1
|
McGrew J, Yu Y, Ruble L, Murray DS. Predictive Analysis of Parent Activation and Autism. J Autism Dev Disord 2024; 54:2471-2483. [PMID: 37133611 DOI: 10.1007/s10803-023-05985-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] [Accepted: 04/03/2023] [Indexed: 05/04/2023]
Abstract
We examined parent activation in families with autistic children over time. Activation is one's belief, knowledge, and persistence in obtaining and managing one's care (e.g., patient activation) and others (e.g., parent activation) and is associated with better outcomes. Four aims were examined: the associations between baseline parent activation and follow up treatment/outcome, between changes in activation and changes in treatment/outcome, differences in activation and treatment/outcome across demographic groups (e.g., gender, race, ethnicity, and income) and comparison of results using three different assessment approaches of parent activation, the Guttman scale (standard approach) and two factor subscales (Yu et al., in J Autism Dev Disord 53:110-120, 2023). The first factor tapped into behaviors aligned with highly active, assertive parental actions (Factor 1: Activated). The second tapped into behaviors representative of uncertainty, passivity, being overwhelmed, with growing awareness of the need for activation (Factor 2: Passive). Findings varied with assessment methods applied. The two subscales assessment approach produced the strongest effect sizes. Baseline activation was related to improved child outcomes at follow-up for Factor 1: Activated and to poorer child outcomes at follow-up for Factor 2: Passive. Changes in activation were unrelated to changes in treatment/outcomes. Outcomes differed based on the activation assessment approach used. Against expectations, activation remained the same over time. Further, no differences in outcomes were observed based on race, ethnicity, or family income. The results suggest that parent activation may behave differently than patient activation based on prior studies. More research is warranted on activation of parents of autistic children.
Collapse
Affiliation(s)
- John McGrew
- Department of Psychology, Indiana University Purdue University Indianapolis, 402 N. Blackford St., LD124, Indianapolis, IN, 46202, USA
| | - Yue Yu
- MIND Institute, University of California-Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - Lisa Ruble
- Teachers College, TC745, Ball State University, Muncie, IN, 47306, USA.
| | - Donna S Murray
- Autism Speaks, 88 Broad Street, 5th Floor, Boston, MA, 02110, USA
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 4002, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH, 45267, USA
| |
Collapse
|
2
|
Lindsay S, Li Y, Joneja S, Hsu S. Experiences of racism and racial disparities in health care among children and youth with autism and their caregivers: a systematic review. Disabil Rehabil 2024:1-20. [PMID: 38864302 DOI: 10.1080/09638288.2024.2364823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 06/02/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE Although the health benefits of early diagnosis and therapeutic approaches for children and youth with autism spectrum disorder (ASD), racial disparities persist. This systematic review explored the experiences of racism and racial disparities in health care among children and youth with ASD and their caregivers. METHODS We conducted a systematic review, drawing on six international databases. Two reviewers screened titles, abstracts, and full texts. Thirty-seven studies met our inclusion criteria and we applied a narrative synthesis to develop themes. RESULTS Four themes were identified: (1) experiences and aspects of racism and racial disparities (i.e., language and cultural barriers, poor quality health care interactions, stereotypes and discrimination, family and community stigma, and indirect barriers); (2) racial disparities in health care (i.e., screening and referral, diagnosis, health care services, and care coordination and medication); (3) facilitators to accessing health care services; and (4) recommendations from caregivers. CONCLUSIONS This review highlights the extensive racial disparities experienced by children with autism. More research is needed to explore youth's perspectives on racism in addition to exploring potential interventions to address racial disparities and improve health equity for youth with ASD.
Collapse
Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Yiyan Li
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Simran Joneja
- Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Shaelynn Hsu
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Faculty of Science, York University, Toronto, Canada
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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.
Collapse
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
| | | |
Collapse
|
5
|
Nasir AK, Strong-Bak W, Bernard M. Diagnostic Evaluation of Autism Spectrum Disorder in Pediatric Primary Care. J Prim Care Community Health 2024; 15:21501319241247997. [PMID: 38650542 PMCID: PMC11036916 DOI: 10.1177/21501319241247997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Children with autism spectrum disorder (ASD) continue to experience significant delays in diagnosis and interventions. One of the main factors contributing to this delay is a shortage of developmental-behavioral specialists. Diagnostic evaluation of ASD by primary care pediatricians (PCPs) has been shown to be reliable and to decrease the interval from first concern to diagnosis. In this paper, we present the results of a primary care ASD diagnosis program in which the PCP serves as the primary diagnostician and leverages the infrastructure of the primary care medical home to support the child and family during the pre- and post-diagnostic periods, along with data on parental satisfaction with this model. METHODS Retrospective data from a cohort of patients evaluated through this program were analyzed to determine the mean age at diagnosis and interval from referral for evaluation to diagnosis. We used survey methodology to obtain data from parents regarding their satisfaction with the process. RESULTS Data from 8 of 20 children evaluated from April 2021 through May 2022 showed a median age of diagnosis of 34.5 months compared to the national average of 49 months. Mean interval from referral for evaluation to diagnosis was 3.5 months. Parental survey responses indicated high satisfaction. CONCLUSIONS This model was successful in shortening the interval from referral to diagnosis resulting in significant decrease of age at diagnosis compared with the national average. Widespread implementation could improve access to timely diagnostic services and improve outcomes for children with ASD.
