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Cappe E, Despax J, Pedoux A, Zylberberg P, Chaste P, De Gaulmyn A, Doyen C, Pommepuy N. Parental involvement and adjustment during the diagnostic evaluation of autism spectrum disorder at two diagnostic centers. L'ENCEPHALE 2024:S0013-7006(24)00046-0. [PMID: 38523027 DOI: 10.1016/j.encep.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/18/2023] [Accepted: 01/12/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVES The primary objective of this study was to determine the effects of permanent, mediated parental presence during all autism spectrum disorder diagnostic evaluations on parental adjustment (perceived parental stress and sense of parental competence) compared with procedures that traditionally only involve parents in pivotal periods of the diagnosis. The level of satisfaction with the diagnostic procedure and parents' needs were also evaluated to complete this first objective. The secondary objective was to assess the effects of psychosocial, individual, and contextual variables on perceived parental stress and sense of parental competence. METHODS The total sample of 49 parents was divided (using simple randomization) into two subgroups, each for a different procedure. Participants were met with once before the first consultation and once after. They completed self-reported questionnaires on parental stress, sense of parental competence, satisfaction with the procedure, social support, locus of control, and appraisal of life events. Statistical analysis was conducted using SPAD and SPSS software. RESULTS There was no difference between the two groups in the variables assessed. Satisfaction with the diagnostic procedure was high in both groups, but parents highlighted that they had important needs following the diagnosis. The child's level of autonomy, the presence of disruptive behaviors, and satisfaction with social support were found to be important for determining parental adjustment. CONCLUSIONS Several hypotheses may explain the lack of differences between the two groups, including that parents may not yet have been in a position to benefit from the procedure aimed at integrating them. Our suggestion is that professional interventions should focus on improving the child's autonomy and helping the parent to develop a satisfactory support network. Finally, parents' needs for the post-diagnosis phase should be given greater consideration, particularly in future research.
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Affiliation(s)
- Emilie Cappe
- Université Paris Cité, Laboratoire de Psychopathologie et Processus de Santé, 92100 Boulogne-Billancourt, France; Institut universitaire de France (IUF), Paris, France.
| | - Johanna Despax
- Université Paris Cité, Laboratoire de Psychopathologie et Processus de Santé, 92100 Boulogne-Billancourt, France
| | - Amandine Pedoux
- Department of Child and Adolescent Psychiatry, Robert-Debré Hospital, AP-HP, Paris University, Paris, France
| | - Pascale Zylberberg
- Unité de psychiatrie pédiatrique, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital Necker-Enfants Malades, 75015 Paris, France
| | - Pauline Chaste
- Service de psychiatrie de l'enfant et de l'adolescent, AP-HP, hôpital universitaire Necker-Enfants Malades, 75015 Paris, France
| | - Aude De Gaulmyn
- CREDAT, centre de recherche de d'évaluation des troubles du neurodéveloppement, GHU Paris psychiatrie et neurosciences, 75014 Paris, France
| | - Catherine Doyen
- CREDAT, centre de recherche de d'évaluation des troubles du neurodéveloppement, GHU Paris psychiatrie et neurosciences, 75014 Paris, France
| | - Noël Pommepuy
- Pôle de psychiatrie de l'enfant et de l'adolescent 93I05, EPS Ville-Evrard, 93330 Neuilly-sur-Marne, France
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Spain D, Stewart GR, Mason D, Robinson J, Capp SJ, Gillan N, Ensum I, Happé F. Autism Diagnostic Assessments With Children, Adolescents, and Adults Prior to and During the COVID-19 Pandemic: A Cross-Sectional Survey of Professionals. Front Psychiatry 2022; 13:789449. [PMID: 35573336 PMCID: PMC9096098 DOI: 10.3389/fpsyt.2022.789449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/23/2022] [Indexed: 12/24/2022] Open
Abstract
Background Access to timely high quality autism diagnostic assessments has traditionally been patchy; many individuals wait months, if not years, for an appointment. The onset of the COVID-19 pandemic has likely impacted autism diagnostic services. This study investigated professionals' experiences of, and thoughts about: (1) how autism diagnostic assessments were conducted before the pandemic; (2) adaptations to service provision because of the pandemic; and (3) challenges, risks, advantages and opportunities associated with autism assessments conducted via online platforms (telehealth). Method Fifty-two professionals, based in different autism diagnostic services and working with children, adolescents and/or adults, completed an online cross-sectional survey in August and September 2020. This comprised demographic questions (about professionals' roles and experiences), and closed and open questions about service provision and telehealth autism assessments. Results There was substantial variation in how autism assessments were conducted prior to and during the pandemic; for example, in relation to the number of professionals involved in the assessment and types of structured, semi-structured and unstructured measures used to conduct this. Fifty-two percent of participants (n = 27) reported some service disruption (e.g., full closure, substantial reduction in provision, and/or pausing of in person appointments). Waiting times for assessment had become longer for 58% of services (n = 30), due to pandemic-related disruption. Six themes emerged from thematic analysis of open responses: (1) the autism diagnostic pathway, pre-pandemic; (2) initial impact of the pandemic on service delivery; (3) conducting autism assessments during the pandemic; (4) working remotely; (5) improving service design and delivery; and (6) post-diagnostic support. Views about the accessibility, validity, and reliability of conducting telehealth autism assessments were polarized. Some participants considered this efficient, flexible, and adequate; others viewed this as unethical and inappropriate. What constitutes good practice in telehealth autism assessments remains unclear, but there is a general openness to using this method (potentially in a hybrid telehealth-in person model), provided rigor and standardization are enhanced. Conclusions The pandemic has potentially compounded existing bottlenecks to the autism diagnostic pathway. Future research should seek to improve timeliness, standardization, accessibility and robustness of this pathway, and the validity and reliability of telehealth autism assessments.
