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Pearson JN, Outlaw JK, Stewart-Ginsburg JH, Martin DLM. "I Know How to Get Around Your 'No'": A Follow-Up of the FACES Psychoeducational Intervention. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2024; 62:406-419. [PMID: 39317372 DOI: 10.1352/1934-9556-62.5.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 06/09/2023] [Indexed: 09/26/2024]
Abstract
Black children and their families encounter systemic disadvantages in their journey to and through an autism diagnosis. Black families often experience social and systemic barriers to service use. Providing family-centered, psychoeducational interventions can reduce barriers to service access and utilization for Black families raising autistic children. Fostering Advocacy, Communication, Empowerment, and Support (FACES) has demonstrated preliminary efficacy in strengthening outcomes among Black families, yet little is known about the long-term impact of the intervention. The purpose of this qualitative interview study was to understand the experiences of FACES graduates 16 months after the intervention. Four major themes emerged: (a) strengthened advocacy, (b) strengthened empowerment, (c) systemic barriers, and (d) home and community barriers. We provide implications for research and practice.
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Affiliation(s)
- Jamie N Pearson
- Jamie N. Pearson, North Carolina State University Janet K. Outlaw, University of South Florida; and Jared H. Stewart-Ginsburg, and DeVoshia L. Mason Martin, North Carolina State University
| | - Janet K Outlaw
- Jamie N. Pearson, North Carolina State University Janet K. Outlaw, University of South Florida; and Jared H. Stewart-Ginsburg, and DeVoshia L. Mason Martin, North Carolina State University
| | - Jared H Stewart-Ginsburg
- Jamie N. Pearson, North Carolina State University Janet K. Outlaw, University of South Florida; and Jared H. Stewart-Ginsburg, and DeVoshia L. Mason Martin, North Carolina State University
| | - DeVoshia L Mason Martin
- Jamie N. Pearson, North Carolina State University Janet K. Outlaw, University of South Florida; and Jared H. Stewart-Ginsburg, and DeVoshia L. Mason Martin, North Carolina State University
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Wright JR, Astrovskaya I, Barns SD, Goler A, Zhou X, Shu C, Snyder LG, Han B, Shen Y, Volfovsky N, Hall JB, Feliciano P, Chung WK. Return of genetic research results in 21,532 individuals with autism. Genet Med 2024; 26:101202. [PMID: 38958063 DOI: 10.1016/j.gim.2024.101202] [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: 01/30/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/04/2024] Open
Abstract
PURPOSE The aim of this study is to identify likely pathogenic (LP) and pathogenic (P) genetic results for autism that can be returned to participants in SPARK (SPARKforAutism.org): a large recontactable cohort of people with autism in the United States. We also describe the process to return these clinically confirmed genetic findings. METHODS We present results from microarray genotyping and exome sequencing of 21,532 individuals with autism and 17,785 of their parents. We returned LP and P (American College of Medical Genetics criteria) copy-number variants, chromosomal aneuploidies, and variants in genes with strong evidence of association with autism and intellectual disability. RESULTS We identified 1903 returnable LP/P variants in 1861 individuals with autism (8.6%). 89.5% of these variants were not known to participants. The diagnostic genetic result was returned to 589 participants (53% of those contacted). Features associated with a higher probability of having a returnable result include cognitive and medically complex features, being female, being White (versus non-White) and being diagnosed more than 20 years ago. We also find results among autistics across the spectrum, as well as in transmitting parents with neuropsychiatric features but no autism diagnosis. CONCLUSION SPARK offers an opportunity to assess returnable results among autistic people who have not been ascertained clinically. SPARK also provides practical experience returning genetic results for a behavioral condition at a large scale.
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Affiliation(s)
- Jessica R Wright
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | | | - Sarah D Barns
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Alexandra Goler
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Xueya Zhou
- Department of Systems Biology, Columbia University Irving Medical Center, New York, NY
| | - Chang Shu
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | | | - Yufeng Shen
- Department of Systems Biology, Columbia University Irving Medical Center, New York, NY; Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY
| | | | | | - Pamela Feliciano
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Wendy K Chung
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
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Rea CJ, Lesch K, Hernandez B, Hayes M, Sprecher E, Epee-Bounya A, Wilson K, Shah SN. "I'm His Voice": Parent Perspectives on Obtaining an Autism Diagnosis and Services and the Influence of Personal and Cultural Factors. J Autism Dev Disord 2024:10.1007/s10803-024-06556-3. [PMID: 39325288 DOI: 10.1007/s10803-024-06556-3] [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: 09/04/2024] [Indexed: 09/27/2024]
Abstract
To assess caregiver-reported barriers and facilitators to receiving a diagnosis of Autism Spectrum Disorder (ASD) and accessing services as well as the influence of personal and cultural factors.Participants included 29 parents whose children had been diagnosed with ASD between January 2019 and November 2021 while receiving primary care at one of two urban, hospital-affiliated clinics. Semi-structured interviews and surveys were conducted between May 2022 and June 2023 in both English and Spanish. Transcripts were coded and themes developed using thematic content analysis. In the survey portion of the study, 80% of parents said the experience of getting the diagnosis was "very easy/somewhat easy," while 28% of parents said the process of accessing autism services was "very difficult." Four general categories emerged from the qualitative analysis: (1) experience getting the diagnosis, (2) service navigation after diagnosis, (3) need for parent advocacy, and (4) perception of condition by others. Parents generally reported positive experiences with their pediatricians, but some felt their concerns were discounted due to personal factors. The most common frustration expressed was difficulty accessing Applied Behavior Analysis therapy after a diagnosis due to long waiting lists, staff turnover and poor quality. Many parents felt that it would be helpful to have a family navigator to assist with paperwork, insurance complexities, and service access. Parents reported many challenges obtaining an autism diagnosis as well as accessing services. Widespread system change will be required to meet the needs of families equitably and effectively.
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Affiliation(s)
- Corinna J Rea
- Division of General Pediatrics, Boston Children's Hospital, Hunnewell Ground, 300 Longwood Ave, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Kayla Lesch
- Division of General Pediatrics, Boston Children's Hospital, Hunnewell Ground, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Barbara Hernandez
- Division of General Pediatrics, Boston Children's Hospital, Hunnewell Ground, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Makeyla Hayes
- Division of General Pediatrics, Boston Children's Hospital, Hunnewell Ground, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Eli Sprecher
- Division of General Pediatrics, Boston Children's Hospital, Hunnewell Ground, 300 Longwood Ave, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Alexandra Epee-Bounya
- Division of General Pediatrics, Boston Children's Hospital, Hunnewell Ground, 300 Longwood Ave, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Kimberly Wilson
- Division of General Pediatrics, Boston Children's Hospital, Hunnewell Ground, 300 Longwood Ave, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Snehal N Shah
- Division of General Pediatrics, Boston Children's Hospital, Hunnewell Ground, 300 Longwood Ave, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
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4
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Pearson JN, Martin DLM, Stewart-Ginsburg JH, Malone KM, Manns LD, Johnson JA, Macko J, Rivera AD, Lewis J, Green K, Minerali A. Analyzing Community-Based Support Requests Made by Black Families Raising Autistic Children. J Autism Dev Disord 2024:10.1007/s10803-024-06539-4. [PMID: 39325284 DOI: 10.1007/s10803-024-06539-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2024] [Indexed: 09/27/2024]
Abstract
PURPOSE Black families experience additional barriers to accessing autism-related supports compared to White families. Community organizations can help mitigate the negative impact of systemic inequities and lack of support that Black caregivers of autistic family members experience. Little is known about the types of support Black families seek from these organizations. Therefore, the purpose of this study was to explore the support needs of Black families raising autistic children as evidenced by communication patterns in a community-based statewide autism organization. Our research questions were: (1) What are the autism-related support needs of Black families raising autistic children; and (2) How do familial demographics influence these support needs? METHODS We explored the support needs of Black caregivers of autistic family members by analyzing a subset of 1,460 entries (16.8% of the total communication entries) within a database of communication entries from a community-based autism organization in one southeastern state in the United States. We analyzed the frequency of support request types and the relationships between support requests and familial demographics (i.e., rurality, gender, age). RESULTS We found that Black families most often requested family or individual support, school-related support, and behavioral support. Families requested support with bullying, social services, and health insurance less often. We found significant interactions between the three most requested services and the rurality, gender, and age of the autistic family member. CONCLUSION We conclude with suggestions for autism support organizations seeking to better meet the needs of Black families.
