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Waizbard-Bartov E, Ferrer E, Heath B, Andrews DS, Rogers S, Kerns CM, Wu Nordahl C, Solomon M, Amaral DG. Changes in the severity of autism symptom domains are related to mental health challenges during middle childhood. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1216-1230. [PMID: 37691349 PMCID: PMC10924781 DOI: 10.1177/13623613231195108] [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: 09/12/2023]
Abstract
LAY ABSTRACT For many autistic children, the severity of their autism symptoms changes during middle childhood. We studied whether these changes are associated with the emergence of other mental health challenges such as anxiety and attention-deficit hyperactivity disorder. Children who had increased social-communication challenges had more anxiety and attention-deficit hyperactivity disorder symptoms and disruptive behavior problems than other children. Children who decreased their restricted and repetitive behaviors, on the contrary, had more anxiety. We discuss why these changes in autism symptoms may lead to increases in other mental health concerns.
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Orsmond GI, Krishnan SG, Munsell EGS, Cohn ES, Coster WJ. Describing Outcomes in Autistic Young Adults One Year After High School Graduation. J Autism Dev Disord 2024:10.1007/s10803-023-06152-x. [PMID: 38285097 DOI: 10.1007/s10803-023-06152-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE Research documents poor outcomes for autistic adults in the domains of employment, independent living, and social relationships. Measurement and sample limitations in prior studies may have amplified past estimates of poor outcomes. The goal of the current study was to improve upon past approaches and to create and describe a measurement approach to capture adult outcomes that reflected the context of young adulthood and the perspectives of autistic individuals, pairing objective outcome indicators with subjective satisfaction indicators. METHODS Thirty-six autistic young adults (mean age 19.8 years) and a parent completed self-report surveys. Using these data, we defined an objective and subjective (i.e., satisfaction) outcome indicator in each of three domains: productivity (employment or post-secondary education), social well-being (frequency of contact with friends), and living situation (autonomy). RESULTS Three-quarters of young adults experienced at least 5 out of 6 positive outcomes. Over 90% were engaged in school, work, or a structured transition program, and an equal percentage were satisfied with their productivity activity. Over three-quarters of adults had a good amount of contact with friends and were satisfied with their social life. Most young adults had a moderate level of autonomy in their daily lives, and all were satisfied with their living situation. CONCLUSION Tailoring outcome measurement approaches specifically for autistic young adults provided a more optimistic portrayal of outcomes than previously noted in the literature. The approach used better reflects a neurodiversity approach and may be useful for evaluating the effectiveness of transition services or interventions.
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Affiliation(s)
- Gael I Orsmond
- Department of Occupational Therapy, Boston University, 635 Commonwealth Ave, Boston, MA, 02215, USA.
| | - Sharada G Krishnan
- Department of Occupational Therapy, Boston University, 635 Commonwealth Ave, Boston, MA, 02215, USA
| | | | - Ellen S Cohn
- Department of Occupational Therapy, Boston University, 635 Commonwealth Ave, Boston, MA, 02215, USA
| | - Wendy J Coster
- Department of Occupational Therapy, Boston University, 635 Commonwealth Ave, Boston, MA, 02215, USA
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Tsiplova K, Ungar WJ. Why it is so challenging to perform economic evaluations of interventions in autism and what to do about it. Autism Res 2023; 16:2061-2070. [PMID: 37606004 DOI: 10.1002/aur.3014] [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: 06/20/2022] [Accepted: 07/29/2023] [Indexed: 08/23/2023]
Abstract
Economic evaluation is used to determine the optimal provision of services and programs under budget constraints and to inform public and private payer funding decisions. To maximize value-for-money in the design and delivery of programs and services for persons with autism spectrum disorder (ASD), it's essential to generate high-quality economic evidence to inform budget allocation. There is a paucity however, of economic evaluations of interventions for ASD. This is due in part to challenges in conducting economic evaluations in this population and the lack of guidance on suitable approaches. These challenges are related to the inherent heterogeneity of the autistic population; establishing short- and long-term effectiveness; measurement of costs and the availability of valid instruments for collecting economic data; the appropriateness of outcomes for use in economic evaluation; and achieving statistical power. This commentary addresses a lack of awareness and needed guidance on these issues by discussing the challenges and providing recommendations for how economic evaluations in ASD could be improved to generate high-quality evidence for program funding decision-making.