Collapse
Affiliation(s)
- Arwa K. Nasir
- University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Marie Bernard
- University of Nebraska Medical Center, Omaha, NE, USA
| |
Collapse
|
6
|
Fell LA, Albright CM, Kryszak EM, Butter E, Kuhlthau KA. Provider Perspectives on Telehealth Services for Children With Autism Spectrum Disorder During the Coronavirus Disease 2019 Pandemic. Acad Pediatr 2023; 23:1196-1203. [PMID: 36871611 PMCID: PMC9985515 DOI: 10.1016/j.acap.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/13/2023] [Accepted: 02/24/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE The purpose of the current study was to explore provider perspectives on the strengths and challenges of telehealth services (e.g., behavioral interventions, physical, speech, and occupational therapy, medication management) for children with autism spectrum disorder during coronavirus disease 2019 related shutdowns. METHODS From September 2020 to May 2021, we conducted qualitative interviews with 35 providers across multiple disciplines from 17 sites in the Autism Care Network. Qualitative data were analyzed using a framework approach and common themes were identified. RESULTS Providers across clinical disciplines identified strengths of the virtual model, such as its flexibility and the opportunity it provided to see children in their home environment. They also indicated that some interventions worked better virtually than others, and that there were several factors that impacted their success. Respondents were generally satisfied providing parent-mediated interventions but expressed mixed satisfaction in using telehealth for direct-to-patient care. CONCLUSIONS Results suggest that telehealth services for children with autism spectrum disorder could be a helpful tool in decreasing barriers and improving service delivery, especially when tailored to the individual needs of the patient. More research is needed on the factors contributing to its success in order to eventually inform clinical guidelines regarding the prioritization of children seen for in-person visits.
Collapse
Affiliation(s)
- Lucy A Fell
- Department of Pediatrics (LA Fell, and KA Kuhlthau), Massachusetts General Hospital, Boston.
| | - Charles M Albright
- Nationwide Children...s Hospital (CM Albright, EM Kryszak, and E Butter), Columbus, OH; Department of Pediatrics and Psychology (CM Albright, EM Kryszak, and E Butter), The Ohio State University, Child Development Center, Nationwide Children's Hospital, Westerville
| | - Elizabeth M Kryszak
- Nationwide Children...s Hospital (CM Albright, EM Kryszak, and E Butter), Columbus, OH; Department of Pediatrics and Psychology (CM Albright, EM Kryszak, and E Butter), The Ohio State University, Child Development Center, Nationwide Children's Hospital, Westerville
| | - Eric Butter
- Nationwide Children...s Hospital (CM Albright, EM Kryszak, and E Butter), Columbus, OH; Department of Pediatrics and Psychology (CM Albright, EM Kryszak, and E Butter), The Ohio State University, Child Development Center, Nationwide Children's Hospital, Westerville
| | - Karen A Kuhlthau
- Department of Pediatrics (LA Fell, and KA Kuhlthau), Massachusetts General Hospital, Boston; Department of Pediatrics (KA Kuhlthau), Harvard Medical School, Boston, MA
| |
Collapse
|
7
|
An Intersectional Examination of Disability and Race Models in Behavior-Analytic Practice. BEHAVIOR AND SOCIAL ISSUES 2022. [DOI: 10.1007/s42822-022-00116-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
Baumbusch J, Lloyd JEV, Lamden-Bennett SR, Ou C. The unintended consequences of COVID-19 public health measures on health care for children with medical complexity. Child Care Health Dev 2022; 48:970-978. [PMID: 35043430 DOI: 10.1111/cch.12968] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/07/2021] [Accepted: 01/12/2022] [Indexed: 11/27/2022]
Abstract
AIM The aim of this work is to explore the unintended consequences of pandemic public health measures on health care service usage by children with medical complexity. BACKGROUND Medical complexity is characterized by the presence of complex, chronic conditions requiring specialized care, substantial health needs, functional dependence and/or limitations, and frequent health care usage. Children with medical complexity are among the highest users of paediatric health care services. METHODS A web-based, cross-sectional survey was conducted in British Columbia, Canada, between August and September 2020. Inclusion criteria were (a) parent/guardian of at least one child (age 0 to 18 years, inclusive) with medical complexity and (b) residence in British Columbia. A convenience sample of 156 parents completed the survey. Data were analysed using a series of descriptive analyses (frequencies, cross-tabulations) and inferential analyses (binary logistic regressions). RESULTS Respondents provided information for 188 children with medical complexity. Access to allied health therapies (physio, occupational, and speech and language) and medical specialists drastically declined in the initial months of the pandemic, with a shift from in-person to virtual platforms for these aspects of care. Regression modelling indicated that age and family structure influenced decisions to use in-patient hospital services. CONCLUSIONS Public health measures implemented in the initial months of the pandemic decreased access to health care services for children with medical complexity. The long-term ramifications of these measures are unknown. Family structure was found to influence decisions to avoid accessing Emergency Department care. Given the volume of services used by these children, paediatric hospital leaders need to take their unique needs into consideration in disaster planning to ensure minimal disruptions in care.
Collapse
Affiliation(s)
- Jennifer Baumbusch
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer E V Lloyd
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | | | - Christine Ou
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
9
|
Rosen V, Blank E, Lampert E, Dominick K, Will M, Erickson C, Pedapati E, Lamy M, Shaffer R. Brief Report: Telehealth Satisfaction Among Caregivers of Pediatric and Adult Psychology and Psychiatry Patients with Intellectual and Developmental Disability in the Wake of Covid-19. J Autism Dev Disord 2022; 52:5253-5265. [PMID: 35987932 PMCID: PMC9392497 DOI: 10.1007/s10803-022-05712-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 11/01/2022]
Abstract
Telehealth has been shown to be both acceptable and effective in many areas of healthcare, yet it was not widely adopted prior to the SARS-CoV-2 (COVID-19) pandemic. Additionally, previous evaluations of telehealth for autism spectrum condition (ASC) and intellectual and developmental disability (IDD) populations are limited in both number and scope. Here, we investigated satisfaction amongst Psychology and Psychiatry patient caregivers at Cincinnati Children’s Hospital Medical Center (CCHMC) after the onset of the COVID-19 pandemic. Results (640 responses) showed high rates of satisfaction across departments, appointment types, and diagnoses, with 92% indicating overall satisfaction with their appointment. There were, however, notable decreases in satisfaction among Group Therapy respondents, and those whose diagnosis was classified as Other.