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Affiliation(s)
- Jamie N Pearson
- North Carolina State University, Campus Box 7801, Raleigh, NC, 27695, USA.
| | | | | | - Kayla M Malone
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lonnie D Manns
- North Carolina State University, Campus Box 7801, Raleigh, NC, 27695, USA
| | - Janelle A Johnson
- North Carolina State University, Campus Box 7801, Raleigh, NC, 27695, USA
| | - Jennifer Macko
- North Carolina State University, Campus Box 7801, Raleigh, NC, 27695, USA
| | - Amelia D Rivera
- North Carolina State University, Campus Box 7801, Raleigh, NC, 27695, USA
| | - Jetta Lewis
- North Carolina State University, Campus Box 7801, Raleigh, NC, 27695, USA
| | - Keshia Green
- University of Northern Colorado, Greeley, CO, USA
| | - Amela Minerali
- North Carolina State University, Campus Box 7801, Raleigh, NC, 27695, USA
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Srivastava S, Cole JJ, Cohen JS, Chopra M, Smith HS, Deardorff MA, Pedapati E, Corner B, Anixt JS, Jeste S, Sahin M, Gurnett CA, Campbell CA. Survey of the Landscape of Society Practice Guidelines for Genetic Testing of Neurodevelopmental Disorders. Ann Neurol 2024. [PMID: 39319594 DOI: 10.1002/ana.27045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 07/09/2024] [Accepted: 07/15/2024] [Indexed: 09/26/2024]
Abstract
Genetic testing of patients with neurodevelopmental disabilities (NDDs) is critical for diagnosis, medical management, and access to precision therapies. Because genetic testing approaches evolve rapidly, professional society practice guidelines serve an essential role in guiding clinical care; however, several challenges exist regarding the creation and equitable implementation of these guidelines. In this scoping review, we assessed the current state of United States professional societies' guidelines pertaining to genetic testing for unexplained global developmental delay, intellectual disability, autism spectrum disorder, and cerebral palsy. We describe several identified shortcomings and argue the need for a unified, frequently updated, and easily-accessible cross-specialty society guideline. ANN NEUROL 2024.
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Affiliation(s)
- Siddharth Srivastava
- Department of Neurology, Rosamund Stone Zander Translational Neuroscience Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jordan J Cole
- Department of Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, CO, USA
| | - Julie S Cohen
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Maya Chopra
- Department of Neurology, Rosamund Stone Zander Translational Neuroscience Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hadley Stevens Smith
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Matthew A Deardorff
- Departments of Pathology and Pediatrics, Keck School of Medicine of USC, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Ernest Pedapati
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Brian Corner
- Department of Pediatrics and Genetics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Julia S Anixt
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Shafali Jeste
- Department of Neurology, Keck School of Medicine of USC, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Mustafa Sahin
- Department of Neurology, Rosamund Stone Zander Translational Neuroscience Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christina A Gurnett
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Colleen A Campbell
- Department of Internal Medicine, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
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Young K, Harris B, Hall-Lande J, Esler A. The Intersection of Systemic, Child, and Evaluation Factors in the Prediction of Autism Special Education Eligibility; Examining the Role of Race and Ethnicity. J Autism Dev Disord 2024; 54:3274-3289. [PMID: 37480439 DOI: 10.1007/s10803-023-06059-7] [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] [Accepted: 06/26/2023] [Indexed: 07/24/2023]
Abstract
Though there is evidence autism identification has been inequitable for populations who are culturally and linguistically minoritized, there is limited research that explains the issue of disproportionality and factors contributing to its occurrence, especially within an educational setting. To explore contributors to racial/ethnic disparities in autism special education eligibility, the current investigation evaluated child and evaluation characteristics as they relate to the absence of autism eligibility. Data were obtained from the Autism and Developmental Disabilities Monitoring (ADDM) Network Study and included children with behavioral characteristics consistent with autism and educational evaluation records. Despite documented characteristics consistent with autism, only 72% of the sample received educational services under autism eligibility. To characterize children without autism eligibility, hierarchical logistic regression was used to evaluate factors documented in evaluation records predicting the absence of autism eligibility. Factors influencing autism eligibility included behavioral characteristics documented, evaluation components completed, intellectual ability, and clinical diagnoses present. There was no unique contribution of race/ethnicity in predicting the absence of autism eligibility when accounting for these previous predictors, but many of these predictors differed by racial/ethnic group. Disproportionality in autism may be the manifestation of inequitable evaluation experiences, including experiencing less comprehensive evaluations, and not receiving an autism specific assessment. Though race/ethnicity did not uniquely contribute to the absence of autism eligibility above and beyond those combined factors, it is important to evaluate and reduce inequities experienced within the autism identification process for populations who are culturally and linguistically minoritized.
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Affiliation(s)
- Kelsey Young
- Department of Research, Assessment, & Measurement, Curriculum Associates, North Billerica, MA, USA.
| | - Bryn Harris
- School of Education & Human Development, University of Colorado Denver, Denver, CO, USA
| | - Jennifer Hall-Lande
- Institute on Community Integration, University of Minnesota; Twin Cities, Minneapolis, MN, USA
| | - Amy Esler
- Department of Pediatrics, University of Minnesota; Twin Cities, Minneapolis, MN, USA
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Sharma P, Kularatna S, Abell B, McPhail SM, Senanayake S. Preferences for Neurodevelopmental Follow-Up Care for Children: A Discrete Choice Experiment. THE PATIENT 2024:10.1007/s40271-024-00717-3. [PMID: 39210193 DOI: 10.1007/s40271-024-00717-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/18/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Identifying and addressing neurodevelopmental delays in children can be challenging for families and the healthcare system. Delays in accessing services and early interventions are common. The design and delivery of these services, and associated outcomes for children, may be improved if service provision aligns with families' needs and preferences for receiving care. The aim of this study is to identify families' preferences for neurodevelopmental follow-up care for children using an established methodology. METHODS We used a discrete choice experiment (DCE) to elicit families' preferences. We collected data from families and caregivers of children with neurodevelopmental needs. The DCE process included four stages. In stage 1, we identified attributes and levels to be included in the DCE using literature review, interviews, and expert advice. The finalised attributes were location, mode of follow-up, out-of-pocket cost per visit, mental health counselling for parents, receiving educational information, managing appointments, and waiting time. In stage 2, we generated choice tasks that contained two alternatives and a 'neither' option for respondents to choose from, using a Bayesian d-efficient design. These choice tasks were compiled in a survey that also included demographic questions. We conducted pre- and pilot tests to ensure the functionality of the survey and obtain priors. In stage 3, the DCE survey was administered online. We received 301 responses. In stage 4, the analysis was conducted using a latent class model. Additionally, we estimated the relative importance of attributes and performed a scenario analysis. RESULTS Two latent classes were observed. More families with full-time employees, higher incomes, postgraduate degrees, and those living in metropolitan areas were in class 1 compared with class 2. Class 1 families preferred accessing local public health clinics, face-to-face follow-up, paying AUD100 to AUD500, mental health support, group educational activities, health service-initiated appointments, and waiting < 3 months. Class 2 families disliked city hospitals when compared with private, preferred paying AUD100 or no cost, and had similar preferences regarding mental health support and wait times as class 1. However, no significant differences were noted in follow-up modality, receiving educational information, and appointment management. The relative importance estimation suggested that location was most important for class 1 (28%), whereas for class 2, cost accounted for nearly half of the importance when selecting an alternative. The expected uptake of follow-up care, estimated under three different hypothetical scenarios, may increase by approximately 24% for class 2 if an 'ideal' scenario taking into account preferences was implemented. CONCLUSION This study offers insights into aspects that may be prioritised by health services and policymakers to improve the design and delivery of neurodevelopmental follow-up care for children. The findings may enhance the organisation and functioning of existing care programmes; and therefore, improve the long-term outcomes of children with neurodevelopmental needs and their families.
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Affiliation(s)
- Pakhi Sharma
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia.
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Bridget Abell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia
- Digital Health and Informatics Directorate, Metro South Health, Brisbane, QLD, Australia
| | - Sameera Senanayake
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
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Washington AM, Mercer AH, Burrows CA, Dager SR, Elison JT, Estes AM, Grzadzinski R, Lee C, Piven J, Pruett JR, Shen MD, Wilfond B, Wolff J, Zwaigenbaum L, MacDuffie KE. Parent attitudes towards predictive testing for autism in the first year of life. J Neurodev Disord 2024; 16:47. [PMID: 39154179 PMCID: PMC11330042 DOI: 10.1186/s11689-024-09561-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/17/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Emerging biomarker technologies (e.g., MRI, EEG, digital phenotyping, eye-tracking) have potential to move the identification of autism into the first year of life. We investigated the perspectives of parents about the anticipated utility and impact of predicting later autism diagnosis from a biomarker-based test in infancy. METHODS Parents of infants were interviewed to ascertain receptiveness and perspectives on early (6-12 months) prediction of autism using emerging biomarker technologies. One group had experience parenting an older autistic child (n=30), and the other had no prior autism parenting experience (n=25). Parent responses were analyzed using inductive qualitative coding methods. RESULTS Almost all parents in both groups were interested in predictive testing for autism, with some stating they would seek testing only if concerned about their infant's development. The primary anticipated advantage of testing was to enable access to earlier intervention. Parents also described the anticipated emotions they would feel in response to test results, actions they might take upon learning their infant was likely to develop autism, attitudes towards predicting a child's future support needs, and the potential impacts of inaccurate prediction. CONCLUSION In qualitative interviews, parents of infants with and without prior autism experience shared their anticipated motivations and concerns about predictive testing for autism in the first year of life. The primary reported motivators for testing-to have more time to prepare and intervene early-could be constrained by familial resources and service availability. Implications for ethical communication of results, equitable early intervention, and future research are discussed.