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Affiliation(s)
- Kate Tsiplova
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Wendy J Ungar
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Kang E, Lerner MD, Gadow KD. The Importance of Parent-Teacher Informant Discrepancy in Characterizing Autistic Youth: A Replication Latent Profile Analysis. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:108-118. [PMID: 36548459 PMCID: PMC9921175 DOI: 10.1080/15374416.2022.2154217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Research about autism spectrum disorder (ASD) supports variation in symptom presentations across settings, and there is a growing literature that explicates how this variability may improve characterization of the autism phenotype. Capitalizing on a well-established literature on informant discrepancy as an index of contextual variability, research suggests that differing parent and teacher perceptions may impact treatment or education-related outcomes. A prior investigation by Lerner and colleagues suggests that parent-teacher discrepancies in ASD symptom ratings define discrete and clinically meaningful subgroups. However, replication in a larger sample is important to support the validity and utility of the subgroups for use in research and practice. METHOD The present paper used latent profile analysis (LPA) to (1) replicate the previous study by Lerner and colleagues in a larger sample of 514 clinic-referred autistic youth (aged 6-18, 83.2% male, 90.4% White, IQ 19-140) and (2) determine if parent-teacher informant discrepancies relate to clinical and functional correlates. We hypothesized that parent-teacher discrepancies in ASD symptom severity ratings would validly characterize ASD subgroups and predict clinical and functional correlates. RESULTS The results of the LPA supported a 4-profile solution made up of two parent-teacher agreement groups (high parent-teacher, 21.2%, and low parent-teacher, 34.2%) and two parent-teacher discrepancy groups (high parent-low teacher, 18.1%, and moderate parent-high teacher, 26.5%), replicating findings from Lerner and colleagues. Latent profile membership differentially predicted IQ, age, and educational outcomes of participants. CONCLUSIONS Unique, clinically useful information about the taxonomy and impact of ASD is obtained by considering informant discrepancies in symptom severity ratings, which underscores the importance of considering contextual variability assessed through multiple informants.
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Affiliation(s)
- Erin Kang
- Psychology Department, Montclair State University
| | | | - Kenneth D Gadow
- Department of Psychiatry, Stony Brook University School of Medicine
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5
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Kwon H, Kim JI, Son SY, Jang YH, Kim BN, Lee HJ, Lee JM. Sparse Hierarchical Representation Learning on Functional Brain Networks for Prediction of Autism Severity Levels. Front Neurosci 2022; 16:935431. [PMID: 35873817 PMCID: PMC9301472 DOI: 10.3389/fnins.2022.935431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Machine learning algorithms have been widely applied in diagnostic tools for autism spectrum disorder (ASD), revealing an altered brain connectivity. However, little is known about whether an magnetic resonance imaging (MRI)-based brain network is related to the severity of ASD symptoms in a large-scale cohort. We propose a graph convolution neural network-based framework that can generate sparse hierarchical graph representations for functional brain connectivity. Instead of assigning initial features for each node, we utilized a feature extractor to derive node features and the extracted representations can be fed to a hierarchical graph self-attention framework to effectively represent the entire graph. By incorporating connectivity embeddings in the feature extractor, we propose adjacency embedding networks to characterize the heterogeneous representations of the brain connectivity. Our proposed model variants outperform the benchmarking model with different configurations of adjacency embedding networks and types of functional connectivity matrices. Using this approach with the best configuration (SHEN atlas for node definition, Tikhonov correlation for connectivity estimation, and identity-adjacency embedding), we were able to predict individual ASD severity levels with a meaningful accuracy: the mean absolute error (MAE) and correlation between predicted and observed ASD severity scores resulted in 0.96, and r = 0.61 (P < 0.0001), respectively. To obtain a better understanding on how to generate better representations, we investigate the relationships between the extracted feature embeddings and the graph theory-based nodal measurements using canonical correlation analysis. Finally, we visualized the model to identify the most contributive functional connections for predicting ASD severity scores.