Collapse
|
10
|
Zhang W, Thompson KL. Access to Care for US Children with Co-Occurrence of Autism Spectrum Disorder and Epilepsy. CHILDREN 2022; 9:children9071094. [PMID: 35884078 PMCID: PMC9318523 DOI: 10.3390/children9071094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/12/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
Epilepsy is a common comorbidity among children with autism spectrum disorder (ASD). There is a lack of understanding of the inequality in access to care for children with co-occurring ASD and epilepsy (ASD-EP). The purpose of this study is to examine key indicators for access to care and care coordination for children with ASD-EP in the US National Survey of Children’s Health (NSCH). Data were collected from the 2017–2019 NSCH. Our analytic sample included children with ASD without epilepsy (N = 2150), children with both ASD and epilepsy (N = 143), and children with epilepsy without ASD (N = 711). The dependent variables included important access to care indicators such as having usual sources of care, having adequate coverage, being frustrated in efforts to get service, and receiving care coordination. The independent variables included ASD-EP status, child demographics, and an intellectual disability (ID) diagnosis. Our results show that demographic characteristics such as sex, race, income level, and insurance type affect access to care. Inadequate access to healthcare was significantly higher among female children, children from low-income families, and children with ID. The access barriers among children with ASD-EP were more likely due to the interplay of multiple clinical and individual factors.
Collapse
Affiliation(s)
- Wanqing Zhang
- Department of Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Correspondence:
| | - Kelsey L. Thompson
- Division of Speech and Hearing Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| |
Collapse
|
11
|
Shillington A, Lamy M, Dominick KC, Sorter M, Erickson CA, Hopkin R. A Collaborative Psychiatric-Genetics Inpatient Care Delivery Model Improves Access to Clinical Genetic Evaluation, Testing, and Diagnosis for Patients With Neurodevelopmental Disorders. Front Genet 2022; 13:901458. [PMID: 35769998 PMCID: PMC9236224 DOI: 10.3389/fgene.2022.901458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Neurodevelopmental disorders including autism spectrum disorder, intellectual disability, and global developmental delay are among the most common indications for referral to clinical genetics evaluation; and clinical genetic testing is indicated for people with neurodevelopmental disorders. There are known barriers to care in accessing clinical genetics evaluation for this patient population. We created a collaborative psychiatric–genetics consultation service and psychiatric–genetics outpatient clinic with the goal to improve care delivery to patients with neurodevelopmental disorders. Two years after the launch of this pilot program, our data demonstrate improved access to genetics evaluation with shorter wait times and fewer patients lost to follow-up. Perhaps most importantly, new genetic diagnoses changed medical care for the majority of patients.
Collapse
Affiliation(s)
- Amelle Shillington
- Cincinnati Children’s Hospital Medical Center, Department of Human Genetics, Cincinnati, OH, United States
- Cincinnati Children’s Hospital Medical Center Department of Psychiatry, Cincinnati, OH, United States
- University of Cincinnati College of Medicine Department of Pediatrics, Cincinnati, OH, United States
- *Correspondence: Amelle Shillington,
| | - Martine Lamy
- Cincinnati Children’s Hospital Medical Center Department of Psychiatry, Cincinnati, OH, United States
- University of Cincinnati College of Medicine Department of Pediatrics, Cincinnati, OH, United States
| | - Kelli C. Dominick
- Cincinnati Children’s Hospital Medical Center Department of Psychiatry, Cincinnati, OH, United States
- University of Cincinnati College of Medicine Department of Pediatrics, Cincinnati, OH, United States
| | - Michael Sorter
- Cincinnati Children’s Hospital Medical Center Department of Psychiatry, Cincinnati, OH, United States
- University of Cincinnati College of Medicine Department of Pediatrics, Cincinnati, OH, United States
| | - Craig A. Erickson
- Cincinnati Children’s Hospital Medical Center Department of Psychiatry, Cincinnati, OH, United States
- University of Cincinnati College of Medicine Department of Pediatrics, Cincinnati, OH, United States
| | - Robert Hopkin
- Cincinnati Children’s Hospital Medical Center, Department of Human Genetics, Cincinnati, OH, United States
- University of Cincinnati College of Medicine Department of Pediatrics, Cincinnati, OH, United States
| |
Collapse
|
12
|
Song W, Salzer MS, Nonnemacher SL, Shea L. Lifespan service receipt and unmet needs among individuals on the autism spectrum. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:694-705. [PMID: 35320442 DOI: 10.1007/s10488-022-01192-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 01/18/2023]
Abstract
Timely data on service use and needs across the lifespan are essential to developing an effective and efficient service delivery system that is responsive to developmental issues. This study uses data from one of the largest statewide surveys conducted between 2017 and 2018 to compare service use and unmet needs among individuals on the autism spectrum across the lifespan. A statewide sample of 5792 caregivers of autistic children and adults were included in the study. Logistic regressions were conducted to compare service use and need among six age groups ranging from early childhood (0-5 years) to later adulthood (31+) while adjusting for sociodemographic characteristics. We found that the transition-age adult group (18-21 years) was less likely to receive services, including speech/language therapy, occupational therapy, one-on-one support, and social skill training, than adolescents. However, case management and mental health services increased with age. Young adults (22-30 years) were more likely to report unmet needs than both adolescents and transition-age adult groups. The use of services overall decrease and service needs increased compared to results from an earlier statewide survey that was conducting in 2009-2010. These results can be used to inform developmentally appropriate autism-related healthcare policies and service development and delivery. This study offers a more detailed look at differences between adult age subgroups that are novel. Further research is needed about the prevalence of ASD in adulthood, clinical trajectories, and outcomes in order to support autistic adults in getting the appropriate services and supports.