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Affiliation(s)
| | | | | | | | | | | | | | - Chimei Lee
- University of Minnesota, Minneapolis, MN, USA
| | - Joseph Piven
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John R Pruett
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Mark D Shen
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Benjamin Wilfond
- University of Washington, Seattle, WA, USA
- Seattle Children's Research Institute, M/S JMB-6, PO Box 5371, Seattle, WA, 98145, USA
| | - Jason Wolff
- University of Minnesota, Minneapolis, MN, USA
| | | | - Katherine E MacDuffie
- University of Washington, Seattle, WA, USA.
- Seattle Children's Research Institute, M/S JMB-6, PO Box 5371, Seattle, WA, 98145, USA.
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Nutor C, Dickerson AS, Hsu T, Al-Jadiri A, Camargo CA, Schweitzer JB, Shuster CL, Karagas MR, Madan JC, Restrepo B, Schmidt RJ, Lugo-Candelas C, Neiderhiser J, Sathyanarayana S, Dunlop AL, Brennan PA. Examining the association between prenatal cannabis exposure and child autism traits: A multi-cohort investigation in the environmental influences on child health outcome program. Autism Res 2024; 17:1651-1664. [PMID: 38953698 PMCID: PMC11341247 DOI: 10.1002/aur.3185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 05/29/2024] [Indexed: 07/04/2024]
Abstract
This study examined the association between prenatal cannabis exposure and autism spectrum disorder (ASD) diagnoses and traits. A total sample of 11,570 children (ages 1-18; 53% male; 25% Hispanic; 60% White) from 34 cohorts of the National Institutes of Health-funded environmental influences on child health outcomes consortium were included in analyses. Results from generalized linear mixed models replicated previous studies showing that associations between prenatal cannabis exposure and ASD traits in children are not significant when controlling for relevant covariates, particularly tobacco exposure. Child biological sex did not moderate the association between prenatal cannabis exposure and ASD. In a large sample and measuring ASD traits continuously, there was no evidence that prenatal cannabis exposure increases the risk for ASD. This work helps to clarify previous mixed findings by addressing concerns about statistical power and ASD measurement.
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Affiliation(s)
- Chaela Nutor
- Department of Psychology, Emory University, Atlanta, Georgia, USA
| | - Aisha S Dickerson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tingju Hsu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aseel Al-Jadiri
- Institute for Child Development, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Carlos A Camargo
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Julie B Schweitzer
- School of Medicine, University of California, Sacramento, California, USA
| | - Coral L Shuster
- Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | | | - Juliette C Madan
- Department of Pediatrics, Psychiatry & Epidemiology, Children's Hospital at Dartmouth, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Bibiana Restrepo
- Department of Pediatrics, University of California Davis School of Medicine, MIND Institute, Sacramento, California, USA
| | - Rebecca J Schmidt
- Department of Public Health Sciences and the MIND Institute, University of California Davis School of Medicine, Davis, California, USA
| | | | - Jenae Neiderhiser
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania, USA
| | | | - Anne L Dunlop
- Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia, USA
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Forsen E, Marrus N, Joyce J, Zhang Y, Constantino JN. Mate selection and current trends in the prevalence of autism. Mol Autism 2024; 15:29. [PMID: 39014500 PMCID: PMC11251233 DOI: 10.1186/s13229-024-00607-3] [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: 01/17/2024] [Accepted: 06/15/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND According to the most recent U.S. CDC surveillance data, the rise in prevalence of childhood autism spectrum disorder among minority children has begun to outpace that of non-Hispanic white children. Since prior research has identified possible differences in the extent of mate selection for autistic traits across families of different ethnicity, this study examined variation in autism related traits in contemporaneous, epidemiologically ascertained samples of spousal pairs representing Hispanic and non-Hispanic white populations. The purpose was to determine whether discrepancies by ethnicity could contribute to differential increases in prevalence in the current generation of young children. METHODS Birth records were used to identify all twin pairs born between 2011 and 2013 in California and Missouri. Families were selected at random from pools of English-speaking Hispanic families in California and Non-Hispanic White families in Missouri. Autistic trait data of parents was obtained using the Adult Report Form of the Social Responsiveness Scale (SRS-2). RESULTS We did not identify a statistically significant difference in the degree of mate selection for autism related traits between Hispanic and non-Hispanic white spousal pairs. However, the degree of spousal correlation observed in this recent cohort was pronounced (on the order of ICC 0.45) and exceeded that typically reported in prior research (on the order of 0.30), surpassing also widely reported estimates for sibling correlation (also on the order of 0.30). LIMITATIONS The sample did not allow for a direct appraisal of change in the magnitude of spousal correlation over time and the ascertainments of trait burden were derived from spouse report. CONCLUSION Across two epidemiologically ascertained samples of spousal pairs representing Hispanic and non-Hispanic white families across two U.S. states (respectively, California and Missouri), the extent of autism-related trait co-variation for parents of the current generation of young children is substantial and exceeds correlations typically observed for siblings. Given the heritability of these traits and their relation to autism risk, societal trends in the degree of mate selection for these traits should be considered as possible contributors to subtle increases in the incidence of autism over time and across generations.
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Affiliation(s)
| | - Natasha Marrus
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Yi Zhang
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - John N Constantino
- Department of Behavioral and Mental Health, Children's Healthcare of Atlanta, Atalanta, GA, 30322, USA.
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Mouat JS, Krigbaum NY, Hakam S, Thrall E, Mellis J, Yasui DH, Cirillo PM, Ludena Y, Schmidt RJ, La Merrill MA, Hertz-Picciotto I, Cohn BA, LaSalle JM. Females with autism spectrum disorders show stronger DNA methylation signatures than males in perinatal tissues. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.07.11.603098. [PMID: 39026708 PMCID: PMC11257592 DOI: 10.1101/2024.07.11.603098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Autism spectrum disorder (ASD) comprises a group of neurodevelopmental conditions currently diagnosed by behavioral assessment in childhood, with reported underdiagnosis in females. Though diagnosis in early life is linked to improved outcomes, we currently lack objective screening tools for newborns. To address this gap, we sought to identify a sex-specific DNA methylation signature for ASD using perinatal tissues that reflect dysregulation in the brain. DNA methylation was assayed from ASD and typically developing (TD) newborn blood, umbilical cord blood, placenta, and post-mortem cortex samples using whole genome bisulfite sequencing (WGBS) in a total of 511 samples. We found that methylation levels of differentially methylated regions (DMRs) differentiated samples by ASD diagnosis in females more than males across the perinatal tissues. We tested three theories for ASD sex differences in newborn blood, finding epigenetic support for an X chromosome-related female protective effect, as well as a high replication rate of DMRs (48.1%) in females across two independent cohorts. In our pan-tissue analysis, three genes (X-linked BCOR, GALNT9, OPCML) mapped to ASD DMRs replicated in all four female tissues. ASD DMRs from all tissues were enriched for neuro-related processes (females) and SFARI ASD-risk genes (females and males). Overall, we found a highly replicated methylation signature of ASD in females across perinatal tissues that reflected dysregulation in the brain and involvement of X chromosome epigenetics. This comparative study of perinatal tissues shows the promise of newborn blood DNA methylation biomarkers for early detection of females at risk for ASD and emphasizes the importance of sex-stratification in ASD studies.
