or non-autistic people. Measurement invariance analysis considered gender and diagnostic status (342 cis-gender autistic men (N = 105) and women (N = 237), 316 cis-gender non-autistic men (N = 104) and women (N = 212)). Strict invariance was achieved between autistic men and women and between non-autistic men and women, but the ASA-A structure is quantitatively different in autistic compared to non-autistic adults. Therefore, this tool cannot be used to directly compare anxiety between these groups. Autistic women scored significantly higher on the ASA-A than autistic men and Uncertainty was the highest scoring factor for autistic participants. Future research should include alternative gender identities.
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Affiliation(s)
- Heather L Moore
- School of Psychology, Dame Margaret Barbour Building, Wallace Street, Newcastle upon Tyne, NE2 4DR, UK.
| | - Mark Freeston
- School of Psychology, Dame Margaret Barbour Building, Wallace Street, Newcastle upon Tyne, NE2 4DR, UK
| | - Jacqui Rodgers
- Population Health Sciences Institute, Sir James Spence Institute, Newcastle University, Royal Victoria Infirmary, Level 3, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Sarah Cassidy
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
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19
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Weitzman C, Nadler C, Blum NJ, Augustyn M. Health Care for Youth With Neurodevelopmental Disabilities: A Consensus Statement. Pediatrics 2024; 153:e2023063809. [PMID: 38596852 DOI: 10.1542/peds.2023-063809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 04/11/2024] Open
Abstract
Individuals with a neurodevelopmental disability (NDD) face significant health care barriers, disparities in health outcomes, and high rates of foregone and adverse health care experiences. The Supporting Access for Everyone (SAFE) Initiative was developed to establish principles of health care to improve equity for youth with NDDs through an evidence-informed and consensus-derived process. With the Developmental Behavioral Pediatric Research Network, the SAFE cochairs convened a consensus panel composed of diverse professionals, caregivers, and adults with NDDs who contributed their varied expertise related to SAFE care delivery. A 2-day public forum (attended by consensus panel members) was convened where professionals, community advocates, and adults with NDDs and/or caregivers of individuals with NDDs presented research, clinical strategies, and personal experiences. After this, a 2-day consensus conference was held. Using nominal group technique, the panel derived a consensus statement (CS) on SAFE care, an NDD Health Care Bill of Rights, and Transition Considerations. Ten CSs across 5 topical domains were established: (1) training, (2) communication, (3) access and planning, (4) diversity, equity, inclusion, belonging, and anti-ableism, and (5) policy and structural change. Relevant and representative citations were added when available to support the derived statements. The final CS was approved by all consensus panel members and the Developmental Behavioral Pediatric Research Network steering committee. At the heart of this CS is an affirmation that all people are entitled to health care that is accessible, humane, and effective.
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Affiliation(s)
| | - Cy Nadler
- Children's Mercy Kansas City, Kansas City, Missouri
| | - Nathan J Blum
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Marilyn Augustyn
- Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, Massachusetts
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20
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Ladwig JC, Broeckelmann EM, Sibley KM, Ripat J, Glazebrook CM. A synthesis of the characteristics of dance interventions engaging adults with neurodevelopmental disabilities: a scoping review. Disabil Rehabil 2024; 46:1954-1961. [PMID: 37272778 DOI: 10.1080/09638288.2023.2217384] [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: 09/12/2022] [Accepted: 05/18/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE Dance can encourage physical activity and promote physical, cognitive, and social development for adults who have neurodevelopmental disabilities (NDD). Dance is defined as a form of expression that may be structured, exploratory, and/or cultural. Current literature supports the benefits of participation in dance for persons with NDD, however less is known about what characteristics support participation in dance. MATERIALS AND METHODS A scoping review was conducted to synthesize the characteristics of dance interventions, teaching strategies, and outcome measures used to assess the efficacy of dance interventions. Searches were conducted across six databases and the results were screened according to: i) adults ≥18yrs of age with a diagnosed NDD, and ii) the program incorporated activities that fall within our definition of dance. RESULTS A range of dance forms and NDDs were represented across the fourteen studies reviewed. Few provided explicit details of the dance interventions, nor how instruction was adapted. All studies that measured fitness, mobility, balance, posture, and functional activity showed significant improvement. Studies that measured psychosocial and well-being focused on autistic characteristics and showed mixed results. CONCLUSIONS Details of interventions, instructions, measures of movement performance, and the relationship between outcomes and the interventions require further development and research.
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Affiliation(s)
- Jacqueline C Ladwig
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada
| | - Elena M Broeckelmann
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada
| | - Kathryn M Sibley
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Jacquie Ripat
- Department of Occupational Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Cheryl M Glazebrook
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada
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21
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Kirby AV, Conner CM, Mazefsky CA. Are autistic females at greater risk of suicide? A call for clarity to advance suicide prevention for the whole community. Autism Res 2024; 17:898-905. [PMID: 38429939 PMCID: PMC11102323 DOI: 10.1002/aur.3120] [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] [Received: 12/15/2023] [Accepted: 02/25/2024] [Indexed: 03/03/2024]
Abstract
Understanding suicide risk is critical for supporting prevention. A growing body of evidence shows autistic people are at greater risk for multiple suicide-related outcomes than non-autistic people. This commentary is in response to an observed pattern of miscommunication in scientific and community spaces about autistic females having higher risk of suicide. However, it is not always clear who they are being compared with in these statements. To address this confusion, we summarize the current population-based evidence on autistic suicide risk, highlighting findings related to sex similarities and differences, which actually indicates comparable rates of suicide death among autistic males and females, and mixed findings related to sex differences in risk of other suicidal behaviors. We call for greater clarity in suicide risk communication moving forward focused on outcomes, measurement, sampling methods, and comparison groups to reflect accurate conclusions about existing evidence. Further research is needed about the full range of suicide-related outcomes for autistic people, including a greater understanding of sex differences as well as potential gender differences to include transgender and nonbinary autistic people. However, studies of sex and gender differences should not overshadow the compelling need for efforts to understand and address the elevated risk of suicidal thoughts, behaviors, and death among autistic people across sex and gender boundaries.
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Affiliation(s)
- Anne V Kirby
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, Utah, USA
| | - Caitlin M Conner
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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22
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Kentrou V, Livingston LA, Grove R, Hoekstra RA, Begeer S. Perceived misdiagnosis of psychiatric conditions in autistic adults. EClinicalMedicine 2024; 71:102586. [PMID: 38596613 PMCID: PMC11001629 DOI: 10.1016/j.eclinm.2024.102586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/11/2024] Open
Abstract
Background Many autistic people, particularly women, do not receive an autism diagnosis until adulthood, delaying their access to timely support and clinical care. One possible explanation is that autistic traits may initially be misinterpreted as symptoms of other psychiatric conditions, leading some individuals to experience misdiagnosis of other psychiatric conditions prior to their autism diagnosis. However, little is currently known about the frequency and nature of psychiatric misdiagnoses in autistic adults. Methods Using data collected in the first half of 2019 from an ongoing longitudinal register of autistic adults in the Netherlands, this study explored the frequency of perceived psychiatric misdiagnoses before receiving an autism diagnosis. Gender differences were also explored. A sample of 1211 autistic adults (52.6% women, mean age 42.3 years), the majority of whom were Dutch and relatively highly educated, was evaluated. Findings Results showed that 24.6% (n = 298) of participants reported at least one previous psychiatric diagnosis that was perceived as a misdiagnosis. Personality disorders were the most frequent perceived misdiagnoses, followed by anxiety disorders, mood disorders, chronic fatigue syndrome/burnout-related disorders, and attention-deficit/hyperactivity disorder. Autistic women (31.7%) reported perceived misdiagnoses more frequently than men (16.7%). Women were specifically more likely than men to report perceived misdiagnoses of personality disorders, anxiety disorders, and mood disorders. Women also reported prior psychiatric diagnoses more often in general (65.8% versus 34.2% in men). Within the group of individuals with a prior diagnosis, perceived misdiagnoses were equally likely for men and women. Interpretation One in four autistic adults, and one in three autistic women, reported at least one psychiatric diagnosis, obtained prior to being diagnosed with autism, that was perceived as a misdiagnosis. Inaccurate diagnoses are linked to long diagnostic pathways and delayed recognition of autism. These findings highlight the need for improved training of mental health practitioners, in order to improve their awareness of the presentation of autism in adulthood and of the complex relationship between autism and co-occurring conditions. The current study constitutes a first step towards showing that autistic adults, and particularly women, may be at greater risk of experiencing misdiagnoses. Future studies based on larger, more representative samples are required, to replicate current findings and provide more reliable estimates of the overall frequency of misdiagnoses as well as the frequency of misdiagnoses for specific psychiatric conditions. Funding This study was made possible by funding from the Netherlands Organisation for Health Research and Development (ZonMW), project number 60-63600-98-834.