Collapse
Affiliation(s)
- Wei Song
- College of Public Health, Temple University, 1700 N. Broad St., Suite 313, 19122, Philadelphia, PA, USA.
| | - Mark S Salzer
- Temple University Collaborative on Community Inclusion of Individuals with, Psychiatric Disabilities, 1700 N. Broad St., Suite 304, 19122, Philadelphia, PA, USA
| | - Stacy L Nonnemacher
- Bureau of Supports for Autism and Special Populations, Department of Human Services, 801 Market St, 19107, Philadelphia, Pennsylvania, PA, USA
| | - Lindsay Shea
- Policy and Analytics Center, A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, 19104, Philadelphia, PA, USA
| |
Collapse
|
13
|
Aranki J, Wright P, Pompa-Craven P, Lotfizadeh AD. Acceptance of Telehealth Therapy to Replace In-Person Therapy for Autism Treatment During COVID-19 Pandemic: An Assessment of Patient Variables. Telemed J E Health 2022; 28:1342-1349. [PMID: 35119331 DOI: 10.1089/tmj.2021.0397] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Importance: Children with autism achieve improved behavioral outcomes with applied behavior analytic (ABA) interventions. Typically, ABA is delivered in a participant's home or in a clinic setting. At the onset of COVID-19, treatment in these environments was not available due to health exposure concerns. A large social service organization in California rapidly pivoted to the delivery of ABA intervention through telehealth. Access disparity for telehealth has been a historical concern in health care delivery, particularly for disenfranchised populations within the autistic participant population. Objective: This study evaluated the demographic and behavioral variables associated with the acceptance or declination of telehealth by the pediatric participants' caregivers at the onset of the pandemic. Design, Setting, Participants: A non-experimental design was used, and archival data were compared for a random sample of 100 participants with autism who accepted telehealth interventions with 100 participants who declined it. Main Outcomes and Measures: Socioeconomic data, gender, age, ethnicity, language, and household size were compared. Clinical data were compared for treatment dosage, standardized Vineland Adaptive Behavior Scales scores, and Verbal Behavior Milestones Assessment and Placement Program scores. Results: None of the demographic variables were statistically significant in a participant's acceptance or declination of telehealth, but there were moderate differences in treatment dosage across the groups. Conclusions: It is concerning that a large portion of participants initially declined intervention via telehealth, resulting in these participants experiencing a gap in intervention during the pandemic. As intervention is imperative for pediatric autism participants, it is untenable that ∼40% of the population initially declined telehealth at the start of the pandemic.
Collapse
Affiliation(s)
- Jenna Aranki
- Autism Services Division, Easterseals Southern California, Irvine, California, USA
| | | | - Paula Pompa-Craven
- Autism Services Division, Easterseals Southern California, Irvine, California, USA
| | - Amin D Lotfizadeh
- Autism Services Division, Easterseals Southern California, Irvine, California, USA
| |
Collapse
|
14
|
Callander EJ, Bull C, Lain S, Wakefield CE, Lingam R, Marshall GM, Wake M, Nassar N. Inequality in early childhood chronic health conditions requiring hospitalisation: A data linkage study of health service utilisation and costs. Paediatr Perinat Epidemiol 2022; 36:156-166. [PMID: 34806212 DOI: 10.1111/ppe.12818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/27/2021] [Accepted: 09/02/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND The cost of socioeconomic inequality in health service use among Australian children with chronic health conditions is poorly understood. OBJECTIVES To quantify the cost of socioeconomic inequality in health service use among Australian children with chronic health conditions. METHODS Cohort study using a whole-of-population linked administrative data for all births in Queensland, Australia, between July 2015 and July 2018. Socioeconomic status was defined by an areas-based measure, grouping children into quintiles from most disadvantaged (Q1) to least disadvantaged (Q5) based on their postcode at birth. Study outcomes included health service utilisation (inpatient, emergency department, outpatient, general practitioner, specialist, pathology and diagnostic imaging services) and healthcare costs. RESULTS Of the 238,600 children included in the analysis, 10.4% had at least one chronic health condition. Children with chronic health conditions in Q1 had higher rates of inpatient (6.6, 95% confidence interval [CI] 6.4, 6.7), emergency department (7.2, 95% CI 7.0, 7.5) and outpatient (20.3, 95% CI 19.4, 21.3) service use compared to children with chronic health conditions in Q5. They also had lower rates of general practitioner (37.5, 95% CI 36.7, 38.4), specialist (8.9, 95% CI 8.5, 9.3), pathology (10.7, 95% CI 10.2, 11.3), and diagnostic imaging (4.3, 95% CI 4.2,4.5) service use. Children with any chronic health condition in Q1 incurred lower median out-of-pocket fees than children in Q5 ($0 vs $741, respectively), lower median Medicare funding ($2710, vs $3408, respectively), and higher median public hospital funding ($31, 052 vs $23, 017, respectively). CONCLUSIONS Children of most disadvantage are more likely to access public hospital provided services, which are accessible free of charge to patients. These children are less likely to access general practitioner, specialist, pathology and diagnostic imaging services; all of which are critical to the ongoing management of chronic health conditions, but often attract an out-of-pocket fee.