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Affiliation(s)
- Julia S Mouat
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, CA USA
- Perinatal Origins of Disparities Center, University of California, Davis, CA USA
- Genome Center, University of California, Davis, CA USA
- MIND Institute, University of California, Davis, CA USA
| | - Nickilou Y Krigbaum
- Child Health and Development Studies, Public Health Institute, Berkeley, CA USA
| | - Sophia Hakam
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, CA USA
- Perinatal Origins of Disparities Center, University of California, Davis, CA USA
- Genome Center, University of California, Davis, CA USA
- MIND Institute, University of California, Davis, CA USA
| | - Emily Thrall
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, CA USA
- Perinatal Origins of Disparities Center, University of California, Davis, CA USA
- Genome Center, University of California, Davis, CA USA
- MIND Institute, University of California, Davis, CA USA
| | - Julia Mellis
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, CA USA
- Perinatal Origins of Disparities Center, University of California, Davis, CA USA
- Genome Center, University of California, Davis, CA USA
- MIND Institute, University of California, Davis, CA USA
| | - Dag H Yasui
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, CA USA
- Perinatal Origins of Disparities Center, University of California, Davis, CA USA
- Genome Center, University of California, Davis, CA USA
- MIND Institute, University of California, Davis, CA USA
| | - Piera M Cirillo
- Child Health and Development Studies, Public Health Institute, Berkeley, CA USA
| | - Yunin Ludena
- MIND Institute, University of California, Davis, CA USA
- Department of Public Health Sciences, University of California, Davis, CA USA
| | - Rebecca J Schmidt
- Perinatal Origins of Disparities Center, University of California, Davis, CA USA
- MIND Institute, University of California, Davis, CA USA
- Department of Public Health Sciences, University of California, Davis, CA USA
| | - Michele A La Merrill
- Perinatal Origins of Disparities Center, University of California, Davis, CA USA
- Genome Center, University of California, Davis, CA USA
- Department of Environmental Toxicology, University of California, Davis, CA USA
- Environmental Health Sciences Center, University of California, Davis, CA USA
| | - Irva Hertz-Picciotto
- Perinatal Origins of Disparities Center, University of California, Davis, CA USA
- MIND Institute, University of California, Davis, CA USA
- Department of Public Health Sciences, University of California, Davis, CA USA
- Environmental Health Sciences Center, University of California, Davis, CA USA
| | - Barbara A Cohn
- Child Health and Development Studies, Public Health Institute, Berkeley, CA USA
| | - Janine M LaSalle
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, CA USA
- Perinatal Origins of Disparities Center, University of California, Davis, CA USA
- Genome Center, University of California, Davis, CA USA
- MIND Institute, University of California, Davis, CA USA
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12
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Castelin S, Okorodudu J, Smith T. Partnering With a Purpose: Promoting Equity and Justice for Black Children With Autism Spectrum Disorder. J Dev Behav Pediatr 2024; 45:e302-e308. [PMID: 39023854 PMCID: PMC11326990 DOI: 10.1097/dbp.0000000000001276] [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: 11/08/2023] [Accepted: 03/12/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE Black children with autism and their families face disparities within clinical care and services, leading to inequitable health outcomes. However, there is limited research centering the voices of the Black autism community in understanding how to address these inequities. In this study, researchers explored the perspectives of caregivers of Black children with autism regarding barriers to equitable care and recommendations for improved services. METHODS Community leaders from an autism advocacy group and researchers from a large academic medical center partnered to conduct a Group Level Assessment with 31 Black families of children with autism. During a three-hour research event, participants discussed their experiences within community, school, and clinical services, collectively coded and interpreted the data, and generated action steps to improve services. RESULTS The findings revealed 6 areas of need regarding the services Black children with autism and their caregivers receive. Black caregivers recommended that systems of care improve access to culturally responsive care, integrate caregiver priorities within their care, and engage in collaborative decision-making with caregivers. Providers should also equip caregivers with an accessible roadmap for navigating their child's services and connect them to care management professionals and resources for mental health support. CONCLUSION The findings of this study address a critical gap in the literature by partnering with the Black autism community to identify solutions to address their needs; these recommendations can be used as a foundation for service providers to reduce disparities and improve outcomes for Black children with autism and their families.
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Affiliation(s)
| | | | - Teresa Smith
- Neurodevelopmental and Behavioral Psychology, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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13
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Al-Saoud S, Nichols ES, Brossard-Racine M, Wild CJ, Norton L, Duerden EG. A transdiagnostic examination of cognitive heterogeneity in children and adolescents with neurodevelopmental disorders. Child Neuropsychol 2024:1-19. [PMID: 38863216 DOI: 10.1080/09297049.2024.2364957] [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: 11/28/2023] [Accepted: 06/02/2024] [Indexed: 06/13/2024]
Abstract
Children and adolescents with neurodevelopmental disorders demonstrate extensive cognitive heterogeneity that is not adequately captured by traditional diagnostic systems, emphasizing the need for alternative assessment and classification techniques. Using a transdiagnostic approach, a retrospective cohort study of cognitive functioning was conducted using a large heterogenous sample (n = 1529) of children and adolescents 7 to 18 years of age with neurodevelopmental disorders. Measures of short-term memory, verbal ability, and reasoning were administered to participants with attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), comorbid ADHD/ASD, and participants without neurodevelopmental disorders (non-NDD) using a 12-task, web-based neurocognitive testing battery. Unsupervised machine learning techniques were used to create a self-organizing map, an artificial neural network, in conjunction with k-means clustering to identify data-driven subgroups. The study aims were to: 1) identify cognitive profiles in the sample using a data-driven approach, and 2) determine their correspondence with traditional diagnostic statuses. Six clusters representing different cognitive profiles were identified, including participants with varying forms of cognitive impairment. Diagnostic status did not correspond with cluster-membership, providing evidence for the application of transdiagnostic approaches to understanding cognitive heterogeneity in children and adolescents with neurodevelopmental disorders. Additionally, the findings suggest that many typically developing participants may have undiagnosed learning difficulties, emphasizing the need for accessible cognitive assessment tools in school-based settings.
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Affiliation(s)
- Sarah Al-Saoud
- Applied Psychology, Faculty of Education, Western University, London, Ontario, Canada
| | - Emily S Nichols
- Applied Psychology, Faculty of Education, Western University, London, Ontario, Canada
- Western Institute for Neuroscience, Western University, London, Ontario, Canada
| | - Marie Brossard-Racine
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Conor J Wild
- Western Institute for Neuroscience, Western University, London, Ontario, Canada
- Physiology and Pharmacology, Western University, London, Ontario, Canada
| | - Loretta Norton
- Psychology, King's University College, Western University, London, Ontario, Canada
| | - Emma G Duerden
- Applied Psychology, Faculty of Education, Western University, London, Ontario, Canada
- Western Institute for Neuroscience, Western University, London, Ontario, Canada
- Neuroscience, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Canada
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14
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Mendez AI, McQueen E, Gillespie S, Klin A, Klaiman C, Pickard K. Access to Part C, Early Intervention for children younger than 4 years evaluated for autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1431-1440. [PMID: 38360525 DOI: 10.1177/13623613241229150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
LAY ABSTRACT Health disparities are defined as preventable differences in the opportunities to achieve optimal health outcomes experienced by marginalized and underrepresented communities. For families with autistic children, health disparities limit accessing early intervention services-which have been found to improve quality of life and other outcomes. One specific early intervention service in the United States is Individuals with Disabilities Education Act, Part C Early Intervention programs, which are federally funded interventions for children birth-to-three with developmental delays. This study adds to this topic by examining which factors impact accessing Part C, Early Intervention services for children who were evaluated for autism. Results showed that only half of the sample received these services despite there being concerns about development for all children. In addition, results showed that those who identified as Black had decreased odds of having accessed Part C, Early Intervention compared to those who identified as White. These results suggest that there are disparities when it comes to accessing important early intervention services that may be negatively impacting the Black autistic community.
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Affiliation(s)
- Adriana I Mendez
- Emory University, USA
- Marcus Autism Center, USA
- Children's Healthcare of Atlanta, USA
| | | | - Scott Gillespie
- Emory University, USA
- Marcus Autism Center, USA
- Children's Healthcare of Atlanta, USA
| | - Ami Klin
- Emory University, USA
- Marcus Autism Center, USA
- Children's Healthcare of Atlanta, USA
| | - Cheryl Klaiman
- Emory University, USA
- Marcus Autism Center, USA
- Children's Healthcare of Atlanta, USA
| | - Katherine Pickard
- Emory University, USA
- Marcus Autism Center, USA
- Children's Healthcare of Atlanta, USA
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15
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Fannin DK, Williams EDG, Fuller M, Pearson JN, Boyd BA, Drame E, Taylor J, Dickerson AS, Spinks-Franklin A, Coles-White D. Unpacking the prevalence: A warning against overstating the recently narrowed gap for Black autistic youth. Autism Res 2024; 17:1072-1082. [PMID: 38804591 PMCID: PMC11186720 DOI: 10.1002/aur.3168] [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: 01/18/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Abstract
Recent findings from the Centers for Disease Control and Prevention's (CDC) Autism and Developmental Disabilities Monitoring (ADDM) Network's 2020 prevalence report indicate that disparities in autism diagnoses between Black and White youth have narrowed, reflecting improved screening, awareness, and access to services (Maenner et al., 2023. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002), 72, 1-14.). Claims of reducing disparities beyond prevalence rates, however, are not fully supported, as indicated by the reality that Black youth whose screenings indicate autistic traits are still not being referred for full evaluation or early intervention services at the same rate as their White peers (Major et al., 2020. Autism, 24, 1629-1638; Smith et al., 2020. Pediatrics, 145, S35-S46.). Black 8-year-olds identified as autistic still experience disparate educational placements (Waitoller et al., 2010. The Journal of Special Education. 44, 29-49.) where services may not be autism-specific or have Individual Education Plan goals only focused on "behavior problems" (Severini et al., 2018. Journal of Autism and Developmental Disorders, 48, 3261-3272.), are served in the most restrictive environments (Skiba et al., 2006. Exceptional Children, 72, 411-424.) and lack consistent augmentative and alternative communication support (Pope et al., 2022. American Journal of Speech-Language Pathology, 31, 2159-2174.). Additionally, ADMM researchers report consistent disparities in the identification of co-occurring intellectual disability where Black autistic children have significantly more co-occurrences than White autistic children. The purpose of this commentary is to first examine the assertion that the narrowed gap indicates, "…improved…access to services among historically underserved groups," (p. 9) (Maenner et al., 2023. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002), 72, 1-14.). We will then recommend strategies to address the ongoing disparities.