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Affiliation(s)
- Vasiliki Kentrou
- Department of Experimental and Applied Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lucy A Livingston
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Rachel Grove
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Rosa A Hoekstra
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Sander Begeer
- Department of Clinical Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
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McKernan EP, Russo N. Investigating the Structure of the CESD-R and DASS-21 Across Adults with Low and High Levels of Autistic Traits. J Autism Dev Disord 2024; 54:2026-2039. [PMID: 36959520 DOI: 10.1007/s10803-023-05944-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 03/25/2023]
Abstract
The current study examined factorial invariance of the Center for Epidemiologic Studies Depression Scale-Revised (CESD-R) and the Depression Anxiety Stress Scales-21 (DASS-21) using a convenience sample of 434 adults surveyed though Amazon Mechanical Turk. Participants were sorted into two groups based on their score on the Autism-Spectrum Quotient. Results indicated that the CESD-R did not demonstrate configural invariance. The DASS-21 demonstrated evidence of scalar invariance, indicating cross-group equality in factor loadings and factor intercepts. Findings suggest that the DASS-21 measures symptoms of depression, anxiety, and stress consistently across individuals with high and low levels of ASD-related traits, whereas the CESD-R may not be valid when assessing symptoms of depression in those with a high level of ASD-related traits.
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Affiliation(s)
- Elizabeth P McKernan
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Natalie Russo
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA.
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Chan DV, Doran JD. Mental health counseling is rated as most helpful by autistic adults: Service perspectives in adulthood. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1190-1202. [PMID: 37679948 PMCID: PMC10918044 DOI: 10.1177/13623613231197446] [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: 09/09/2023]
Abstract
LAY ABSTRACT The number of autistic adults is growing, but there are fewer services to support them in adulthood. Many autistic adults need some support services to lead successful adult lives. We know a lot about the services autistic adults use and some of the problems with using these services, but we do not know which services are most helpful to them and how the services they use relate to how they interact with their communities. Forty autistic adults took part in a study about service use and community participation. They completed surveys, interviews, and carried a global positioning system tracker. They answered questions about which services are most helpful in adulthood, things that make it hard to use services, and what services they needed. Most participants used two services in the past 2 years, most frequently mental health and employment services. Adults who were currently seeing a mental health counselor were more likely to be working full-time and visit more locations in the community compared to those who were not seeing a counselor. Mental health services were reported as the most helpful service they received as adults, followed by employment services. We often focus on the importance of employment services after high school, but our findings show a need for both mental health and employment services for autistic adults.
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Affiliation(s)
- Dara V Chan
- University of North Carolina at Chapel Hill, USA
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25
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Ames JL, Davignon MN, Hayes EA, Croen LA. Health Care for Autistic Children: A Public Health Perspective. Pediatr Clin North Am 2024; 71:111-125. [PMID: 38423712 DOI: 10.1016/j.pcl.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Autism has been the subject of large-scale public health investment. These investments are increasingly shifting toward mitigating the lifelong disability and impairment associated with autism. Key efforts include bolstering screening schedules, accelerating the path to diagnosis and early entry into evidence-based therapies, and providing preventive management of common co-occurring conditions. Enhancing their implementation will necessitate addressing neurodiversity and health equity. Pediatric primary care teams continue to be important stewards in population-level initiatives to promote autistic health. To thrive in this role, these providers will benefit from specific educational and logistical supports from the health care system.
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Affiliation(s)
- Jennifer L Ames
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Drive, Building B, Pleasanton, CA 94588, USA.
| | - Meghan N Davignon
- Kaiser Permanente Roseville Medical Center, 1600 Eureka Road, Building C, Department of Pediatric Subspecialties, Roseville, CA 95661, USA
| | - Elizabeth A Hayes
- Kaiser Permanente Oakland Medical Center, Department of Pediatrics, 275 West Macarthur Boulevard, Oakland, CA 94611, USA
| | - Lisa A Croen
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Drive, Building B, Pleasanton, CA 94588, USA
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26
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Allahdad M, Gluyas E, Spain D, Blainey S, Doswell S, Onyejiaka A. Implementing 'Transforming Care' - The first two years of a pilot service for autistic adults experiencing mental health crisis warranting psychiatric admission. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 147:104700. [PMID: 38430720 DOI: 10.1016/j.ridd.2024.104700] [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: 11/09/2023] [Revised: 01/11/2024] [Accepted: 02/14/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Autistic adults are at increased risk of mental health difficulties; however Adult Mental Health Services (AMHS) often struggle to offer appropriate support to this group. Within England, Government initiatives, such as the 'Transforming Care' programme which included 'Building the Right Support' (NHS England, 2015) have promoted the need for AMHS to consider how they can better provide autism-informed support to autistic adults. AIMS/METHODS Here, we describe the first two years of work of the Transforming Care in Autism (TCA) Team; a specialist service that supports autistic adults, without a moderate or severe intellectual disability or presenting significant risk to others, experiencing a mental health crisis. The service model is described, and descriptive data is presented over the two years of the service operation. RESULTS Between February 2019 and February 2021, 110 referrals were received; 52 (47%) were accepted. Support offered to autistic adults included psychoeducation, psychological interventions, family-focused interventions, and consultation with professionals about specific individuals. Seventy autism training sessions were delivered to professionals working in medical health settings, AMHS, social care and residential services. CONCLUSIONS/IMPLICATIONS Developing more autism-informed community and inpatient AMHS is vital for improving care. Further research about the experiences and needs of autistic adults using AMHS is needed, along with improved awareness of autism and provision of tailored intervention within these settings. LAY ABSTRACT Autistic people have mental health problems more often than people who are not autistic. When autistic people need help from mental health services, often these services do not know how to help autistic people. The Government says mental health services must do more to help autistic people. In this paper we write about a new team, called the Transforming Care in Autism team. In its first two years the team was asked to help 110 people and worked with 52 of them. Help included talking to autistic people about how autism affects them and offering therapy. We also worked with families and professionals supporting autistic adults and offered 70 training sessions. More work is needed to make sure mental health services work well with autistic people. We also need to ask autistic people about their experiences of getting help from mental health services.
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Affiliation(s)
- Mahdieh Allahdad
- South London & Maudsley NHS Foundation Trust, London, UK; Department of Psychology, Sport and Geography, University of Hertfordshire, Hatfield, UK
| | - Emma Gluyas
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Debbie Spain
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Sarah Blainey
- South London & Maudsley NHS Foundation Trust, London, UK; Central and North-West London NHS Foundation Trust, UK
| | - Sophie Doswell
- South London & Maudsley NHS Foundation Trust, London, UK
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27
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Lee D, Frey GC, Cothran DJ, Harezlak J, Shih PC. Concordance Between Accelerometer-Measured and Self-Reported Physical Activity and Sedentary Time in Adults with Autism. J Autism Dev Disord 2024; 54:1517-1526. [PMID: 36637594 DOI: 10.1007/s10803-022-05862-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 01/14/2023]
Abstract
This study examined the concordance between accelerometry-measured and self-reported physical activity (PA) and sedentary time in adults with autism. Twenty-four participants wore an ActiGraph GT3X + accelerometer for seven consecutive days and completed the International Physical Activity Questionnaire-Short Form (IPAQ-SF) on the last day of their study participation. Bland-Altman plots assessed the magnitude of agreement between the two measures. Nearly 80% of the participants accumulated the recommended ≥ 150 min of moderate to vigorous PA (MVPA)/week, but were also sedentary for over nine hours/day according to accelerometry data. Findings showed that adults with autism tended to overreport MVPA (b = 1.606, p < 0.01) and underreport sedentary time (b = 1.161, p = 0.03) via the IPAQ-SF, as compared to objective measurements.