Collapse
Affiliation(s)
- Emily J Callander
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Claudia Bull
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Samantha Lain
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Raghu Lingam
- Population Child Health Research Group, School of Women and Children's Health, UNSW Sydney, Sydney, Australia
| | - Glenn M Marshall
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
- Children's Cancer Institute, Lowy Centre, UNSW Sydney, Sydney, Australia
- School of Women and Children's Health, UNSW Sydney, Sydney, Australia
| | - Melissa Wake
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, Australia
- Menzies Centre for Health Policy, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
15
|
Cantor J, McBain RK, Kofner A, Stein BD, Yu H. Where are US outpatient mental health facilities that serve children with autism spectrum disorder? A national snapshot of geographic disparities. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:169-177. [PMID: 34120484 DOI: 10.1177/13623613211024046] [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] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT There has been a rise in the observed prevalence of autism spectrum disorder among children. Existing studies show the share of counties with a treatment facility that offers care for children with autism spectrum disorder. However, no estimates exist of the share of US outpatient mental health treatment facilities that provide services for children with autism spectrum disorder. We identified key facility-level characteristics in offering mental health care for children with autism spectrum disorder. We used a telephone survey to contact almost all outpatient mental health treatment facilities in the contiguous United States. We asked the facilities if they provided mental health care for children with autism spectrum disorder. We took the results of this survey and estimated multivariable regressions to examine county- and facility-level predictors of offering services. We found that over half (50.3%) of the 6156 outpatient facilities reported offering care for children with autism spectrum disorder. Non-metro counties, counties with a lower percentage of non-White residents, counties with a higher percentage of uninsured residents, and counties with a higher poverty rate had fewer outpatient mental health treatment facilities providing care for children with autism spectrum disorder. Facilities accepting Medicaid as a form of payment, offering telehealth, and private for-profit facilities were more likely to provide services for children with autism spectrum disorder. Because only half of outpatient mental health treatment facilities offer care for children with autism spectrum disorder, public health officials and policymakers should do more to ensure that this vulnerable population has access to mental health services.
Collapse
Affiliation(s)
| | | | | | | | - Hao Yu
- Harvard Medical School, USA
| |
Collapse
|
16
|
Strauss P, Cook A, Watson V, Winter S, Whitehouse A, Albrecht N, Wright Toussaint D, Lin A. Mental health difficulties among trans and gender diverse young people with an autism spectrum disorder (ASD): Findings from Trans Pathways. J Psychiatr Res 2021; 137:360-367. [PMID: 33761424 DOI: 10.1016/j.jpsychires.2021.03.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 01/29/2021] [Accepted: 03/02/2021] [Indexed: 01/16/2023]
Abstract
Recent research highlights an overlap of gender diversity and autism spectrum disorders (ASD); however, data on individuals who are trans and also on the autism spectrum are largely from clinical samples and may not be representative of individuals who are trans with ASD in the general population. In addition, there is scant literature on the mental health of these individuals and their experiences in accessing gender-affirming care. We investigated the prevalence of ASD in trans young people, their mental health (psychiatric diagnoses and self-harm and suicidal behaviors) and experiences in accessing gender-affirming care. This is an analysis of data collected in an Australian cross-sectional mixed methods survey (N = 859) of trans young people aged 14-25 years. Overall, 22.5% of participants had ever received a diagnosis of ASD from a health professional. This group was more likely to exhibit current psychopathology, have engaged in self-harming and suicidal behaviors, and was also more likely than the non-ASD diagnosed reference group to have received a psychiatric diagnosis. The ASD-diagnosed group were also more likely to experience barriers in accessing gender-affirming care. This is the first large population-based sample of trans individuals with ASD to report on mental health outcomes and experiences in accessing gender-affirming care. We highlight the necessity for clinicians working with either trans or ASD populations to have awareness of the co-occurrence, and to cultivate skills to work with individuals who are both trans and on the autism spectrum.
Collapse
Affiliation(s)
- Penelope Strauss
- Telethon Kids Institute, The University of Western Australia, Perth, Australia; School of Population and Global Health, The University of Western Australia, Perth, Australia.
| | - Angus Cook
- School of Population and Global Health, The University of Western Australia, Perth, Australia.
| | - Vanessa Watson
- Youth Mental Health, North Metropolitan Health Service, Western Australian Department of Health, Perth, Australia.
| | - Sam Winter
- School of Public Health, Curtin University, Perth, Australia.
| | - Andrew Whitehouse
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.
| | - Nicole Albrecht
- Youth Mental Health, North Metropolitan Health Service, Western Australian Department of Health, Perth, Australia.
| | | | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.
| |
Collapse
|
17
|
Jafarabadi MA, Gholipour K, Shahrokhi H, Malek A, Ghiasi A, Pourasghari H, Iezadi S. Disparities in the quality of and access to services in children with autism spectrum disorders: a structural equation modeling. ACTA ACUST UNITED AC 2021; 79:58. [PMID: 33902706 PMCID: PMC8074455 DOI: 10.1186/s13690-021-00577-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/08/2021] [Indexed: 11/11/2022]
Abstract
Background Socioeconomic disparities in health and healthcare are global issues that affect both adults as well as children. Children with exceptional healthcare needs, especially those with developmental impairments, including Autism Spectrum Disorders (ASD), encounter major disparities in access to and quality of health services. However, disparities in the population of children are rarely studied. The main aim of this paper is to study the socioeconomic disparities in children with ASD by examining the association between their Social Determinants of Health (SDH) status and access to and the quality of services. Methods This is a cross-sectional study on 202 children with ASD conducted in 2019 in two provinces including Ardabil and East-Azerbaijan, in the North-West of Iran. A structured, valid questionnaire was used to collect data on demographic, SDH status, quality of services, and access to services in a population of children with ASD aged 2–16-year-old. Around 77% participants were male and the mean age of children was 2 years and 6 months. Structural Equation Modeling (SEM) were used to assess the relationship. Results Based on the results of this study, the overall mean scores of the quality of services, access to services, and SDH status were 61.23 (30.01), 65.91 (21.89), and 29.50 (22.32) out of 100, respectively. All the associations between the quality and access dimensions and quality (B: 0.464–0.704) and access (B: 0.265–0.726) scales were statistically significant (P < 0.001). By adjusting to covariates, the access was also significantly related to service quality (P = 0.004). Finally, the associations between SDH score with service quality (P = 0.039) and access (P < 0.001) were positively significant. Conclusions There are socioeconomic disparities in the quality of and access to services among children with ASD, who use ASD services, in the North-West of Iran. We recommend health/medical centers, where children are diagnosed with ASD, conducting SDH screening and providing families of low-SDH status with specific information about the quality of and access to services for children with ASD. Additionally, medical universities must have a plan to routinely monitor the quality of and access to services provided for the children with low SDH. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00577-5.