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Affiliation(s)
- Danai Kasambira Fannin
- Department of Communication Sciences and Disorders, North Carolina Central University, Durham, NC
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC
| | | | - Marcus Fuller
- Department of Education, University of Maryland Eastern Shore, Princess Anne, MD
| | - Jamie N. Pearson
- Department of Teacher Education and Learning Sciences, North Carolina State University, Raleigh, NC
| | - Brian A. Boyd
- School of Education, University of North Carolina, Chapel Hill, NC
- Frank Porter Graham Child Development Institute, Chapel Hill, NC
| | - Elizabeth Drame
- Department of Teaching and Learning, University of Wisconsin, Milwaukee, WI
- Division of Diversity, Equity, and Inclusion, University of Wisconsin, Milwaukee, WI
| | - Jonte’ Taylor
- Department of Educational Psychology, Counseling, and Special Education, Penn State University, University Park, PA
| | - Aisha S. Dickerson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - D’Jaris Coles-White
- Department of Speech, Language, Hearing Science, Western Michigan University, Kalamazoo, MI
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16
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Nutor C, Dunlop A, Sadler O, Brennan PA. Prenatal Cannabis Use and Offspring Autism-Related Behaviors: Examining Maternal Stress as a Moderator in a Black American Cohort. J Autism Dev Disord 2024; 54:2355-2367. [PMID: 37097527 PMCID: PMC10127191 DOI: 10.1007/s10803-023-05982-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 04/26/2023]
Abstract
Prenatal cannabis use and maternal stress have been proposed as risk factors for autism spectrum disorder (ASD). Black mothers and mothers of lower socioeconomic status (SES) may be especially likely to experience high levels of stress. This study examined the impact of prenatal cannabis use and maternal stress (i.e., prenatal distress, racial discrimination, and lower SES) on child ASD-related behaviors in a sample of 172 Black mother-child pairs. We found that prenatal stress was significantly associated with ASD-related behaviors. Prenatal cannabis use did not predict ASD-related behaviors and did not interact with maternal stress to predict ASD-related behaviors. These findings replicate previous work on prenatal stress-ASD associations and add to the limited literature on prenatal cannabis-ASD associations in Black samples.
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Affiliation(s)
- C Nutor
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA, 30322, USA.
| | - A Dunlop
- Department of Gynecology and Obstetrics, Emory University, 1365 E Clifton Rd NE, Atlanta, GA, 30322, USA
| | - O Sadler
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA, 30322, USA
| | - P A Brennan
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA, 30322, USA
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17
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Mancilla-Martinez J, Oh MH, Luk G, Rollins A. Special Education Representation Trends Vary by Language Status: Evidence of Underrepresentation in Tennessee. JOURNAL OF LEARNING DISABILITIES 2024; 57:153-167. [PMID: 37309592 PMCID: PMC11044507 DOI: 10.1177/00222194231178285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Using U.S. state-level data, we report unadjusted and adjusted odds ratio of special education (SPED) trends in Tennessee from 2009 to 2019 for students in Grades 3 to 8 by three language groups: native English speakers (NES), English-proficient bilinguals (EPB), and Current English learners (Current EL). We report trends across all SPED disability categories and across five prevalent disability categories (specific learning disability, specific language impairment, intellectual disability, other health impairments, and autism). The cross-sectional analytic sample included 812,783 students from 28 districts that met the SPED risk ratio threshold set by the state. Results revealed that, compared with NES students, both EPB and Current EL students were generally less likely to receive SPED services, suggesting evidence of language status disparities in SPED representation. Furthermore, findings varied depending on whether adjustments were made to generate odds ratios, especially for higher-incidence disabilities (specific learning disability, specific language impairment, and intellectual disability). Finally, the most severe evidence of underrepresentation was in lower-incidence disabilities (other health impairments and autism). Our results underscore the need for further examination into low rates of SPED identification among learners whose first language is not English (EPB and Current EL). We discuss the contextualized research, practice, and policy implications of our findings.
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Affiliation(s)
| | - Min Hyun Oh
- University of Virginia, Charlottesville, USA
| | - Gigi Luk
- McGill University, Montreal, Quebec, Canada
| | - Adam Rollins
- Tennessee Department of Education, Nashville, USA
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18
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Furnier SM, Ellis Weismer S, Rubenstein E, Gangnon R, Rosenberg S, Nadler C, Wiggins LD, Durkin MS. Using adaptive behavior scores to convey level of functioning in children with autism spectrum disorder: Evidence from the Study to Explore Early Development. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1135-1149. [PMID: 37609907 PMCID: PMC10884350 DOI: 10.1177/13623613231193194] [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: 08/24/2023]
Abstract
LAY ABSTRACT Autistic people are often described as "low-" or "high-functioning" based on their scores on cognitive tests. These terms are common in publications and in everyday communication. However, recent research and feedback from the autistic community suggests that relying on cognitive ability alone to describe functioning may miss meaningful differences in the abilities of autistic children and adults and in the kinds of support they may need. Additional methods are needed to describe "functioning" in autistic children. We examined whether scores from a test measuring adaptive behaviors would provide information on the functional abilities of children with autism that is different from cognitive ability and autism symptom severity. Adaptive behaviors include age-appropriate skills that allow people to function in their everyday lives and social interactions. We found that a large amount of the variation in adaptive behavior scores was not explained by cognitive development, autism symptom severity, and behavioral and emotional problems. In addition, there was a wide range of adaptive ability levels in children with autism in our study, including in those with low, average, or high cognitive scores. Our results suggest that adaptive behavior scores could provide useful information about the strengths and support needs of autistic children above and beyond measures of cognitive ability and autism symptom severity. Adaptive behavior scores provide important information on the needs of autistic people.
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19
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Ames JL, Davignon MN, Hayes EA, Croen LA. Health Care for Autistic Children: A Public Health Perspective. Pediatr Clin North Am 2024; 71:111-125. [PMID: 38423712 DOI: 10.1016/j.pcl.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Autism has been the subject of large-scale public health investment. These investments are increasingly shifting toward mitigating the lifelong disability and impairment associated with autism. Key efforts include bolstering screening schedules, accelerating the path to diagnosis and early entry into evidence-based therapies, and providing preventive management of common co-occurring conditions. Enhancing their implementation will necessitate addressing neurodiversity and health equity. Pediatric primary care teams continue to be important stewards in population-level initiatives to promote autistic health. To thrive in this role, these providers will benefit from specific educational and logistical supports from the health care system.
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Affiliation(s)
- Jennifer L Ames
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Drive, Building B, Pleasanton, CA 94588, USA.
| | - Meghan N Davignon
- Kaiser Permanente Roseville Medical Center, 1600 Eureka Road, Building C, Department of Pediatric Subspecialties, Roseville, CA 95661, USA
| | - Elizabeth A Hayes
- Kaiser Permanente Oakland Medical Center, Department of Pediatrics, 275 West Macarthur Boulevard, Oakland, CA 94611, USA
| | - Lisa A Croen
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Drive, Building B, Pleasanton, CA 94588, USA
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20
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Wallis KE, Guthrie W. Screening for Autism: A Review of the Current State, Ongoing Challenges, and Novel Approaches on the Horizon. Pediatr Clin North Am 2024; 71:127-155. [PMID: 38423713 DOI: 10.1016/j.pcl.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Screening for autism is recommended in pediatric primary care. However, the median age of autism spectrum disorder (ASD) diagnosis is substantially higher than the age at which autism can reliably be identified, suggesting room for improvements in autism recognition at young ages, especially for children from minoritized racial and ethnic groups, low-income families, and families who prefer a language other than English. Novel approaches are being developed to utilize new technologies in aiding in autism recognition. However, attention to equity is needed to minimize bias. Additional research on the benefits and potential harms of universal autism screening is needed. The authors provide suggestions for pediatricians who are considering implementing autism-screening programs.
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Affiliation(s)
- Kate E Wallis
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Whitney Guthrie
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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21
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Leng LL, Zhu YW, Zhou LG. Explaining differences in autism detection timing: Age of diagnosis and associated individual and socio-familial factors in Chinese children. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:896-907. [PMID: 37491952 DOI: 10.1177/13623613231187184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
LAY ABSTRACT Timely detection is an issue of paramount importance in the care of children with autism spectrum disorder. Whether the delayed autism spectrum disorder diagnosis can be explained by children's clinical presentations and socio-familial status in China is a question to be addressed. We investigated 1235 autism spectrum disorder children from 132 rehabilitation organisations in Shenzhen, China. These children were found to have a mean age of diagnosis of 31.4 ± 12.7 months and a median age of diagnosis of 30.0 months. The majority of these children were able to receive their diagnosis during toddlerhood. However, about one in six were not diagnosed until they entered preschool or later, thus missing the golden window of opportunity for early intervention. The age of diagnosis was likely to be late if the children were older, were less severe and presented with no intellectual impairment. The odds of having a delayed autism spectrum disorder diagnosis were more than 9 times higher among migrant autism spectrum disorder children than among those with local household registrations, thus underscoring the importance of identifying culturally sensitive socio-economic determinants in autism spectrum disorder detection, as these factors are likely to affect the quality of life of many autism spectrum disorder children and their families.