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Affiliation(s)
- Daehyoung Lee
- Department of Applied Human Sciences, University of Minnesota Duluth, MN, Duluth, USA.
| | - Georgia C Frey
- Department of Kinesiology, Indiana University, Bloomington, IN, USA
| | | | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics, Indiana University, Bloomington, IN, USA
| | - Patrick C Shih
- Department of Informatics, Indiana University, Bloomington, IN, USA
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28
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Salari Z, Moslemizadeh A, Tezerji SS, Sabet N, Parizi AS, Khaksari M, Sheibani V, Jafari E, Shafieipour S, Bashiri H. Sex-dependent alterations of inflammatory factors, oxidative stress, and histopathology of the brain-gut axis in a VPA-induced autistic-like model of rats. Birth Defects Res 2024; 116:e2310. [PMID: 38563145 DOI: 10.1002/bdr2.2310] [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] [Received: 08/03/2023] [Revised: 12/23/2023] [Accepted: 01/21/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION In this study, we aimed to investigate the inflammatory factors, oxidative stress, and histopathological consequences of the brain-gut axis in male and female rats prenatally exposed to VPA. METHODS Pregnant Wistar rats were randomly divided into two groups. The animals received saline, and valproic acid (VPA) (600 mg/kg, i.p.) on embryonic day 12.5 (E12.5). All offspring were weaned on postnatal day 21, and the experiments were done in male and female rats on day 60. The brain and intestine tissues were extracted to assess histopathology, inflammation, and oxidative stress. RESULTS An increase of interleukin-1β (IL-1β) and interleukin-6 (IL-6) and a decrease of interleukin-10 (IL-10) were observed in the two sexes and two tissues of the autistic rats. In the VPA-exposed animals, malondialdehyde (MDA) and protein carbonyl (PC) increased in the brain of both sexes and the intestines of only the males. The total antioxidant capacity (TAC), superoxide dismutase (SOD), and catalase (CAT) significantly decreased in both tissues of male and female autistic groups. Histopathological evaluation showed that the %apoptosis of the cortex in the autistic male and female groups was more than in controls whereas this parameter in the CA1 and CA3 was significant only in the male rats. In the intestine, histopathologic changes were seen only in the male autistic animals. CONCLUSION The inflammatory and antioxidant factors were in line in the brain-gut axis in male and female rats prenatally exposed to VPA. Histopathological consequences were more significant in the VPA-exposed male animals.
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Affiliation(s)
- Zahra Salari
- Gastroenterology and Hepatology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Sara Sheibani Tezerji
- Department of Behavioural and Molecular Neurobiology, Regensburg Center for Neuroscience, University of Regensburg, Regensburg, Germany
| | - Nazanin Sabet
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Saeidpour Parizi
- Gastroenterology and Hepatology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Khaksari
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Vahid Sheibani
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
- Department of Physiology and Pharmacology, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Elham Jafari
- Pathology and Stem Cells Research Center, Department of Pathology, Afzalipour School of Medicine, Kerman University of Medical Science, Kerman, Iran
| | - Sara Shafieipour
- Gastroenterology and Hepatology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamideh Bashiri
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
- Department of Physiology and Pharmacology, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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McDonald TAM, Scudder A. Mind the NIH-Funding Gap: Structural Discrimination in Physical Health-Related Research for Cognitively Able Autistic Adults. J Autism Dev Disord 2024; 54:1411-1424. [PMID: 36635433 PMCID: PMC10762646 DOI: 10.1007/s10803-022-05856-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 01/14/2023]
Abstract
Autistic adults experience disparities in physical health and health care access. A major barrier to addressing these disparities is a lack of federal funding for research on this topic. In seeking funding from the National Institutes of Health (NIH), we discovered nodes that contribute to structural discrimination in physical health-related research for autistic adults. To examine this structural discrimination, we systematically searched funded research on all physical health-disparity conditions in autistic adults using NIH RePORTER. Among 61 unique studies, none focused on improving the relevant physical health condition through intervention, programs, or services for autistic adults. Thus, we need updated policies and procedures that support research on physical health disparities in populations with developmental or mental health conditions.
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Affiliation(s)
- T A Meridian McDonald
- Department of Neurology, Vanderbilt University Medical Center, 37235, Nashville, TN, USA.
| | - Audrey Scudder
- Department of Psychology, Vanderbilt University, 37240-7817, Nashville, TN, USA
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30
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Chiu HT, Ip IN, Ching FNY, Wong BPH, Lui WH, Tse CS, Wong SWH. Resting Heart Rate Variability and Emotion Dysregulation in Adolescents with Autism Spectrum Disorder. J Autism Dev Disord 2024; 54:1482-1493. [PMID: 36710299 DOI: 10.1007/s10803-022-05847-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 01/31/2023]
Abstract
Emotion dysregulation is common among individuals with autism spectrum disorder (ASD). This study examined the relationship between emotion dysregulation and resting heart rate variability (HRV), a marker of the autonomic nervous system, in ASD adolescents. Resting HRV data were collected from ASD (n = 23) and typically developing (TD) adolescents (n = 32) via short-term electrocardiogram. Parents/caregivers reported participants' level of emotion dysregulation with the Emotion Dysregulation Inventory (EDI). Controlling for the effects of age and gender, regression analyses revealed moderating effects of group, suggesting that lower resting HRV was more strongly associated with greater emotion dysregulation in ASD than TD adolescents. The results support the view that disruptions in autonomic functioning may contribute to emotion dysregulation in ASD.
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Affiliation(s)
- Hey Tou Chiu
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong, China
- Laboratory for Brain and Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Isaac Nam Ip
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong, China
- Laboratory for Brain and Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Fiona Ngai Ying Ching
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong, China
- Laboratory for Brain and Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Bernard Pak-Ho Wong
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Wan-Hap Lui
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Shing Tse
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Savio Wai Ho Wong
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong, China.
- Laboratory for Brain and Education, The Chinese University of Hong Kong, Hong Kong, China.
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31
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Keating CT, Hickman L, Geelhand P, Takahashi T, Leung J, Monk R, Schuster B, Rybicki A, Girolamo TM, Clin E, Papastamou F, Belenger M, Eigsti IM, Cook JL, Kosaka H, Osu R, Okamoto Y, Sowden-Carvalho S. Cross-cultural variation in experiences of acceptance, camouflaging and mental health difficulties in autism: A registered report. PLoS One 2024; 19:e0299824. [PMID: 38507392 PMCID: PMC10954134 DOI: 10.1371/journal.pone.0299824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 02/15/2024] [Indexed: 03/22/2024] Open
Abstract
Recent findings suggest that stigma and camouflaging contribute to mental health difficulties for autistic individuals, however, this evidence is largely based on UK samples. While studies have shown cross-cultural differences in levels of autism-related stigma, it is unclear whether camouflaging and mental health difficulties vary across cultures. Hence, the current study had two aims: (1) to determine whether significant relationships between autism acceptance, camouflaging, and mental health difficulties replicate in a cross-cultural sample of autistic adults, and (2) to compare these variables across cultures. To fulfil these aims, 306 autistic adults from eight countries (Australia, Belgium, Canada, Japan, New Zealand, South Africa, the United Kingdom, and the United States) completed a series of online questionnaires. We found that external acceptance and personal acceptance were associated with lower levels of depression but not camouflaging or stress. Higher camouflaging was associated with elevated levels of depression, anxiety, and stress. Significant differences were found across countries in external acceptance, personal acceptance, depression, anxiety, and stress, even after controlling for relevant covariates. Levels of camouflaging also differed across countries however this effect became non-significant after controlling for the covariates. These findings have significant implications, identifying priority regions for anti-stigma interventions, and highlighting countries where greater support for mental health difficulties is needed.
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Affiliation(s)
- Connor Tom Keating
- Centre for Developmental Science, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Lydia Hickman
- Centre for Developmental Science, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Philippine Geelhand
- ACTE (Autism in Context: Theory and Experiment) at LaDisco (Center for Linguistics Research) and ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Toru Takahashi
- Faculty of Human Sciences, Waseda University, Tokorozawa, Japan
| | - Joan Leung
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - Ruth Monk
- Autistic Member of the Autism New Zealand Community Advisory Group, New Zealand/School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - Bianca Schuster
- Centre for Developmental Science, School of Psychology, University of Birmingham, Birmingham, United Kingdom
- Department of Cognition, Emotion and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Alicia Rybicki
- Centre for Developmental Science, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Teresa Marie Girolamo
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA, United States of America
| | - Elise Clin
- ACTE (Autism in Context: Theory and Experiment) at LaDisco (Center for Linguistics Research) and ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Fanny Papastamou
- ACTE (Autism in Context: Theory and Experiment) at LaDisco (Center for Linguistics Research) and ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Marie Belenger
- ACTE (Autism in Context: Theory and Experiment) at LaDisco (Center for Linguistics Research) and ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Inge-Marie Eigsti
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States of America
| | - Jennifer Louise Cook
- Centre for Developmental Science, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Hirotaka Kosaka
- Department of Neuropsychiatry, University of Fukui, Fukui, Japan
| | - Rieko Osu
- Faculty of Human Sciences, Waseda University, Tokorozawa, Japan
| | - Yuko Okamoto
- Waseda Institute for Advanced Study, Waseda University, Tokyo, Japan
| | - Sophie Sowden-Carvalho
- Centre for Developmental Science, School of Psychology, University of Birmingham, Birmingham, United Kingdom
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Davies J, Romualdez AM, Pellicano E, Remington A. Career progression for autistic people: A scoping review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241236110. [PMID: 38477466 DOI: 10.1177/13623613241236110] [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: 03/14/2024]
Abstract
LAY ABSTRACT Lots of autistic people are unemployed. Even when they are employed, autistic people might be given fewer opportunities than non-autistic people to progress in their careers. For example, assumptions about autistic people's differences in social communication might mean they are not given as many promotions. Indeed, we know that many autistic people are in jobs lower than their abilities (known as 'underemployment'). We reviewed 33 studies that tell us something about career progression for autistic people. Our review found that lots of autistic people want to progress in their careers, but there are many barriers in their way. For example, when they told their employer about being autistic, some people were given fewer opportunities. Research has also shown that autistic people do not get enough support to progress and that gaps in their employment history can make it difficult to progress. Our review suggested that good employment support (e.g. mentors) might help autistic people to progress in their careers. However, not much research has evaluated employment support for autistic people, which means we do not know how useful it is. Future research should find the best support that allows autistic people to live and work in ways that are meaningful to them.