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Affiliation(s)
- Debbie Spain
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Gavin R. Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - David Mason
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Janine Robinson
- Cambridge Lifespan Autism Spectrum Service, Cambridge, United Kingdom
| | - Simone J. Capp
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Nicola Gillan
- Bristol Autism Spectrum Service, Bristol, United Kingdom
| | - Ian Ensum
- Bristol Autism Spectrum Service, Bristol, United Kingdom
| | - Francesca Happé
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Guillon Q, Baduel S, Bejarano-Martín Á, Canal-Bedia R, MagÁn-Maganto M, FernÁndez-Álvarez C, Martín-Cilleros MV, SÁnchez-Gómez MC, García-Primo P, Rose-Sweeney M, Boilson A, LinertovÁ R, Roeyers H, Van der Paelt S, Schendel D, Warberg CK, Cramer S, Narzisi A, Muratori F, Scattoni ML, Moilanen I, Yliherva A, Saemundsen E, Jonsdottir SL, Efrim-Budisteanu M, Arghir A, Papuc SM, Vicente A, Rasga C, Xenia Kafka J, Poustka L, Kothgassner OD, Kawa R, Pisula E, Sellers T, Posada de la Paz M, Rogé B. Determinants of satisfaction with the detection process of autism in Europe: Results from the ASDEU study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:2136-2150. [PMID: 35261293 DOI: 10.1177/13623613221080318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Professional guidance and support in response to first concerns appears to be an important predictor of the level of satisfaction with the detection process of autism in young children. In this study, we analyzed the views of 1342 family members, including 1278 parents, who completed an online survey form collecting information about their experience and satisfaction with the early detection of autism in their child. Specifically, we were interested in how specific experiences with the detection process relate to the satisfaction with it and whether we could identify important predictors of satisfaction. The detection process is an emotionally charged period for parents, often described as painful, chaotic, and lengthy. A better understanding of their experiences is important to take appropriate action to improve the detection process. In our sample, the level of satisfaction with the detection process varied greatly from one respondent to another. Among the different experiences we considered, whether or not respondents received professional guidance and support in response to first concerns explained most of this variation. We also found that difficulty finding information about detection services, lack of professional guidance and support in response to first concerns, having to find a diagnostic service on one's own, and longer delays between confirmation of concerns and first appointment with a specialist were experiences associated with a greater likelihood of being unsatisfied. The findings of this study highlight the importance of the parent-professional relationship in the detection process and have important practical implications for health administrations to improve the detection process.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Renata LinertovÁ
- Canary Island Foundation for Health Research (Fundación Canaria de Investigación Sanitaria/FUNCANIS) and Health Service Research Network for Chronic Diseases (Red de Investigación en Servicios de Salud en Enfermedades Crónicas/REDISSEC), Spain
| | | | | | - Diana Schendel
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark.,Aarhus University, Denmark.,Drexel University, USA
| | | | | | | | | | | | - Irma Moilanen
- University of Oulu, Finland.,Oulu University Hospital, Finland
| | | | | | | | | | - Aurora Arghir
- Victor Babes - National Institute of Pathology, Romania
| | | | - Astrid Vicente
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Portugal
| | - Celia Rasga
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Portugal
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