Collapse
Affiliation(s)
- Mohammad Asghari Jafarabadi
- Department of Statistics and Epidemiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.,Center for the Development of Interdisciplinary Research in Islamic Sciences, and Health Sciences Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamal Gholipour
- Social Determinants of Health Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Hassan Shahrokhi
- Research Center of Psychiatry and Behavioral Science, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ayyoub Malek
- Research Center of Psychiatry and Behavioral Science, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akbar Ghiasi
- HEB School of Business & Administration, University of the Incarnate Word, San Antonio, TX, USA
| | - Hamid Pourasghari
- Hospital Management Research Center, Iran University of Medical Science, Tehran, Iran
| | - Shabnam Iezadi
- Hospital Management Research Center, Iran University of Medical Science, Tehran, Iran.
| |
Collapse
|
18
|
Lopez-Espejo MA, Nuñez AC, Moscoso OC, Escobar RG. Brief Report: Health-Related Quality of Life in Preschoolers with Autism Spectrum Disorder is Related to Diagnostic Age and Autistic Symptom Severity. J Autism Dev Disord 2021; 51:4704-4710. [PMID: 33569707 DOI: 10.1007/s10803-021-04909-w] [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: 01/29/2021] [Indexed: 10/22/2022]
Abstract
We conducted a cross-sectional study to explore whether clinical characteristics and autism diagnostic-traits severity are associated with caregiver-reported impairment of health-related quality of life (Pediatric Quality of Life Inventory Generic Core Scales, Fourth Edition) in 93 Chilean toddlers (age: 2-4 years) with autism spectrum disorder. Median total scale, physical health, and psychosocial health scores were 76 (IQR 70-81), 88 (IQR 81-94), and 71 (IQR 62-79), respectively. In multiple-regression analysis, diagnostic age (β = 0.219; p 0.021) and Calibrated Severity Score of Autism Diagnostic Observation Schedule, second edition (β = - 0.434; p < 0.001) were independently correlated to the total scale score. Lower age and higher autistic traits severity at diagnosis are correlated with worse well-being perception by caregivers.
Collapse
Affiliation(s)
- Mauricio A Lopez-Espejo
- Unit of Neurology, Division of Pediatrics, School of Medicine, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Chile.
| | - Alicia C Nuñez
- Unit of Neurology, Division of Pediatrics, School of Medicine, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Chile
| | - Odalie C Moscoso
- Unit of Neurology, Division of Pediatrics, School of Medicine, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Chile
| | - Raul G Escobar
- Unit of Neurology, Division of Pediatrics, School of Medicine, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Chile
| |
Collapse
|
19
|
Angell AM, Deavenport-Saman A, Yin L, Zou B, Bai C, Varma D, Solomon O. Sex Differences in Co-occurring Conditions Among Autistic Children and Youth in Florida: A Retrospective Cohort Study (2012-2019). J Autism Dev Disord 2021; 51:3759-3765. [PMID: 33394250 DOI: 10.1007/s10803-020-04841-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 01/08/2023]
Abstract
Autistic children have a high prevalence of co-occurring mental health, developmental/behavioral, and medical conditions, but research on sex/gender differences has been mixed. We used Florida healthcare claims data to characterize sex differences (female/male) in co-occurring conditions among autistic children ages 1-21 (N = 83,500). After adjusting for age, race, ethnicity, urbanicity, and insurance, autistic girls had significantly higher odds of anxiety disorders, mood disorders, intellectual disability, developmental disorders, epilepsy, metabolic disorders, gastrointestinal disorders, and sleep disorders compared to autistic boys. Autistic girls had significantly lower odds of ADHD. The findings contribute to the growing body of research on the unique healthcare needs of autistic girls.
Collapse
Affiliation(s)
- Amber M Angell
- University of Florida, Gainesville, USA.
- University of Southern California, Los Angeles, USA.