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Affiliation(s)
- Jade Davies
- Centre for Research in Autism and Education (CRAE), Department of Psychology and Human Development, IOE, UCL's Faculty of Education and Society, UK
| | - Anna Melissa Romualdez
- Centre for Research in Autism and Education (CRAE), Department of Psychology and Human Development, IOE, UCL's Faculty of Education and Society, UK
| | | | - Anna Remington
- Centre for Research in Autism and Education (CRAE), Department of Psychology and Human Development, IOE, UCL's Faculty of Education and Society, UK
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33
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Davies J, Remington A, Buckley C, Crane L, Smalley K. 'It seems like a luxury to be able to offer that': Factors influencing the implementation of annual health checks for autistic people in England. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:656-673. [PMID: 37431819 PMCID: PMC10913342 DOI: 10.1177/13623613231182011] [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: 07/12/2023]
Abstract
LAY ABSTRACT Autistic people are more likely to have mental and physical health problems than non-autistic people. Annual health checks could reduce these problems by finding and treating them early. Annual health checks are yearly medical appointments where a primary healthcare provider (such as a doctor or nurse) can check things like a patient's weight and heart rate and ask if they have any worries about their health. In this study, we wanted to understand what might encourage primary healthcare providers to use annual health checks with their autistic patients. First, we spoke to 10 autistic people and 11 primary healthcare providers. Using the findings from these conversations, we created an online survey for primary healthcare providers in England. We used the findings from the interviews and survey to help us understand what would encourage primary healthcare providers to offer annual health checks for autistic people. Our participants said that a lack of time and staff would make it hard to provide health checks. To help, they said other members of staff (such as nurses and healthcare assistants) could do the health checks, rather than doctors. They also said parts of the process could be made automatic to save time (e.g. sending automatic reminders). Knowledge about autism was important too (e.g. knowing about the common conditions autistic people have, and how to best support autistic patients). Participants said training on these topics, produced and delivered with autistic people, could encourage them to use annual health checks with their autistic patients.
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Affiliation(s)
| | | | | | | | - Katelyn Smalley
- University College London, UK
- University of Plymouth, UK
- Imperial College London
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34
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Longo A, Radford D, Hand BN. A US national update of health condition prevalence among privately-insured autistic adults. J Comp Eff Res 2024; 13:e230051. [PMID: 38294339 PMCID: PMC10945414 DOI: 10.57264/cer-2023-0051] [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: 04/08/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024] Open
Abstract
Aim: Previous research using state or regional samples has shown that autistic adults have a higher prevalence of health conditions in comparison to the general population. Methods: To build upon this important previous research, we conducted a cross-sectional retrospective study of 2019-2020 healthcare claims to determine the prevalence of conditions in a US national sample of privately insured autistic adults (n = 30,258) and an age- and sex-matched population comparison (n = 60,516) group of adults without autism diagnoses. Results: Like previous studies, we found that autistic adults had significantly greater odds of most mental and physical health conditions. However, our prevalence estimates differed from previous studies for several mental and physical health conditions. For example, our sample of autistic adults had higher prevalence of anxiety disorders (55%) and attention deficit hyperactivity disorders (34%), but lower prevalence of asthma (9%) and sleep disorders (3%) than previous studies. Discussion & conclusion: Our use of a large US national sample, more recent healthcare claims data, and different methods for identifying health conditions may have contributed to these differences. Our findings alert healthcare providers and policymakers to the health conditions most common among the growing population of autistic adults. We hope these findings lead to improved screening and management of these conditions, inform initiatives to improve access to healthcare, and guide future funding.
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Affiliation(s)
- Anne Longo
- The Ohio State University, 228E Atwell Hall, 453 W 10th Ave, Columbus, OH 43210, USA
| | - Deondray Radford
- The Ohio State University, 228E Atwell Hall, 453 W 10th Ave, Columbus, OH 43210, USA
| | - Brittany N Hand
- The Ohio State University, 228E Atwell Hall, 453 W 10th Ave, Columbus, OH 43210, USA
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35
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Greenwood E, Cooklin A, Barbaro J, Miller C. Autistic patients' experiences of the hospital setting: A scoping review. J Adv Nurs 2024; 80:908-923. [PMID: 37743597 DOI: 10.1111/jan.15880] [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: 04/14/2023] [Revised: 08/25/2023] [Accepted: 09/10/2023] [Indexed: 09/26/2023]
Abstract
AIM To explore the factors that affect the experiences of autistic patients in the hospital setting. DESIGN A scoping review. DATA SOURCES A systematic literature search using the databases CINAHL, Medline and Google Scholar was undertaken in September 2021 and updated in January 2023. This review is based on the methodological framework of Arksey and O'Malley (International Journal of Social Research Methodology, 8(1):19-32, 2005), which was further refined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. RESULTS Autistic patients, as well as their families and healthcare staff, face several barriers that can impact their healthcare experiences within hospital settings. Of 211 articles screened, 30 were eligible and included. Through our review, we identified two main themes. The first theme, 'challenges to hospital experiences', includes four sub-themes: (1) communication, (2) a mismatch between the needs for autistic patients and the hospital environment, (3) challenges related to parents' experiences and (4) challenges related to hospital systems. The second theme, 'facilitators that improve hospital experiences', includes three sub-themes: (1) provision of care pathways, (2) partnership between parents and experts and (3) facilitators to improve hospital systems. By understanding these themes, we can work to address the barriers that autistic patients and their families face, while leveraging the facilitators to improve their hospital experiences. CONCLUSION It is critical to understand the experiences of autistic patients in the hospital setting because they present a substantial risk of hospital admission due to their associated acute to chronic health conditions. Additionally, nurses and other medical staff must understand the unique hospital experiences and challenges of autistic patients to improve care and facilitate better hospital experiences. This review further highlights the crucial need to adopt a collaborative and inclusive approach between autistic patients, their families and healthcare staff. To achieve this, co-design initiatives that incorporate the perspectives and lived experiences of the autistic community are necessary. By placing autistic voices at the forefront of these initiatives, it is hoped that changes are meaningful, relevant and can be sustained. IMPACT Understanding the unique hospital experiences and challenges of autistic patients can improve their quality of life and well-being by reducing stress and anxiety during hospitalization, leading to better health outcomes and potentially shorter hospital stays. It can also promote a more positive view of healthcare among autistic individuals, encouraging them to seek medical care when needed and have broader societal impacts such as reducing healthcare costs and improving the overall health and well-being of the population. Autistic patients present a substantial risk of hospital admission due to their associated acute to chronic conditions. Nurses and other medical staff must understand the unique hospital experiences and challenges of autistic patients to improve care and facilitate better hospital experiences. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Elly Greenwood
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Amanda Cooklin
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Charne Miller
- Department of Nursing, School of Health Sciences, University of Melbourne Affiliated with School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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Huang YH, Wu SI, Lee MJ, Chen YL, Yang YH, Kuo TY, Hung TH, Dewey ME, Stewart R, Chen VCH. Excess Mortality in Individuals with Autism Spectrum Disorder: A Population-Based Cohort Study. Neuropsychiatr Dis Treat 2024; 20:247-255. [PMID: 38348059 PMCID: PMC10860845 DOI: 10.2147/ndt.s437766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/29/2024] [Indexed: 02/15/2024] Open
Abstract
Purpose Autism spectrum disorder (ASD) may be associated with increased mortality, but relevant findings have been inconsistent. The modifying effects of gender and intellectual disability on excess mortality in individuals with ASD are underexplored. Patients and Methods Using Taiwan's National Health Insurance Research Database and the National Death Registry, this population-based cohort study selected the data of 75,946 patients with ASD (ASD cohort) and 75,946 age group-, gender-, and income-matched (1:1) patients without ASD (non-ASD cohort). Cox proportional hazards models were used to compare mortality rates between the cohorts, and stratified analyses were used to evaluate the influence of gender and intellectual disability on mortality risk. Results The ASD cohort had higher mortality rates for all causes of death than did the non-ASD cohort (adjusted hazard ratio 1.64, 95% confidence interval 1.54-1.75). Comorbid intellectual disability was associated with an increased risk of mortality, and this association was stronger in female patients than in male patients. Moreover, when focusing on deaths from natural causes, we found a significantly higher odds ratio for mortality in the ASD population with ID compared to those without ID. Conclusion ASD is associated with increased mortality, especially among female individuals and those with intellectual disability.