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Affiliation(s)
- Hyeokjin Kwon
- Department of Electronic Engineering, Hanyang University, Seoul, South Korea
| | - Johanna Inhyang Kim
- Department of Psychiatry, Hanyang University Medical Center, Seoul, South Korea
| | - Seung-Yeon Son
- Department of Artificial Intelligence, Hanyang University, Seoul, South Korea
| | - Yong Hun Jang
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea
| | - Bung-Nyun Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun Ju Lee
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
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Kuhn J, Szidon K, Kraemer B, Steinbrenner JR, Tomaszewski B, Hume K, DaWalt L. Implementation of a multi-family autism transition program in the high school setting. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:615-627. [PMID: 34991370 DOI: 10.1177/13623613211065533] [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: 11/15/2022]
Abstract
LAY ABSTRACT Transitioning Together is an intervention that supports families of adolescents on the autism spectrum as they prepare for the transition to adulthood. While it has been delivered successfully and shown to result in positive outcomes for families in the university setting, questions remain about whether and how well it can be widely provided to families in real-world settings such as high schools. In this study, we analyzed predictors, facilitators, and barriers to providing Transitioning Together to families at 30 high schools across three US states, all of which received training from a team of researchers to deliver this intervention. Our findings highlight struggles and successes with real-world use of the intervention. Seventeen of the 30 schools were successful in providing Transitioning Together to families. Schools who had higher community socioeconomic status, higher quality family involvement, and higher quality transition planning programming before changing anything for this study were much more likely to provide this new intervention to families. Schools who used the intervention were mostly able to deliver it as designed and received positive feedback from families who participated. Common parts of the intervention that schools struggled with most included following the structure of the sessions, including group problem-solving and dialogue in the sessions, and collecting feedback from families. Future research is needed to learn how to make it even easier for public high schools and other service systems to provide this intervention to families, in a way that also maximizes its effectiveness and accessibility for historically underserved autism spectrum populations.
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Affiliation(s)
| | | | | | | | | | - Kara Hume
- University of North Carolina-Chapel Hill, USA
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7
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Bellon-Harn ML, Boyd RL, Manchaiah V. Applied Behavior Analysis as Treatment for Autism Spectrum Disorders: Topic Modeling and Linguistic Analysis of Reddit Posts. FRONTIERS IN REHABILITATION SCIENCES 2022; 2:682533. [PMID: 36188818 PMCID: PMC9397756 DOI: 10.3389/fresc.2021.682533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022]
Abstract
Background: It is critical for professionals to understand the discourse landscape within various online and social media outlets in order to support families of children with autism in treatment decision-making. This need is heightened when considering treatments that have garnered excitement and controversy, such as applied behavioral analysis (ABA) therapy. Method: The specific aims of this study were to identify the main themes in Reddit posts about ABA-based interventions for autism using topic modeling, to examine the linguistic aspects of Reddit conversations using the Linguistic Inquiry and Word Count (LIWC) analysis, and to examine the relationship between linguistic aspects and user category (i.e., pro- vs. anti-ABA vs. undecided, parent vs. professional vs. an individual with autism). Results: The topic modeling resulted in 11 themes that ranged across various elements, such as autism as a condition and its management, stakeholders, and consequences of autism and the support needed. The posts of individuals were focused on personal experiences and opinions as opposed to clinical and research information sharing. Linguistic analysis indicated that the posts reveal an intimate stance rather than an empirical stance. Conclusions: Results provide insight into perspectives of ABA. This type of research may help in developing and distributing appropriate and evidence-based information.
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Affiliation(s)
- Monica L. Bellon-Harn
- Department of Communication Sciences and Disorders, Piedmont University, Demorest, GA, United States
- Virtual Hearing Lab, Collaborative Initiative Between Lamar University and University of Pretoria, Beaumont, TX, United States
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal, India
- *Correspondence: Monica L. Bellon-Harn
| | - Ryan L. Boyd
- Department of Psychology, Lancaster University, Lancaster, United Kingdom
- Security Lancaster, Lancaster University, Lancaster, United Kingdom
- Data Science Institute, Lancaster University, Lancaster, United Kingdom
| | - Vinaya Manchaiah
- Department of Communication Sciences and Disorders, Piedmont University, Demorest, GA, United States
- Virtual Hearing Lab, Collaborative Initiative Between Lamar University and University of Pretoria, Beaumont, TX, United States
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal, India
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, United States
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Holingue C, Jang Y, Azad G, Landa R. Key stakeholder perspectives on obstacles to an autism-specific Medicaid waiver service delivery model. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:205-216. [PMID: 34558157 DOI: 10.1111/jar.12940] [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: 12/02/2020] [Revised: 08/27/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Children and youth with autism spectrum disorder have significant, multi-system needs that require supports, such as the autism waiver (AW) service delivery model. This study aimed to identify and describe characteristics of the AW, define obstacles and strengths in the provision of adequate services and provide recommendations for improving overall effectiveness. METHODS This mixed-methods exploratory study used an electronic survey to gain information and perceptions of AW provider agency directors (n = 27) and service coordinators (n = 30). RESULTS The key barriers reported were the shortage of qualified staff, inadequate staff training, complexity of cases or symptom severity of clients and lack of communication at multiple levels throughout the agency as well as with parents. CONCLUSIONS Recommendations include reinforcing the workforce through higher salaries, greater training and communication interventions. These strategies may reduce staff turnover and shortage, lighten the caseload, reduce the waitlist period and improve the effectiveness and responsiveness of AW services.