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22
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Rockhold MN, Gimbel BA, Richardson AA, Kautz-Turnbull C, Speybroeck EL, de Water E, Myers J, Hargrove E, May M, Abdi SS, Petrenko CLM. Racial and ethnic disparities in psychological care for individuals with FASD: a dis/ability studies and critical race theory perspective toward improving prevention, assessment/diagnosis, and intervention. Front Public Health 2024; 12:1355802. [PMID: 38544727 PMCID: PMC10965703 DOI: 10.3389/fpubh.2024.1355802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/16/2024] [Indexed: 05/14/2024] Open
Abstract
Fetal alcohol spectrum disorders (FASD) are among the most common neurodevelopmental disorders and substantially impact public health. FASD can affect people of all races and ethnicities; however, there are important racial and ethnic disparities in alcohol-exposed pregnancy prevention, assessment and diagnosis of FASD, and interventions to support individuals with FASD and their families. In this article we use the Dis/Ability Studies and Critical Race Theory (Dis/Crit) framework to structure the exploration of disparities and possible solutions within these three areas (prevention, diagnosis, intervention). Dis/Crit provides a guide to understanding the intersection of dis/ability and race, while framing both as social constructs. Following the Dis/Crit framework, the systemic, historical, and contemporary racism and ableism present in psychological care is further discussed. We aim to elucidate these racial and ethnic disparities within the fields of psychology and neuropsychology through the Dis/Crit framework and provide potential points of action to reduce these disparities.
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Affiliation(s)
| | - Blake A. Gimbel
- Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | | | | | - Emily L. Speybroeck
- Mt. Hope Family Center, University of Rochester, Rochester, NY, United States
| | - Erik de Water
- Great Lakes Neurobehavioral Center, Edina, MN, United States
| | - Julianne Myers
- Mt. Hope Family Center, University of Rochester, Rochester, NY, United States
| | - Emily Hargrove
- International Adult Leadership Collaborative of FASD Changemakers
| | - Maggie May
- International Adult Leadership Collaborative of FASD Changemakers
| | - Samia S. Abdi
- Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, MN, United States
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23
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Furnier SM, Gangnon R, Daniels JL, Ellis Weismer S, Nadler C, Pazol K, Reyes NM, Rosenberg S, Rubenstein E, Wiggins LD, Yeargin-Allsopp M, Durkin MS. Racial and ethnic disparities in the co-occurrence of intellectual disability and autism: Impact of incorporating measures of adaptive functioning. Autism Res 2024; 17:650-667. [PMID: 38415400 PMCID: PMC11151777 DOI: 10.1002/aur.3107] [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: 11/14/2023] [Accepted: 01/27/2024] [Indexed: 02/29/2024]
Abstract
Intellectual disability (ID) commonly co-occurs in children with autism. Although diagnostic criteria for ID require impairments in both cognitive and adaptive functioning, most population-based estimates of the frequency of co-occurring ID in children with autism-including studies of racial and ethnic disparities in co-occurring autism and ID-base the definition of ID solely on cognitive scores. The goal of this analysis was to examine the effect of including both cognitive and adaptive behavior criteria on estimates of co-occurring ID in a well-characterized sample of 2- to 5-year-old children with autism. Participants included 3264 children with research or community diagnoses of autism enrolled in the population-based Study to Explore Early Development (SEED) phases 1-3. Based only on Mullen Scales of Early Learning (MSEL) composite cognitive scores, 62.9% (95% confidence interval [CI]: 61.1, 64.7%) of children with autism were estimated to have co-occurring ID. After incorporating Vineland Adaptive Behavior Scales, Second Edition (VABS-II) composite or domains criteria, co-occurring ID estimates were reduced to 38.0% (95% CI: 36.2, 39.8%) and 45.0% (95% CI: 43.1, 46.9%), respectively. The increased odds of meeting ID criteria observed for non-Hispanic (NH) Black and Hispanic children relative to NH White children when only MSEL criteria were used were substantially reduced, though not eliminated, after incorporating VABS-II criteria and adjusting for selected socioeconomic variables. This study provides evidence for the importance of considering adaptive behavior as well as socioeconomic disadvantage when describing racial and ethnic disparities in co-occurring ID in epidemiologic studies of autism.
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Affiliation(s)
- Sarah M. Furnier
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ronald Gangnon
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Julie L. Daniels
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Susan Ellis Weismer
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Cy Nadler
- Division of Developmental and Behavioral Health, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Karen Pazol
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nuri M. Reyes
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Steven Rosenberg
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Eric Rubenstein
- Department of Epidemiology, Boston University, Boston, Massachusetts, USA
| | - Lisa D. Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marshalyn Yeargin-Allsopp
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maureen S. Durkin
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
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24
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Thomas RP, de Marchena A, Wieckowski AT, Stahmer A, Milan S, Burke JD, Barton ML, Robins DL, Fein DA. Accuracy of initial diagnostic impressions of autism in toddlers and behaviors that inform these impressions. Autism Res 2024; 17:568-583. [PMID: 38216522 PMCID: PMC11025624 DOI: 10.1002/aur.3088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/09/2023] [Indexed: 01/14/2024]
Abstract
Clinicians form initial impressions about a child's diagnosis based on behavioral features, but research has not yet identified specific behaviors to guide initial diagnostic impressions. Participants were toddlers (N = 55, mean age 22.9 months) from a multi-site early detection study, referred for concern for ASD due to screening or parent/provider concern. Within 5 min of meeting a child, clinicians noted ASD or non-ASD impression, confidence in impression, and behaviors that informed their impression. These clinicians also determined final diagnoses for each child. When a child's final diagnosis was ASD (n = 35), senior clinicians formed an initial impression of ASD in 22 cases (63%) but missed 13 cases (37%). When final diagnosis was non-ASD (n = 20), senior clinicians made an initial impression of non-ASD in all cases (100%). Results were similar among junior clinicians. Senior and junior clinicians used the same behaviors to form accurate impressions of ASD and non-ASD: social reciprocity, nonverbal communication, and eye contact. Senior clinicians additionally used focus of attention when forming accurate impressions of ASD and non-ASD; junior clinicians used this behavior only when forming accurate non-ASD impressions. Clinicians' initial impressions of ASD are very likely to be consistent with final diagnoses, but initial impressions of non-ASD need follow-up. Toddlers who show all four atypical behaviors (social reciprocity, nonverbal communication, eye contact, and focus of attention) might receive expedited ASD diagnoses. However, presence of apparently typical behaviors should not rule out ASD; for some children a longer evaluation is necessary to allow for more opportunities to observe subtle social behavior.
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Affiliation(s)
- Rebecca P. Thomas
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut
| | - Ashley de Marchena
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | | | - Aubyn Stahmer
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, MIND Institute, Sacramento, California
| | - Stephanie Milan
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut
| | - Jeffrey D. Burke
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut
| | - Marianne L. Barton
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut
| | - Diana L. Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Deborah A. Fein
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut
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25
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Weitlauf AS, Miceli A, Vehorn A, Dada Y, Pinnock T, Harris JW, Hine J, Warren Z. Screening, Diagnosis, and Intervention for Autism: Experiences of Black and Multiracial Families Seeking Care. J Autism Dev Disord 2024; 54:931-942. [PMID: 36626007 PMCID: PMC10330934 DOI: 10.1007/s10803-022-05861-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Despite advances in screening and awareness, Black and multiracial families continue to experience challenges when seeking an autism diagnosis for their children. METHODS We surveyed 400 Black and multiracial families of young children with autism from an existing research database in the United States about their retrospective diagnostic experiences. We gathered quantitative and qualitative data and engaged in iterative coding to understand timing and content of first concerns, families' experiences of care providers and systems, and the impact of race and culture on accessing care. RESULTS Families provided examples of early developmental concern and described provider, systemic, and cultural barriers and facilitators to care. Families also provided insight into the influence of culture and made recommendations on how the medical system could better care for Black and multiracial families of children with autism. CONCLUSIONS Results add to a growing body of literature supporting the need for culturally sensitive and accessible care related to developmental monitoring, diagnosis, and follow-up care for Black and multiracial children.
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Affiliation(s)
- Amy S Weitlauf
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Alexandra Miceli
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alison Vehorn
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yewande Dada
- Department of Pediatrics, Meharry Medical College, Nashville, TN, USA
| | - Theodora Pinnock
- Department of Pediatrics, Meharry Medical College, Nashville, TN, USA
| | - Joyce W Harris
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey Hine
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zachary Warren
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Special Education, Vanderbilt University, Nashville, TN, USA
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26
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Klaiman C, White S, Richardson S, McQueen E, Walum H, Aoki C, Smith C, Minjarez M, Bernier R, Pedapati E, Bishop S, Ence W, Wainer A, Moriuchi J, Tay SW, Deng Y, Jones W, Gillespie S, Klin A. Expert Clinician Certainty in Diagnosing Autism Spectrum Disorder in 16-30-Month-Olds: A Multi-site Trial Secondary Analysis. J Autism Dev Disord 2024; 54:393-408. [PMID: 36396807 PMCID: PMC9672659 DOI: 10.1007/s10803-022-05812-8] [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: 10/30/2022] [Indexed: 11/18/2022]
Abstract
Differential diagnosis of young children with suspected autism spectrum disorder (ASD) is challenging, and clinician uncertainty about a child's diagnosis may contribute to misdiagnosis and subsequent delays in access to early treatment. The current study was designed to replicate and expand a recent report in this Journal (McDonnell et al. in J Autism Dev Disord 49:1391-1401, https://doi.org/10.1080/15374416.2020.1823850 , 2019), in which only 60% of diagnoses were made with complete certainty by clinicians evaluating 478 toddlers and preschool children referred for possible ASD to specialized clinics. In this study, secondary analyses were performed on diagnostic, demographic and clinical data for 496 16-30-month-old children who were consecutive referrals to a 6-site clinical trial executed by specialized centers with experienced clinicians following best-practice procedures for the diagnosis of ASD. Overall, 70.2% of diagnoses were made with complete certainty. The most important factor associated with clinician uncertainty was mid-level autism-related symptomatology. Mid-level verbal age equivalents were also associated with clinician uncertainty, but measures of symptomatology were stronger predictors. None of the socio-demographic variables, including sex of the child, was significantly associated with clinician certainty. Close to one third of early diagnoses of ASD are made with a degree of uncertainty. The delineation of specific ranges on the ADOS-2 most likely to result in clinician uncertainty identified in this study may provide an opportunity to reduce random subjectivity in diagnostic decision-making via calibration of young-child diagnostic thresholds based on later-age longitudinal diagnostic outcome data, and via standardization of decision-making in regard to clinical scenarios frequently encountered by clinicians.