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Affiliation(s)
- Yu-Hsin Huang
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Psychiatry, MacKay Memorial Hospital, Taipei City, Taiwan
| | - Shu-I Wu
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Psychiatry, MacKay Memorial Hospital, Taipei City, Taiwan
| | - Min-Jing Lee
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yi-Lung Chen
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
| | - Ting-Yu Kuo
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
| | - Tai-Hsin Hung
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Michael E Dewey
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley National Health Services Foundation Trust, London, UK
| | - Vincent Chin-Hung Chen
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
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Yu EX, Dou JF, Volk HE, Bakulski KM, Benke K, Hertz-Picciotto I, Schmidt RJ, Newschaffer CJ, Feinberg JI, Daniels J, Fallin MD, Ladd-Acosta C, Hamra GB. Prenatal Metal Exposures and Child Social Responsiveness Scale Scores in 2 Prospective Studies. ENVIRONMENTAL HEALTH INSIGHTS 2024; 18:11786302231225313. [PMID: 38317694 PMCID: PMC10840406 DOI: 10.1177/11786302231225313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/20/2023] [Indexed: 02/07/2024]
Abstract
Background Prenatal exposure to metals is hypothesized to be associated with child autism. We aim to investigate the joint and individual effects of prenatal exposure to urine metals including lead (Pb), mercury (Hg), manganese (Mn), and selenium (Se) on child Social Responsiveness Scale (SRS) scores. Methods We used data from 2 cohorts enriched for likelihood of autism spectrum disorder (ASD): Early Autism Risk Longitudinal Investigation (EARLI) and the Markers of Autism Risk in Babies-Learning Early Signs (MARBLES) studies. Metal concentrations were measured in urine collected during pregnancy. We used Bayesian Kernel Machine Regression and linear regression models to investigate both joint and independent associations of metals with SRS Z-scores in each cohort. We adjusted for maternal age at delivery, interpregnancy interval, maternal education, child race/ethnicity, child sex, and/or study site. Results The final analytic sample consisted of 251 mother-child pairs. When Pb, Hg, Se, and Mn were at their 75th percentiles, there was a 0.03 increase (95% credible interval [CI]: -0.11, 0.17) in EARLI and 0.07 decrease (95% CI: -0.29, 0.15) in MARBLES in childhood SRS Z-scores, compared to when all 4 metals were at their 50th percentiles. In both cohorts, increasing concentrations of Pb were associated with increasing values of SRS Z-scores, fixing the other metals to their 50th percentiles. However, all the 95% credible intervals contained the null. Conclusions There were no clear monotonic associations between the overall prenatal metal mixture in pregnancy and childhood SRS Z-scores at 36 months. There were also no clear associations between individual metals within this mixture and childhood SRS Z-scores at 36 months. The overall effects of the metal mixture and the individual effects of each metal within this mixture on offspring SRS Z-scores might be heterogeneous across child sex and cohort. Further studies with larger sample sizes are warranted.
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Affiliation(s)
- Emma X Yu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John F Dou
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Heather E Volk
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Wendy Klag Center for Autism and Developmental Disabilities, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kelly M Bakulski
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Kelly Benke
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Irva Hertz-Picciotto
- Department of Public Health Sciences and the MIND Institute, University of California Davis School of Medicine, Davis, CA, USA
| | - Rebecca J Schmidt
- Department of Public Health Sciences and the MIND Institute, University of California Davis School of Medicine, Davis, CA, USA
| | - Craig J Newschaffer
- Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Jason I Feinberg
- Wendy Klag Center for Autism and Developmental Disabilities, Baltimore, MD, USA
| | - Jason Daniels
- Wendy Klag Center for Autism and Developmental Disabilities, Baltimore, MD, USA
| | | | - Christine Ladd-Acosta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ghassan B Hamra
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Warreman EB, Ester WA, Geurts HM, Vermeiren RRJM, Nooteboom LA. How do primary care providers and autistic adults want to improve their primary care? A Delphi-study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:449-460. [PMID: 37194206 PMCID: PMC10851648 DOI: 10.1177/13623613231172865] [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: 05/18/2023]
Abstract
LAY ABSTRACT Autistic adults often encounter different types of healthcare barriers. Because autistic adults also have an increased risk for health problems, the aim of this study was to evaluate barriers and to explore how primary care providers and autistic adults want to improve their primary healthcare. In this co-created study, semi-structured interviews with three autistic adults, two parents of autistic children and six care providers were performed to evaluate barriers in Dutch healthcare. Next, in the survey-study (using the Delphi-method including controlled feedback in three consecutive questionnaires), 21 autistic adults and 20 primary care providers rated the impact of barriers and the usefulness and feasibility of recommendations to improve primary healthcare. In the interviews, 20 barriers in Dutch healthcare for autistic people were found. In the survey-study, the primary care providers rated the negative impact of most barriers lower than the autistic adults. This survey-study resulted in 22 recommendations to improve primary healthcare focused on: primary care providers (including education in collaboration with autistic people), autistic adults (including improvement of preparation for general practitioner-appointments) and organization of general practice (including improvement of continuity in care). In conclusion, primary care providers seem to view healthcare barriers as less impactful than autistic adults. In this co-created study, recommendations to improve primary healthcare for autistic adults were identified, based on the needs of autistic adults and primary care providers. These recommendations provide a basis for primary care providers, autistic adults and their support network to start conversations about, for example, strategies to improve primary care providers' knowledge, autistic adults' preparation for a general practitioner-appointment and organization of primary care.
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Affiliation(s)
- Eva B Warreman
- Leiden University Medical Center Curium, the Netherlands
| | - Wietske A Ester
- Leiden University Medical Center Curium, the Netherlands
- Parnassia Psychiatric Institute, the Netherlands
- Sarr Autisme Rotterdam, the Netherlands
| | - Hilde M Geurts
- University of Amsterdam, the Netherlands
- Dr. Leo Kannerhuis, Youz, Parnassia Psychiatric Institute, the Netherlands
| | - Robert RJM Vermeiren
- Leiden University Medical Center Curium, the Netherlands
- Parnassia Psychiatric Institute, the Netherlands
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Lee NR, McQuaid GA, Grosman HE, Jayaram S, Wallace GL. Vocational Outcomes in ASD: An Examination of Work Readiness Skills as well as Barriers and Facilitators to Employment Identified by Autistic Adults. J Autism Dev Disord 2024; 54:477-490. [PMID: 36394783 PMCID: PMC9670084 DOI: 10.1007/s10803-022-05804-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2022] [Indexed: 11/18/2022]
Abstract
Little is known about work readiness skills among autistic adults. This study sought to address this by examining work readiness skills and their relation to vocational outcomes among 281 autistic young adults. It also examined perceived barriers and facilitators to employment as articulated by a subset of autistic adults. Results revealed a variegated work readiness profile. Stronger work readiness skills (particularly work style/adaptability) were associated with more favorable vocational outcomes. Autistic participants articulated both barriers and facilitators to employment related to the autism phenotype, job search/work readiness, and workplace education. These findings indicate the need for research on phenotype-driven vocational rehabilitation strategies as well as workplace psychoeducation/accommodations to support vocational outcomes for autistic adults.