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Affiliation(s)
- Calliope Holingue
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yeon Jang
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Gazi Azad
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University, New York, New York, USA.,Center for Autism and the Developing Brain, Weill Cornell Medicine, New York State Psychiatric Institute, New York, New York, USA
| | - Rebecca Landa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Bürki L, Höfer J, Kamp-Becker I, Poustka L, Roessner V, Stroth S, Wolff N, Hoffmann F, Bachmann C. Special educational support in children and adolescents with Autism Spectrum Disorder in Germany: Results from a parent survey. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 112:103931. [PMID: 33690110 DOI: 10.1016/j.ridd.2021.103931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Children and adolescents with Autism Spectrum Disorder (ASD) often receive special educational support (SES). This study aimed to evaluate SES prevalence in children and adolescents with ASD in Germany. METHODS A mail survey was distributed to the caregivers of 637 children and adolescents recruited at three German ASD outpatient clinics. RESULTS Among the 211 respondents (response: 33.1 %), 82.5 % were provided with a special educational needs statement, and 63.9 % received special education, most of them attending a public special school (57.9 %). The most frequently indicated additional support was a classroom assistant (69.0 %), followed by smaller learning groups (31.7 %). Special education was less frequently provided to individuals with Asperger syndrome than to those with childhood or atypical autism (36.0 %, 76.1 %, and 63.4 %, respectively). Using logistic regression analysis, receiving special education was significantly associated with lower IQ (<85) (Odds Ratio (OR): 8.72; 95 % confidence interval (CI): 3.41-22.32) and younger age (≤11 years, OR: 2.87; 95 % CI: 1.11-7.38), but not with ASD symptom severity. CONCLUSIONS The majority of children and adolescents with ASD received SES, indicating a satisfactory supply of such services in Germany. The finding that lower IQ but not ASD symptom severity predicted access to SES raises questions about the specificity of the used selection criteria.
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Affiliation(s)
- Lara Bürki
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstr. 140, 26129 Oldenburg, Germany.
| | - Juliana Höfer
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstr. 140, 26129 Oldenburg, Germany
| | - Inge Kamp-Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University Marburg, Hans-Sachs-Str. 4, 35039 Marburg, Germany
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Göttingen, Von-Siebold-Str. 5, 37075 Göttingen, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Medical Faculty of the TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Sanna Stroth
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University Marburg, Hans-Sachs-Str. 4, 35039 Marburg, Germany
| | - Nicole Wolff
- Department of Child and Adolescent Psychiatry, Medical Faculty of the TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstr. 140, 26129 Oldenburg, Germany
| | - Christian Bachmann
- Department of Child and Adolescent Psychiatry, University of Ulm, Steinhövelstr. 5, 89075 Ulm, Germany
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Sturm A, Williams J, Kasari C. Who gains and who loses? Sociodemographic disparities in access to special education services among autistic students. Autism Res 2021; 14:1621-1632. [PMID: 33904253 DOI: 10.1002/aur.2517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 03/06/2021] [Accepted: 03/18/2021] [Indexed: 11/10/2022]
Abstract
Little is known about differences in the allocation of special education services to students with autism compared with students with other primary learning differences (e.g., intellectual disability [ID], specific learning disability [SLD]) and the comparative impact of sociodemographic factors on special education service receipt. The present study aimed to compare allocation of services (i.e., quantity and types) between students eligible for special education services under autism, SLD and ID, and to identify differences in sociodemographic predictors (e.g., race, neighborhood income) of service allocation. Data were culled from special education administrative records from a large urban, primarily Hispanic, Latino, or Spanish-serving school district from academic years 2011-2012 to 2016-2017. Participants included N = 76,428 students (Nautism = 18,151, NSLD = 54,001, NID = 4,276) ages 2-18. Results showed that autistic students received, on average, more services than students with SLD. Services received by students served under autism and SLD eligibility were more congruent with areas of need (e.g., language, occupational therapy) relative to students served under ID. Student-level socioeconomic status (free and reduced lunch) was more positively predictive of the number of special education services received than the neighborhood income of the school the student attended. Finally, the most significant racial disparities in service allocation were observed among students served under autism eligibility. The present study demonstrates the critical role of economic resources in the quantity and types of services received, and the desirability of a public education for well-resourced families who are possibly best situated to navigate special education services. LAY SUMMARY: An eligibility of autism in special education confers a significant advantage in the number of services a student receives. Disparity in the quantity of special education services exists among autistic students across many sociodemographic factors. Most notably, greater allocation of services to non-Hispanic, Latino, or Spanish, White American, European American, or Middle Eastern American students and students who do not receive free and reduced lunch.