| | - Alexis Deavenport-Saman
- Children's Hospital Los Angeles, Los Angeles, USA
- University of Southern California, Los Angeles, USA
| | - Larry Yin
- Children's Hospital Los Angeles, Los Angeles, USA
- University of Southern California, Los Angeles, USA
| | - Baiming Zou
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Chen Bai
- University of Florida, Gainesville, USA
| | | | - Olga Solomon
- Children's Hospital Los Angeles, Los Angeles, USA
- University of Southern California, Los Angeles, USA
| |
Collapse
|
20
|
Walsh C, Lydon S, Hehir A, O'Connor P. Development and evaluation of a novel caregiver-report tool to assess barriers to physical healthcare for people on the autism spectrum. RESEARCH IN AUTISM SPECTRUM DISORDERS 2020; 79:101680. [PMID: 33072182 PMCID: PMC7554131 DOI: 10.1016/j.rasd.2020.101680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/15/2020] [Accepted: 10/04/2020] [Indexed: 05/25/2023]
Abstract
INTRODUCTION People on the autism spectrum often experience poorer health than the general population despite higher engagement with the health services. This suggests a disparity in the accessibility of appropriate healthcare for autistic individuals. To improve access, barriers the autism community experience in healthcare first need to be identified. This paper aimed to: 1) develop and evaluate a caregiver-report tool; 2) identify barriers to physical healthcare for autistic individuals; and 3) identify potential contributing factors. METHODS A previously established taxonomy of barriers to healthcare for autistic individuals informed the development of the tool; this was then distributed to caregivers of autistic adults and children. Exploratory factor analysis (EFA) assessed validity and reliability of the tool. Multiple Regressions were performed to identify predictors of barriers. RESULTS In total, caregivers of 194 autistic children or adults participated in the study. The EFA produced four factors: 1) patient-level barriers; 2) healthcare provider-level (HCP) barriers; 3) healthcare system-level barriers; and 4) barriers related to managing healthcare. The greatest barriers included difficulties with identifying/reporting symptoms (endorsed by 62.4% of participants); difficulties handling the waiting area (60.3% of participants); and a lack of HCP knowledge regarding autism (52.1% of participants). Autism severity, general adjustment problems, anxiety, age and having unmet needs predicted the frequency and/or severity of barriers. CONCLUSIONS A tool that allows assessment of patient-, HCP-, and system-level barriers to healthcare was developed and evaluated. Patient-level barriers appear to occur frequently and pose substantial challenges. This tool will help identify areas most in need of intervention and support intervention evaluation.
Collapse
Affiliation(s)
- C Walsh
- Department of General Practice, School of Medicine, National University of Ireland Galway, Ireland
| | - S Lydon
- School of Medicine, National University of Ireland Galway, Ireland
| | - A Hehir
- School of Medicine, National University of Ireland Galway, Ireland
| | - P O'Connor
- Department of General Practice, School of Medicine, National University of Ireland Galway, Ireland
| |
Collapse
|
21
|
Baghdadli A, Picot MC, Miot S, Munir K. A Call to Action to Implement Effective COVID-19 Prevention and Screening of Individuals with Severe Intellectual Developmental and Autism Spectrum Disorders. J Autism Dev Disord 2020; 51:2566-2568. [PMID: 33000394 PMCID: PMC7526962 DOI: 10.1007/s10803-020-04719-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A Baghdadli
- Center of Excellence in Autism and Neurodevelopmental Disorders, University and CHU of Montpellier, Montpellier, France.
- Center of Resources in Autism, University and CHU of Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier Cedex 05, France.
| | - M C Picot
- Center of Excellence in Autism and Neurodevelopmental Disorders, University and CHU of Montpellier, Montpellier, France
- Clinical Research and Epidemiology Unit, University and CHU of Montpellier, 34000, Montpellier, France
| | - S Miot
- Center of Excellence in Autism and Neurodevelopmental Disorders, University and CHU of Montpellier, Montpellier, France
- Geriatrics Department, Center of Excellence in Autism and Neurodevelopmental Disorders, University and CHU of Montpellier, 34000, Montpellier, France
| | - K Munir
- Developmental Medicine Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
22
|
Watson SL, Stine F, Tumin D, Stiles KM. Employment and well-being among caregivers of children with autism spectrum disorder. CHILDRENS HEALTH CARE 2020. [DOI: 10.1080/02739615.2020.1810576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Sarah L. Watson
- Department of Sociology, East Carolina University, Greenville, NC, USA
| | - Fritz Stine
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Karen M. Stiles
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| |
Collapse
|
23
|
Lindly OJ, Chan J, Fenning RM, Farmer JG, Neumeyer AM, Wang P, Swanson M, Parker RA, Kuhlthau KA. Vision care among school-aged children with autism spectrum disorder in North America: Findings from the Autism Treatment Network Registry Call-Back Study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 25:840-853. [DOI: 10.1177/1362361320942091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children with autism spectrum disorder have a high risk of vision problems yet little is known about their vision care. This cross-sectional survey study, therefore, examined vision care among 351 children with autism spectrum disorder ages 6–17 years in the United States or Canada who were enrolled in the Autism Treatment Network Registry. Vision care variables were vision tested with pictures, shapes, or letters in the past 2 years; vision tested by an eye care practitioner (e.g. ophthalmologist, optometrist) in the past 2 years; prescribed corrective eyeglasses; and wore eyeglasses as recommended. Covariates included sociodemographic, child functioning, and family functioning variables. Multivariable models were fit for each vision care variable. Though 78% of children with autism spectrum disorder had their vision tested, only 57% had an eye care practitioner test their vision in the past 2 years. Among the 30% of children with autism spectrum disorder prescribed corrective eyeglasses, 78% wore their eyeglasses as recommended. Multivariable analysis results demonstrated statistically significant differences in vision care among children with autism spectrum disorder by parent education, household income, communication abilities, intellectual functioning, and caregiver strain. Overall, study results suggest many school-aged children with autism spectrum disorder do not receive recommended vision care and highlight potentially modifiable disparities in vision care. Lay Abstract Children with autism are at high risk for vision problems, which may compound core social and behavioral symptoms if untreated. Despite recommendations for school-aged children with autism to receive routine vision testing by an eye care practitioner (ophthalmologist or optometrist), little is known about their vision care. This study, therefore, examined vision care among 351 children with autism ages 6–17 years in the United States or Canada who were enrolled in the Autism Treatment Network Registry. Parents were surveyed using the following vision care measures: (1) child’s vision was tested with pictures, shapes, or letters in the past 2 years; (2) child’s vision was tested by an eye care practitioner in the past 2 years; (3) child was prescribed corrective eyeglasses; and (4) child wore eyeglasses as recommended. Sociodemographic characteristics such as parent education level, child functioning characteristics such as child communication abilities, and family functioning characteristics such as caregiver strain were also assessed in relationship to vision care. Although 78% of children with autism had their vision tested, only 57% had an eye care practitioner test their vision in the past 2 years. Among the 30% of children with autism prescribed corrective eyeglasses, 78% wore their eyeglasses as recommended. Differences in vision care were additionally found among children with autism by parent education, household income, communication abilities, intellectual functioning, and caregiver strain. Overall, study results suggest many school-aged children with autism do not receive recommended vision care and highlight potentially modifiable disparities in vision care.