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Affiliation(s)
- Nancy Raitano Lee
- Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street, Stratton 119, Philadelphia, PA, 19104, USA.
| | - Goldie A McQuaid
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Hannah E Grosman
- Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street, Stratton 119, Philadelphia, PA, 19104, USA
| | - Sanjana Jayaram
- Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, DC, USA
| | - Gregory L Wallace
- Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, DC, USA
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40
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Arnold SRC, Bruce G, Weise J, Mills CJ, Trollor JN, Coxon K. Barriers to healthcare for Australian autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:301-315. [PMID: 37161777 PMCID: PMC10851652 DOI: 10.1177/13623613231168444] [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: 05/11/2023]
Abstract
LAY ABSTRACT This study looked at how Australian autistic and non-autistic adults experience barriers to healthcare. We asked autistic and non-autistic adults to complete the Barriers to Healthcare Checklist Short-Form (BHC). We analysed data from 263 autistic adults and 70 non-autistic adults. We found that autistic adults experienced more barriers to healthcare than non-autistic adults. Gender diversity, feeling more anxious, having greater disability and feeling unsatisfied with social support contributed to barriers to healthcare in autistic participants. We recommend interventions such as developing and implementing a national action plan, similar to the National Roadmap for Improving the Health of People with Intellectual Disability (2021) to reduce barriers and address unmet healthcare needs of Australian autistic adults. We also recommend working with autistic adults to develop new policies and strategies, implementing environmental adaptations to health care facilities, and increasing Autism education opportunities for health professionals to address gaps in knowledge.
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Affiliation(s)
- Samuel RC Arnold
- UNSW Sydney, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
| | | | | | | | - Julian N Trollor
- UNSW Sydney, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
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Bitektine E, Hintermayer MA, Chen A, Ko A, Rodriguez C. Medical students' perceptions on preparedness and care delivery for patients with autism or intellectual disability. CANADIAN MEDICAL EDUCATION JOURNAL 2024; 15:37-47. [PMID: 38528903 PMCID: PMC10961132 DOI: 10.36834/cmej.76338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Introduction To provide competent care to patients with autism spectrum disorder (ASD) or intellectual developmental disorder (IDD), healthcare professionals must recognize the needs of neurodivergent populations and adapt their clinical approach. We assessed the perceived preparedness of medical students to adapt care delivery for patients with ASD/IDD, as well as their perceptions on neurodiversity education. Methods We conducted a sequential explanatory mixed-methods study on undergraduate medical students at McGill University during the academic year 2020-2021. We administered an online survey, followed by semi-structured interviews. We analyzed data using descriptive statistics and thematic analysis. We integrated findings at the interpretation level. Results We included two-hundred-ten survey responses (~29% of class), and 12 interviews. Few students felt prepared to adjust care for patients with ASD/IDD despite most indicating doing so was important. Ninety-seven percent desired more training regarding care accommodation for neurodivergent patients. Thematic analysis unveiled the perception of current insufficient education, and the value of experiential learning. Discussion/Conclusions This study highlights low perceived preparedness of medical students to accommodate care for neurodivergent patients, and a desire for more instruction. Incorporating interactive training in medical school curricula regarding modifying care delivery for neurodivergent individuals may improve the perceived preparedness of medical trainees to work with these patients and care quality.
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Affiliation(s)
- E Bitektine
- Department of Medicine and Dentistry, McGill University, Quebec, Canada
| | - M A Hintermayer
- Department of Medicine and Dentistry, McGill University, Quebec, Canada
- Montreal Neurological Institute, McGill University, Quebec, Canada
| | - A Chen
- Department of Medicine and Dentistry, McGill University, Quebec, Canada
| | - A Ko
- Department of Medicine and Dentistry, McGill University, Quebec, Canada
| | - C Rodriguez
- Department of Family Medicine, School of Medicine, Faculty of Medicine and Health Sciences, McGill University, Quebec, Canada
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Quebec, Canada
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Dunsky A, Barak S. Health Promotion with Long-Term Physical Activity Program for Adults with Autism Spectrum Disorder. Healthcare (Basel) 2024; 12:247. [PMID: 38255134 PMCID: PMC10815153 DOI: 10.3390/healthcare12020247] [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] [Received: 12/05/2023] [Revised: 12/31/2023] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Individuals with autism spectrum disorder (ASD) are at higher risk for developing common chronic diseases. Engagement in physical activity (PA) can prevent health issues; however, people with ASD are known to engage in lower levels of PA in comparison to their peers. This study evaluated the effect of a long-term, 12-month PA intervention on the fitness and quality of life of adults with ASD. A quantitative approach was implemented to assess participants' fitness, functional ability, quality of life, and participation in a range of PA classes at three different time points. Qualitative data were collected via in-depth, semi-structured interviews with three participants with ASD and three staff members. A total of 34 adults with ASD (mean age 39.76 + 7.27) participated in the quantitative part of the study. Approximately 53% of the participants exhibited perseverance and conducted adequate PA each month. Significant improvements were found in one fitness component and two quality-of-life components. Factors revealed for the program's success were the individuals' free choice of the PA classes and supporting people and a budget that tailored the project. Policymakers who plan health promotion programs for adults with ASD should consider long-term PA programs, with freedom of choice among PA modalities and schedules.
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Affiliation(s)
- Ayelet Dunsky
- Department of Human Movement and Sport Sciences, The Levinsky-Wingate Academic College, Netanya 4290200, Israel;
| | - Sharon Barak
- Nursing Department, School of Health Sciences, Ariel University, Ariel 40700, Israel
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children’s Hospital, The Chaim Sheba Medical Center, Ramat-Gan 52621, Israel
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McKenna K, Prasad S, Cooper J, King AM, Shahzeidi S, Mittal J, Zalta M, Mittal R, Eshraghi AA. Incidence of Otolaryngological Manifestations in Individuals with Autism Spectrum Disorder: A Special Focus on Auditory Disorders. Audiol Res 2024; 14:35-61. [PMID: 38247561 PMCID: PMC10801499 DOI: 10.3390/audiolres14010005] [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: 10/16/2023] [Revised: 12/14/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024] Open
Abstract
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by stereotyped and repetitive behavior patterns. In addition to neurological and behavioral problems, individuals with ASD commonly experience otolaryngological comorbidities. Individuals with ASD often have auditory disorders including hearing loss and auditory processing disorders such as central auditory processing disorder (CAPD), as well as both chronic and recurrent otitis media. These challenges negatively impact a person's ability to effectively communicate and may further impact their neurological functioning, particularly when not appropriately treated. Individuals diagnosed with ASD also have difficulty sleeping which contributes to increased irritability and may further aggravate the core behavioral symptoms of autism. The individuals with ASD also have a higher rate of sinusitis which contributes to the worsening of the autism behavior phenotype. The high prevalence of otolaryngological comorbidities in individuals with ASD warrants a better collaboration between their various healthcare providers and otolaryngologists with expertise in auditory, sleep, and sinus disorders in pursuit of improving the quality of life of affected individuals and their families/caregivers.
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Affiliation(s)
- Keelin McKenna
- Hearing Research and Cochlear Implant Laboratory, Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (K.M.); (S.P.); (J.C.); (A.M.K.); (J.M.); (R.M.)
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Soumil Prasad
- Hearing Research and Cochlear Implant Laboratory, Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (K.M.); (S.P.); (J.C.); (A.M.K.); (J.M.); (R.M.)
| | - Jaimee Cooper
- Hearing Research and Cochlear Implant Laboratory, Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (K.M.); (S.P.); (J.C.); (A.M.K.); (J.M.); (R.M.)
- School of Medicine, New York Medical College, Valhalla, NY 10595, USA
| | - Ava M. King
- Hearing Research and Cochlear Implant Laboratory, Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (K.M.); (S.P.); (J.C.); (A.M.K.); (J.M.); (R.M.)
| | | | - Jeenu Mittal
- Hearing Research and Cochlear Implant Laboratory, Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (K.M.); (S.P.); (J.C.); (A.M.K.); (J.M.); (R.M.)
| | - Max Zalta
- Hearing Research and Cochlear Implant Laboratory, Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (K.M.); (S.P.); (J.C.); (A.M.K.); (J.M.); (R.M.)
| | - Rahul Mittal
- Hearing Research and Cochlear Implant Laboratory, Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (K.M.); (S.P.); (J.C.); (A.M.K.); (J.M.); (R.M.)
| | - Adrien A. Eshraghi
- Hearing Research and Cochlear Implant Laboratory, Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (K.M.); (S.P.); (J.C.); (A.M.K.); (J.M.); (R.M.)