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Affiliation(s)
- Cheryl Klaiman
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Stormi White
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Shana Richardson
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Emma McQueen
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Hasse Walum
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Christa Aoki
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Mendy Minjarez
- Seattle Children's Hospital & Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - Raphael Bernier
- Seattle Children's Hospital & Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - Ernest Pedapati
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Somer Bishop
- University of California San Francisco, San Francisco, CA, USA
| | - Whitney Ence
- University of California San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Warren Jones
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Center for Translational Social Neuroscience, Emory University, 954 Gatewood Road, Atlanta, GA, USA
| | - Scott Gillespie
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Ami Klin
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
- Center for Translational Social Neuroscience, Emory University, 954 Gatewood Road, Atlanta, GA, USA.
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27
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Coulter KL, Moreno P, Barton M, Dumont-Mathieu T, Robins DL, Fein DA. Validity of the Toddler Autism Symptom Inventory in Non-Hispanic White and Black Toddlers. J Autism Dev Disord 2024; 54:339-352. [PMID: 36316523 PMCID: PMC10148924 DOI: 10.1007/s10803-022-05756-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 05/01/2023]
Abstract
Racial disparities exist in autism diagnosis, and yet, the development of most diagnostic tools has not explicitly examined measurement equity between racial and ethnic groups. We examined the validity of the Toddler Autism Symptom Inventory (TASI), a semi-structured interview developed for diagnosis of toddlers, in non-Hispanic Black/African American and non-Hispanic White children. After controlling for group differences in socio-economic status, no differences in diagnosis, age at diagnosis, mean developmental level, or autism severity were found. TASI ROC curves for both groups, in the overall sample, and in samples stratified by SES, showed high AUC values. Validity of two cutoff scores was acceptable. Lack of significant differences in TASI score or responses to individual items suggests similar symptomatology. These results provide early support for the use of the TASI in diagnostic evaluations of Black and White children.
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Affiliation(s)
- Kirsty L Coulter
- University of Connecticut, 406 Unit 1020, Babbidge Rd, 06269, Storrs, CT, USA.
| | - Paula Moreno
- University of Connecticut, 406 Unit 1020, Babbidge Rd, 06269, Storrs, CT, USA
| | - Marianne Barton
- University of Connecticut, 406 Unit 1020, Babbidge Rd, 06269, Storrs, CT, USA
| | - Thyde Dumont-Mathieu
- University of Connecticut School of Medicine, Connecticut Children's Medical Center, Farmington, CT, USA
| | | | - Deborah A Fein
- University of Connecticut, 406 Unit 1020, Babbidge Rd, 06269, Storrs, CT, USA
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28
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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.
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Affiliation(s)
- Arwa K. Nasir
- University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Marie Bernard
- University of Nebraska Medical Center, Omaha, NE, USA
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29
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Wagner L, Vehorn A, Weitlauf AS, Lavanderos AM, Wade J, Corona L, Warren Z. Development of a Novel Telemedicine Tool to Reduce Disparities Related to the Identification of Preschool Children with Autism. J Autism Dev Disord 2023:10.1007/s10803-023-06176-3. [PMID: 38064003 PMCID: PMC11161552 DOI: 10.1007/s10803-023-06176-3] [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: 10/29/2023] [Indexed: 12/20/2023]
Abstract
The wait for ASD evaluation dramatically increases with age, with wait times of a year or more common as children reach preschool. Even when appointments become available, families from traditionally underserved groups struggle to access care. Addressing care disparities requires designing identification tools and processes specifically for and with individuals most at-risk for health inequities. This work describes the development of a novel telemedicine-based ASD assessment tool, the TELE-ASD-PEDS-Preschool (TAP-Preschool). We applied machine learning models to a clinical data set of preschoolers with ASD and other developmental concerns (n = 914) to generate behavioral targets that best distinguish ASD and non-ASD features. We conducted focus groups with clinicians, early interventionists, and parents of children with ASD from traditionally underrepresented racial/ethnic and linguistic groups. Focus group themes and machine learning analyses were used to generate a play-based instrument with assessment tasks and scoring procedures based on the child's language (i.e., TAP-P Verbal, TAP-P Non-verbal). TAP-P procedures were piloted with 30 families. Use of the instrument in isolation (i.e., without history or collateral information) yielded accurate diagnostic classification in 63% of cases. Children with existing ASD diagnoses received higher TAP-P scores, relative to children with other developmental concerns. Clinician diagnostic accuracy and certainty were higher when confirming existing ASD diagnoses (80% agreement) than when ruling out ASD in children with other developmental concerns (30% agreement). Utilizing an equity approach to understand the functionality and impact of tele-assessment for preschool children has potential to transform the ASD evaluation process and improve care access.
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Affiliation(s)
- Liliana Wagner
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1241 Blakemore Avenue, # 161, Nashville, TN, 37212, USA.
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Alison Vehorn
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1241 Blakemore Avenue, # 161, Nashville, TN, 37212, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amy S Weitlauf
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1241 Blakemore Avenue, # 161, Nashville, TN, 37212, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ambar Munoz Lavanderos
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1241 Blakemore Avenue, # 161, Nashville, TN, 37212, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joshua Wade
- Adaptive Technology Consulting, LLC, Murfreesboro, USA
| | - Laura Corona
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1241 Blakemore Avenue, # 161, Nashville, TN, 37212, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zachary Warren
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1241 Blakemore Avenue, # 161, Nashville, TN, 37212, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Special Education, Vanderbilt University, Nashville, TN, USA
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30
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Stephenson KG, Levine A, Russell NCC, Horack J, Butter EM. Measuring intelligence in Autism and ADHD: Measurement invariance of the-Binet 5th edition and impact of subtest scatter on abbreviated IQ accuracy. Autism Res 2023; 16:2350-2363. [PMID: 37767546 DOI: 10.1002/aur.3034] [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: 03/21/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023]
Abstract
Scatter and heterogeneity in cognitive profiles is thought to be common in autism spectrum disorder (ASD), which may indicate differences in the construct of IQ. However, less research has investigated IQ scatter in attention-deficit/hyperactivity disorder (ADHD). Scatter is also thought to negatively impact the predictive validity of IQ summary scores, although there is research refuting this notion. Abbreviated IQ tests, such as the Stanford-Binet fifth edition (SB-5) abbreviated battery IQ (ABIQ), may be especially susceptible to the influence of scatter. We tested the measurement invariance of the SB-5 as well as the predictive validity of the ABIQ in predicting FSIQ in 1679 youth (21% female) ages 2-16 years with a clinical diagnosis of ASD or ADHD. Results indicated the SB-5 is measuring IQ the same way in ASD and ADHD. There were no differences between diagnostic groups in scatter between ABIQ (i.e., routing) subtests. Additionally, scatter was not related to dimensional autistic traits. Higher degree of scatter was associated with poorer predictive validity of the ABIQ and a higher likelihood of overestimating FSIQ, regardless of diagnosis. Overall, we found more similarities than differences between the ASD and ADHD groups. Our results show that the SB-5 ABIQ is generally a strong predictor of FSIQ in youth with neurodevelopmental disorders. However, the use of the SB-5 ABIQ in research and clinical applications, without consideration of scatter on routing subtests, is potentially problematic.