Collapse
Affiliation(s)
| | | | - Rachel M Fenning
- California State University, Fullerton, USA
- University of California, Irvine, USA
| | | | - Ann M Neumeyer
- Massachusetts General Hospital, USA
- Lurie Center for Autism, USA
- Harvard Medical School, USA
| | | | | | - Robert A Parker
- Massachusetts General Hospital, USA
- Harvard Medical School, USA
| | | |
Collapse
|
24
|
Cantor J, McBain RK, Kofner A, Stein BD, Yu H. Fewer Than Half Of US Mental Health Treatment Facilities Provide Services For Children With Autism Spectrum Disorder. Health Aff (Millwood) 2020; 39:968-974. [PMID: 32479238 PMCID: PMC7773216 DOI: 10.1377/hlthaff.2019.01557] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Despite estimates of rising prevalence of children with autism spectrum disorder (ASD) in the US, there is little research on the availability of behavioral health care services for this vulnerable population. To fill the gap, we surveyed 8,184 mental health treatment facilities in the contiguous US. As of August 2019, 43.0 percent of facilities reported providing behavioral health care for children with ASD, and 36.6 percent were accepting such children as new patients. Only 12.7 percent reported having a clinician with specialized training, and 4.3 percent reported having a specialized treatment program. Multivariable regression results indicated that there was poorer access to specialized ASD care in rural and lower-income communities. New policies are needed to increase the availability of behavioral health care for children with ASD.
Collapse
Affiliation(s)
- Jonathan Cantor
- Jonathan Cantor is an associate policy researcher in the Department of Economics, Sociology, and Statistics, RAND Corporation, in Santa Monica, California
| | - Ryan K McBain
- Ryan K. McBain is a policy researcher in the Department of Behavioral and Policy Sciences, RAND Corporation, in Boston, Massachusetts
| | - Aaron Kofner
- Aaron Kofner is a research programmer in the Research Programming Group, RAND Corporation, in Arlington, Virginia
| | - Bradley D Stein
- Bradley D. Stein is a senior physician policy researcher in the Department of Behavioral and Policy Sciences, RAND Corporation, in Pittsburgh, Pennsylvania, and an adjunct associate professor of psychiatry at the University of Pittsburgh
| | - Hao Yu
- Hao Yu is an associate professor of population medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute, both in Boston
| |
Collapse
|
25
|
Rubenstein E, Croen L, Lee LC, Moody E, Schieve LA, Soke GN, Thomas K, Wiggins L, Daniels J. Community-based service use in preschool children with autism spectrum disorder and associations with insurance status. RESEARCH IN AUTISM SPECTRUM DISORDERS 2019; 66:101410. [PMID: 32831903 PMCID: PMC7430759 DOI: 10.1016/j.rasd.2019.101410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND ASD-related services can improve outcomes for children, but less is known about service outside of school settings during preschool age. We aimed to describe amount and category of community-based service use among 3-5-year-old children with ASD and examine differences by health insurance. METHODS We used cross-sectional data on 792 children with ASD diagnoses in the Study to Explore Early Development, a community-based study of neurodevelopment with enrollment between 2012-2016. Mothers reported current child service use and insurance status at study entry. We used log-Poisson and logistic regression to compare service use by insurance group. RESULTS Nearly 40% of children were not receiving community-based services at study entry. Children with public insurance had fewer total services than children with private or both insurances. After adjustment for sociodemographic confounders, insurance status was not associated with types of different categories of community-based services. However, children with public insurance alone were least likely to receive community-based behavioral therapy and most likely to receive psychotropic medication compared to other insurances. CONCLUSION Many preschool-aged children do not receive community-based services, with receipt associated with insurance type. Increasing access and availability for evidence-based service, especially for beneficiaries of public insurance, may improve service use and outcomes.
Collapse
Affiliation(s)
- Eric Rubenstein
- University of Wisconsin Madison, Waisman Center, 1500 Highland Ave, Madison WI, 53705
| | - Lisa Croen
- Division of Research, Kaiser Permanente of Northern California, 2000 Broadway, Oakland, CA 94612
| | - Li-Ching Lee
- Bloomberg School of Public Health, Johns Hopkins University, 315 N Wolfe St, Baltimore, MD 21231
| | - Eric Moody
- Wyoming Institute of Disabilities, University of Wyoming, 1000 E. University Ave. Laramie, WY 82071
| | - Laura A. Schieve
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, 1600 Clifton Road, Atlanta, GA 30329
| | - Gnakub N. Soke
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, 1600 Clifton Road, Atlanta, GA 30329
| | - Kathleen Thomas
- Cecil G. Sheps Center for Health Services Research, University of North Carolina Chapel Hill, 725 Martin Luther King Jr. Blvd. Chapel Hill, NC 27599-7590
| | - Lisa Wiggins
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, 1600 Clifton Road, Atlanta, GA 30329
| | - Julie Daniels
- University of North Carolina Gillings School of Global Public Health, Department of Biostatistics, 137 East Franklin Street Room 6702 CB# 8030 Chapel Hill, NC 27514
| |
Collapse
|