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Affiliation(s)
- Alexandra Sturm
- University of California, Center for Autism Research and Treatment, Los Angeles, California, USA.,Department of Psychology, Loyola Marymount University, Los Angeles, California, USA
| | - Justin Williams
- University of California, Center for Autism Research and Treatment, Los Angeles, California, USA
| | - Connie Kasari
- University of California, Center for Autism Research and Treatment, Los Angeles, California, USA
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Service Use Among Transition-Age Youth with Autism Spectrum Disorder. J Autism Dev Disord 2021; 52:1051-1065. [PMID: 33864557 DOI: 10.1007/s10803-021-04999-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
This study explored predictors of service use among 174 transition-age youth (age 16-30) with an Autism Spectrum Disorder using Andersen's (J Health Soc Behav 36(1):1-10, 1995) healthcare utilization model. Family caregivers were interviewed about past 6-month use of 15 services. On average, youth used 6.1 and needed 3.2 additional services. Greater service use was associated with two predisposing (caregiver college educated, caregiver not married/partnered), two enabling (youth has Medicaid waiver, youth in high school), and one need factor (lower adaptive functioning). Use of specific services was most strongly related to enabling (Medicaid waiver, in high school) and need factors (lower adaptive functioning, comorbid mental health diagnosis). Findings provide a snapshot of the "service cliff" faced by families and highlight the need for additional research.
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Atypical communication characteristics among clinic-referred youth with and without autism spectrum disorder: Stability and associations with clinical correlates. Dev Psychopathol 2020; 32:1240-1253. [PMID: 32938518 DOI: 10.1017/s095457942000070x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Atypical communication characteristics (ACCs), such as speech delay, odd pitch, and pragmatic difficulties, are common features of autism spectrum disorder (ASD) as are the symptoms of a wide range of psychiatric disorders. Using a simple retrospective method, this study aimed to better understand the relation and stability of ACCs with a broad range of psychiatric symptoms among large, well-characterized samples of clinic-referred children and adolescents with and without ASD. Youth with ASD had higher rates and a more variable pattern of developmental change in ACCs than the non-ASD diagnostic group. Latent class analysis yielded three ACC stability subgroups within ASD: Stable ACCs, Mostly Current-Only ACCs, and Little Professors. Subgroups exhibited differences in severity of ASD symptomatology, co-occurring psychiatric symptoms, and other correlates. Our findings provide support for the clinical utility of characterizing caregiver-perceived changes in ACCs in identifying children at risk for co-occurring psychopathology and other clinically relevant variables.
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Abstract
The Autism impact measure (AIM) is a caregiver-reported questionnaire assessing autism symptom frequency and impact in children, previously shown to have good test-retest reliability, convergent validity and structural validity. This study extended previous work by exploring the AIM's ability to discriminate between 'known-groups' of children, and estimating thresholds for clinically important responses. Data were collected online and electronically on computer and mobile devices; hence, it was also possible to confirm other psychometric properties of the AIM in this format. This study provides confirmatory and additional psychometric validation of the AIM. The AIM offers a valid, quick and inexpensive method for caregivers to report core symptoms of autism spectrum disorder (ASD) including communication deficits, difficulties with social interactions and repetitive behaviors.
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