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL 33146, USA
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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Oshima F, Takahashi T, Tamura M, Guan S, Seto M, Hull L, Mandy W, Tsuchiya K, Shimizu E. The association between social camouflage and mental health among autistic people in Japan and the UK: a cross-cultural study. Mol Autism 2024; 15:1. [PMID: 38178255 PMCID: PMC10768303 DOI: 10.1186/s13229-023-00579-w] [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] [Received: 08/08/2023] [Accepted: 12/10/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND To examine the relationship between social camouflage and mental health in Japanese autistic adults and make an international comparison with a sample from the UK. METHODS This study analysed secondary data of participants with a self-reported diagnosis of autism from Japan (N = 210; 123 men and 87 women) and the UK (N = 305; 181 women, 104, men, and 18 nonbinary). The relationships between the quadratic term of the Camouflaging Autistic Traits Questionnaire and mental health scales, including depression and anxiety, were assessed. RESULTS The UK sample showed linear relationships, whereas the Japanese sample showed significant nonlinear relationships. The quadratic terms of the Camouflaging Autistic Traits Questionnaire slightly explained generalised anxiety (β = .168, p = .007), depression (β = .121, p = .045), and well-being (β = - .127, p = .028). However, they did not explain the association between social anxiety and the Camouflaging Autistic Traits Questionnaire. LIMITATIONS Participants had self-reported diagnoses, and while the autism-spectrum quotient provides a cut-off value for screening, it does not enable confirming diagnoses. Mean scores of the Japanese version of the Camouflaging Autistic Traits Questionnaire were lower as compared to the original CAT-Q, which implies that the social camouflage strategy types used by autistic people in Japan and the UK could differ. The cross-sectional design limits causal inferences. CONCLUSION In the UK, more social camouflage was associated with poorer mental health scores, whereas too little or too much social camouflage was associated with a low mental health score in Japan. The Japanese population is seemingly less aware of and educated on autistic characteristics and considers 'average' behaviour a good thing. This could influence Japanese autistic people's social camouflage use, differing from that of autistic people in the UK. The differences in the relationship between social camouflage and mental health between Japan and the UK could be associated with national-level divergence regarding the culture of autism.
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Affiliation(s)
- Fumiyo Oshima
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuouku, Chiba, 260-8670, Japan.
- United Graduate School of Child Development, Osaka University, Kanazawa University; Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Osaka, Japan.
| | - Toru Takahashi
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Masaki Tamura
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Siqing Guan
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuouku, Chiba, 260-8670, Japan
- Graduate School of Human Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Mikuko Seto
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuouku, Chiba, 260-8670, Japan
| | - Laura Hull
- Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - William Mandy
- Research Department for Clinical, Educational & Health Psychology, University College London, London, UK
| | - Kenji Tsuchiya
- United Graduate School of Child Development, Osaka University, Kanazawa University; Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Osaka, Japan
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuouku, Chiba, 260-8670, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University; Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Osaka, Japan
- Graduate School of Human Sciences, Waseda University, Tokorozawa, Saitama, Japan
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Dey I, Chakrabarty S, Nandi R, Shekhar R, Singhi S, Nayar S, Ram JR, Mukerji S, Chakrabarti B. Autism community priorities in diverse low-resource settings: A country-wide scoping exercise in India. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:187-198. [PMID: 36999343 PMCID: PMC10771024 DOI: 10.1177/13623613231154067] [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: 04/01/2023]
Abstract
LAY ABSTRACT It is vital to directly engage with the autism community in order to develop better services and drive the research agenda. While some studies in high-income countries have mapped the priorities of the autism community, there is a severe dearth of such efforts in the global south. Five million autistic individuals are estimated to live in India alone, and there has been little effort to map their priorities. Moreover, studies in high-income countries focused largely on research priorities, and not so much on skills training and interventions. Keeping these needs in mind, we conducted an online survey followed by an in-depth conversation with parents of autistic children and autistic adults drawn from across India. We found that the respondents reported self-help skills to be the most important for training, as they considered it fundamental for every other aspect of life. Speech and language therapy was considered to be the highest intervention priority for this group, highlighting the importance of social communication. Mental health counselling was also considered to be a high priority, but several parents identified it as being more relevant for themselves rather than for their children. Within research, the topmost priority was to understand ways in which the community can better support autistic people. We hope that these findings will help researchers, policymakers and service providers to be able to make well-informed decisions, develop relevant services and shape future research.
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Affiliation(s)
| | | | | | | | | | - Shoba Nayar
- Auckland University of Technology, New Zealand
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Plourde ER, Ali MM, West KD. Psychotropic Medication and Psychosocial Service Use Among Transition Age Youth With Autism Spectrum Disorder. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2024; 129:1-9. [PMID: 38147886 DOI: 10.1352/1944-7558-129.1.1] [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: 04/27/2022] [Accepted: 02/21/2023] [Indexed: 12/28/2023]
Abstract
People with autism spectrum disorder (ASD) experience high rates of psychotropic medication utilization and barriers to psychosocial services, yet limited literature explores use of these services and the association between a mental health condition (MH) and use. Using national multipayer claims data, this study estimates a multinomial logistic regression model to discern psychotropic medication and psychosocial service use among transition age youth (TAY) with ASD (12-26 years; N = 52,083) compared to a matched cohort of those without ASD (12-26 years; N = 52,083). Approximately one-third of TAY with ASD and no MH condition receive only psychotropic medication and the likelihood of using both psychosocial services and medication is higher only when TAY with ASD have a co-occurring MH condition.
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Affiliation(s)
- Emma R Plourde
- Emma R. Plourde, Mir M. Ali, and Kristina D. West, U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning & Evaluation
| | - Mir M Ali
- Emma R. Plourde, Mir M. Ali, and Kristina D. West, U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning & Evaluation
| | - Kristina D West
- Emma R. Plourde, Mir M. Ali, and Kristina D. West, U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning & Evaluation
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Yenkoyan K, Mkhitaryan M, Bjørklund G. Environmental Risk Factors in Autism Spectrum Disorder: A Narrative Review. Curr Med Chem 2024; 31:2345-2360. [PMID: 38204225 DOI: 10.2174/0109298673252471231121045529] [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] [Received: 03/08/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 01/12/2024]
Abstract
Existing evidence indicates that environmental factors might contribute up to 50% of the variance in autism spectrum disorder (ASD) risk. This structured narrative review offers a comprehensive synthesis of current knowledge on environmental risk factors in ASD, including evaluation of conflicting evidence, exploration of underlying mechanisms, and suggestions for future research directions. Analysis of diverse epidemiological investigations indicates that certain environmental factors, including advanced parental age, preterm birth, delivery complications, and exposure to toxic metals, drugs, air pollutants, and endocrine-disrupting chemicals, are linked to an increased ASD risk through various mechanisms such as oxidative stress, inflammation, hypoxia, and its consequences, changes in neurotransmitters, disruption of signaling pathways and some others. On the other hand, pregnancy-related factors such as maternal diabetes, maternal obesity, and caesarian section show a weaker association with ASD risk. At the same time, other environmental factors, such as vaccination, maternal smoking, or alcohol consumption, are not linked to the risk of ASD. Regarding nutritional elements data are inconclusive. These findings highlight the significance of environmental factors in ASD etiology and emphasize that more focused research is needed to target the risk factors of ASD. Environmental interventions targeting modifiable risk factors might offer promising avenues for ASD prevention and treatment.
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Affiliation(s)
| | - Meri Mkhitaryan
- Neuroscience Laboratory, Cobrain Center, YSMU, Yerevan, 0025, Armenia
| | - Geir Bjørklund
- Department of Research, Council for Nutritional and Environmental Medicine, Mo i Rana, Norway
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O'Nions E, Lewer D, Petersen I, Brown J, Buckman JE, Charlton R, Cooper C, El Baou CÉ, Happé F, Manthorpe J, McKechnie DG, Richards M, Saunders R, Zanker C, Mandy W, Stott J. Estimating life expectancy and years of life lost for autistic people in the UK: a matched cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2024; 36:100776. [PMID: 38188276 PMCID: PMC10769892 DOI: 10.1016/j.lanepe.2023.100776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 01/09/2024]
Abstract
Background Previous research has shown that people who have been diagnosed autistic are more likely to die prematurely than the general population. However, statistics on premature mortality in autistic people have often been misinterpreted. In this study we aimed to estimate the life expectancy and years of life lost experienced by autistic people living in the UK. Methods We studied people in the IQVIA Medical Research Database with an autism diagnosis between January 1, 1989 and January 16, 2019. For each participant diagnosed autistic, we included ten comparison participants without an autism diagnosis, matched by age, sex, and primary care practice. We calculated age- and sex-standardised mortality ratios comparing people diagnosed autistic to the reference group. We used Poisson regression to estimate age-specific mortality rates, and life tables to estimate life expectancy at age 18 and years of life lost. We analysed the data separately by sex, and for people with and without a record of intellectual disability. We discuss the findings in the light of the prevalence of recorded diagnosis of autism in primary care compared to community estimates. Findings From a cohort of nearly 10 million people, we identified 17,130 participants diagnosed autistic without an intellectual disability (matched with 171,300 comparison participants), and 6450 participants diagnosed autistic with an intellectual disability (matched with 64,500 comparison participants). The apparent estimates indicated that people diagnosed with autism but not intellectual disability had 1.71 (95% CI: 1.39-2.11) times the mortality rate of people without these diagnoses. People diagnosed with autism and intellectual disability had 2.83 (95% CI: 2.33-3.43) times the mortality rate of people without these diagnoses. Likewise, the apparent reduction in life expectancy for people diagnosed with autism but not intellectual disability was 6.14 years (95% CI: 2.84-9.07) for men and 6.45 years (95% CI: 1.37-11.58 years) for women. The apparent reduction in life expectancy for people diagnosed with autism and intellectual disability was 7.28 years (95% CI: 3.78-10.27) for men and 14.59 years (95% CI: 9.45-19.02 years) for women. However, these findings are likely to be subject to exposure misclassification biases: very few autistic adults and older-adults have been diagnosed, meaning that we could only study a fraction of the total autistic population. Those who have been diagnosed may well be those with greater support needs and more co-occurring health conditions than autistic people on average. Interpretation The findings indicate that there is a group of autistic people who experience premature mortality, which is of significant concern. There is an urgent need for investigation into the reasons behind this. However, our estimates suggest that the widely reported statistic that autistic people live 16-years less on average is likely incorrect. Nine out of 10 autistic people may have been undiagnosed across the time-period studied. Hence, the results of our study do not generalise to all autistic people. Diagnosed autistic adults, and particularly older adults, are likely those with greater-than-average support needs. Therefore, we may have over-estimated the reduction in life expectancy experienced by autistic people on average. The larger reduction in life expectancy for women diagnosed with autism and intellectual disability vs. men may in part reflect disproportionate underdiagnosis of autism and/or intellectual disability in women. Funding Dunhill Medical Trust, Medical Research Council, National Institute for Health and Care Research, and the Royal College of Psychiatrists.
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Affiliation(s)
- Elizabeth O'Nions
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, 1 – 19 Torrington Place, London, WC1E 7HB, UK
| | - Dan Lewer
- Institute of Epidemiology and Healthcare, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Irene Petersen
- UCL Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | - Jude Brown
- National Autistic Society, 393 City Rd, London, EC1V 1NG, UK
| | - Joshua E.J. Buckman
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, 1 – 19 Torrington Place, London, WC1E 7HB, UK
- iCope – Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, NW1 0PE, UK
| | - Rebecca Charlton
- Department of Psychology, Goldsmiths University of London, New Cross, London, SE14 6NW, UK
| | - Claudia Cooper
- Queen Mary University of London, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, London, E1 2AD, UK
| | - CÉline El Baou
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, 1 – 19 Torrington Place, London, WC1E 7HB, UK
| | - Francesca Happé
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Memory Lane, London, SE5 8AF, UK
| | - Jill Manthorpe
- NIHR Health & Social Care Workforce Research Unit, King's College London, Strand, London, WC2R 2LS, UK
| | - Douglas G.J. McKechnie
- UCL Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Rob Saunders
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, 1 – 19 Torrington Place, London, WC1E 7HB, UK
| | | | - Will Mandy
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, 1 – 19 Torrington Place, London, WC1E 7HB, UK
| | - Joshua Stott
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, 1 – 19 Torrington Place, London, WC1E 7HB, UK
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Warreman EB, Nooteboom LA, Leenen PJM, Geurts HM, Terry MB, Bos JHJ, Hak E, Hoek HW, van Rossum EFC, Vermeiren RRJM, Ester WA. Metabolic syndrome in adults with autistic traits: associated psychological, behavioral, and biological factors in females and males - a PharmLines initiative. Front Psychiatry 2023; 14:1303840. [PMID: 38193131 PMCID: PMC10773724 DOI: 10.3389/fpsyt.2023.1303840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/30/2023] [Indexed: 01/10/2024] Open
Abstract
Background While cardiovascular diseases is highly prevalent and an important cause of mortality in autistic adults, knowledge on their increased cardiovascular risk is limited. Hence, this study aimed to investigate psychological, behavioral, and physical factors associated with metabolic syndrome (MetS) in adults with autistic traits. Methods In total, 17,705 adults from the Lifelines Cohort were included and categorized using Autism Spectrum Quotient-10 sum-scores. The quartiles with highest (HQ-traits-group females: n = 2,635; males: n = 1803) and lowest levels of autistic traits (LQ-traits-group, n = idem) were analyzed. Using multivariable logistic regression, the associations between MetS and (self-reported and interviewed) psychological, behavioral, and physically measured factors in these stratified groups were investigated. Results Among females, MetS was more common in the HQ-traits-group than in the LQ-traits-group (10.0% versus 7.5%, p < 0.01), while this was not the case among males (HQ-traits-group 13.8% versus LQ-traits-group 13.1%, p = 0.52). In both the female and male HQ-traits-group, the presence of MetS was associated with poorer self-reported health, less daily physical activity, and altered leukocyte counts. Conclusion These findings underline the relevance of adequate cardiovascular prevention in adults with higher levels of autistic traits. Future research could gain more insight into the relationship between cardiovascular risk and autistic traits in females, and into tailored cardiovascular prevention.
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Affiliation(s)
- E. B. Warreman
- Department of Child and Adolescent Psychiatry, LUMC Curium, Leiden University Medical Center, Oegstgeest, Netherlands
| | - L. A. Nooteboom
- Department of Child and Adolescent Psychiatry, LUMC Curium, Leiden University Medical Center, Oegstgeest, Netherlands
| | - P. J. M. Leenen
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - H. M. Geurts
- Dutch Autism and ADHD Research Center, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
- Dr. Leo Kannerhuis, Youz, Parnassia Group, Amsterdam, Netherlands
| | - M. B. Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - J. H. J. Bos
- Groningen Research Institute of Pharmacy, PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen, Netherlands
| | - E. Hak
- Groningen Research Institute of Pharmacy, PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen, Netherlands
| | - H. W. Hoek
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
- Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
- Parnassia Group, Youz, The Hague, Netherlands
| | - E. F. C. van Rossum
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - R. R. J. M. Vermeiren
- Department of Child and Adolescent Psychiatry, LUMC Curium, Leiden University Medical Center, Oegstgeest, Netherlands
- Parnassia Group, Youz, The Hague, Netherlands
| | - W. A. Ester
- Department of Child and Adolescent Psychiatry, LUMC Curium, Leiden University Medical Center, Oegstgeest, Netherlands
- Parnassia Group, Youz, The Hague, Netherlands
- Sarr Autism Rotterdam, Youz, Parnassia Group, Rotterdam, Netherlands
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50
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Moore HL, Cassidy S, Rodgers J. Exploring the mediating effect of camouflaging and the moderating effect of autistic identity on the relationship between autistic traits and mental wellbeing. Autism Res 2023. [PMID: 38108621 DOI: 10.1002/aur.3073] [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: 05/04/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Abstract
Mental health difficulties are prevalent among autistic adults. Camouflaging (behaving differently to fit in) may be a mechanism by which autistic traits and mental health difficulties relate to each other, but little research has considered the role of different facets of camouflaging. Additionally, autistic identity might buffer against camouflaging and mental health difficulties. This research aims to explore the mediating effects of camouflaging behaviours on the relationship between autistic traits and both positive and negative mental wellbeing, as well as how autistic identity might moderate the relationship between autistic traits and camouflaging, and also mental health. Data were available for 627 autistic adults, recruited through volunteer databases and social media. Participants completed measures of autistic traits, anxiety, depression, positive wellbeing, camouflaging behaviours (compensating for difficulties, masking, and assimilating/putting on an act) and autistic identity. Mediation and moderated mediation models were tested, applying 95% bootstrapped CIs (10,000 resamples) and including age, gender and diagnosis as covariates. There were no significant direct effects between autistic traits and mental wellbeing. Assimilation was a significant mediator of all mental wellbeing measures, and compensation was a significant mediator of positive wellbeing only. Autistic identity was not a significant moderator. Assimilation and compensation should be considered when offering psychological interventions to support mental wellbeing of autistic people. Additional research into external drivers of camouflaging (e.g. stigma) and mechanisms by which camouflaging impacts mental wellbeing, such as autonomy, authenticity, skill mastery and community, may identify other areas of support. Concurrently, societal change is necessary to reduce the need to camouflage.
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Affiliation(s)
| | - Sarah Cassidy
- School of Psychology, University of Nottingham, University Park, Nottingham, UK
| | - Jacqui Rodgers
- Population Health Sciences Institute, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
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