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Affiliation(s)
- Kevin G Stephenson
- Child Development Center, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
- Departments of Pediatrics and Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Ann Levine
- Child Development Center, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
- Departments of Pediatrics and Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Nicholas C C Russell
- Child Development Center, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
- Departments of Pediatrics and Psychology, The Ohio State University, Columbus, Ohio, USA
| | - John Horack
- Child Development Center, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Eric M Butter
- Child Development Center, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
- Departments of Pediatrics and Psychology, The Ohio State University, Columbus, Ohio, USA
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31
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Baires NA, Cañón LF, García-Zambrano S, Guerrero-Wickham P, Castro-Hostetler M. A Contextual Behavioral Framework for Enhancing Cultural Responsiveness in Behavioral Service Delivery for Latino Families. Behav Anal Pract 2023; 16:938-962. [PMID: 38076756 PMCID: PMC10700274 DOI: 10.1007/s40617-023-00788-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 04/22/2024] Open
Abstract
In recent years, the field of behavior analysis has shifted its attention to issues of diversity, social justice, and cultural responsiveness. With various cultural groups in the United States, behavior analytic practitioners increasingly find themselves serving clients of diverse cultural backgrounds. One of the populations that continue to face underrepresentation is Latinos. In the current article, a cultural understanding of the Latino culture is provided to support cultural responsiveness in behavioral service delivery. This article explores the Latino identity of individuals receiving behavioral services, systemic barriers faced by Latinos, the use of acceptance and commitment training for Latino families and clients, and Latino cultural values and their role in behavioral service delivery. Most important, a shift in perspective to account for the barriers perceived by practitioners within the context of Latino cultural values is offered through a contextual behavioral framework, the literature, and the authors' personal and professional experiences as Latino behavior analysts. Recommendations in the areas of assessment, treatment design, service delivery, and collaboration when working with Latinos are also discussed.
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Affiliation(s)
- Natalia A. Baires
- School of Psychological and Behavioral Sciences, Behavior Analysis and Therapy Program, Southern Illinois University, Carbondale, IL 62901 USA
| | - Luisa F. Cañón
- Institute for Effective Behavioral Interventions/ACT to Thrive, Encino, CA USA
| | - Sebastián García-Zambrano
- School of Psychological and Behavioral Sciences, Behavior Analysis and Therapy Program, Southern Illinois University, Carbondale, IL 62901 USA
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32
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Herkert D, Sullivan C, Zhu Y, Dawson G. Prevalence and nature of prior developmental and medical concerns in toddlers who screen positive for autism in primary care. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:2361-2371. [PMID: 37838915 PMCID: PMC10593482 DOI: 10.1177/13623613231162146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
LAY ABSTRACT The American Academy of Pediatrics recommends that all children be screened for autism at their 18- and 24-month well-child visit. For children who screen positive for autism, it is unknown whether this usually represents the first time a developmental concern has been raised or if other developmental concerns typically precede a positive autism screen. Such knowledge could help guide providers in how to appropriately convey feedback regarding autism screening. This study found that, for close to 80% of children with a positive autism screen, caregivers or providers had a prior autism, language, motor, or other developmental concern documented in the electronic health record. Many also had other prior concerns frequently linked to autism, such as sleep and gastrointestinal problems, and received physical or speech therapy. On average, prior to screening children who received a positive Modified-Checklist for Autism in Toddlers had two documented concerns by at 1 year of age and three concerns by 2 years of age. These findings imply that screening for autism as a part of routine pediatric care likely takes place in the context of larger conversations regarding existing developmental concerns, allowing for a less stigmatizing discussion of autism. Framing the presence of prior concerns in the setting of a positive screen in this context may create a reaffirming space for existing caregiver concerns and a lessened emotional burden on caregivers.
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Affiliation(s)
- Darby Herkert
- Duke University School of Medicine, 8 Searle Center Dr, Durham, NC 27710
| | - Connor Sullivan
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705, U.S.A
| | - YiQin Zhu
- Duke University School of Medicine, 8 Searle Center Dr, Durham, NC 27710
| | - Geraldine Dawson
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705, U.S.A
- Duke University School of Medicine, 8 Searle Center Dr, Durham, NC 27710
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33
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Habayeb S, Inge A, Myrick Y, Hastings A, Long M, Hoffman SB, Parker S, Theodorou P, Soutullo O, Beers L, Godoy L. A Multisystem Approach to Improving Autism Care. Pediatrics 2023; 152:e2022060584. [PMID: 37795558 DOI: 10.1542/peds.2022-060584] [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: 07/12/2023] [Indexed: 10/06/2023] Open
Abstract
Children with autism face significant barriers to accessing evaluations and intervention services often because of confusing referral processes, lack of centralized coordination across organizations serving children with autism, insurance coverage gaps, multiyear waitlists for diagnostic services, and limited provider knowledge about autism. Racism and systemic inequities exist and persist in autism care across the United States. This article reviews targeted initiatives implemented by a multidisciplinary team to advocate for, and address barriers faced, by autistic children and their families in Washington, DC. We describe initiatives across multiple levels of the health care system including: 1. infrastructure-building initiatives (eg, coalition-building, policy, and advocacy); 2. enabling services (eg, population- and community-level supports that increase provider capacity to serve children's and families' needs); and 3. direct services (eg, innovative, gap-filling programs that directly serve children and families). We review outcomes and describe lessons learned.
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Affiliation(s)
- Serene Habayeb
- Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Anne Inge
- Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Yetta Myrick
- DC Autism Parents, Washington, District of Columbia
| | - Amanda Hastings
- Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Melissa Long
- Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | | | - Shaakira Parker
- Children's National Hospital, Washington, District of Columbia
| | | | - Olivia Soutullo
- Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Lee Beers
- Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Leandra Godoy
- Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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El-Ansary A, Al-Ayadhi L. Effects of Walnut and Pumpkin on Selective Neurophenotypes of Autism Spectrum Disorders: A Case Study. Nutrients 2023; 15:4564. [PMID: 37960217 PMCID: PMC10647375 DOI: 10.3390/nu15214564] [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: 09/19/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Special diets or nutritional supplements are regularly given to treat children with autism spectrum disorder (ASD). The increased consumption of particular foods has been demonstrated in numerous trials to lessen autism-related symptoms and comorbidities. A case study on a boy with moderate autism who significantly improved after three years of following a healthy diet consisting of pumpkin and walnuts was examined in this review in connection to a few different neurophenotypes of ASD. We are able to suggest that a diet high in pumpkin and walnuts was useful in improving the clinical presentation of the ASD case evaluated by reducing oxidative stress, neuroinflammation, glutamate excitotoxicity, mitochondrial dysfunction, and altered gut microbiota, all of which are etiological variables. Using illustrated figures, a full description of the ways by which a diet high in pumpkin and nuts could assist the included case is offered.
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Affiliation(s)
- Afaf El-Ansary
- Autism Center, Lotus Holistic Alternative Medical Center, Abu Dhabi P.O. Box 110281, United Arab Emirates
- Autism Research and Treatment Center, P.O. Box 2925, Riyadh 11461, Saudi Arabia;
| | - Laila Al-Ayadhi
- Autism Research and Treatment Center, P.O. Box 2925, Riyadh 11461, Saudi Arabia;
- Department of Physiology, Faculty of Medicine, King Saud University, P.O. Box 2925, Riyadh 11461, Saudi Arabia
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Stephenson KG, Fenning RM, Macklin EA, Lu F, Norris M, Steinberg-Epstein R, Butter EM. Child Behavior Problems and Parenting Stress in Underserved Families of Children with ASD: Investigation of Family Resources and Parenting Self-efficacy. J Autism Dev Disord 2023; 53:3787-3798. [PMID: 35879640 DOI: 10.1007/s10803-022-05681-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 10/16/2022]
Abstract
Behavior problems in children with autism spectrum disorder (ASD) may exacerbate parenting stress. Parenting self-efficacy and family resources may influence this association. We examined cross-sectional statistical mediation effects of parenting self-efficacy on the relationship between child behavior problems and parenting stress and hypothesized that family-level resources moderated this indirect effect. Participants included 132 underserved (Medicaid-eligible) children with ASD (ages 3-13) with racial/ethnic diversity; many (63%) had intellectual disability. Greater externalizing problems were linked with lower parenting self-efficacy, which in turn was associated with increased parenting stress. A larger mediation effect was observed for families with fewer resources. A plausible alternative model (parenting stress mediating parenting self-efficacy) exhibited poorer fit. Implications for family supports and benefits of longitudinal follow-up are discussed.
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Affiliation(s)
- Kevin G Stephenson
- Child Development Center, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, 43205, USA.
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA.
| | - Rachel M Fenning
- Department of Psychological Science and Claremont Autism Center, Claremont McKenna College, Claremont, CA, USA
- Department of Child and Adolescent Studies and Center for Autism, California State University, Fullerton, CA, USA
- The Center for Autism and Neurodevelopmental Disorders, Department of Pediatrics, University of California, Irvine, Santa Ana, CA, USA
| | - Eric A Macklin
- Biostatistics Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Frances Lu
- Biostatistics Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Megan Norris
- Child Development Center, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, 43205, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Robin Steinberg-Epstein
- The Center for Autism and Neurodevelopmental Disorders, Department of Pediatrics, University of California, Irvine, Santa Ana, CA, USA
| | - Eric M Butter
- Child Development Center, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, 43205, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
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Honaker MG, Weitlauf AS, Swanson AR, Hooper M, Sarkar N, Wade J, Warren ZE. Paisley: Preliminary validation of a novel app-based e-Screener for ASD in children 18-36 months. Autism Res 2023; 16:1963-1975. [PMID: 37602567 PMCID: PMC10857772 DOI: 10.1002/aur.2997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/12/2023] [Indexed: 08/22/2023]
Abstract
The purpose of this study was to assess the validity of an autism e-screener, Paisley, when utilized in a clinical research setting via a tablet application. The Paisley application used a series of play-based activities, all of which incorporated varying aspects of the ASD-PEDS. Participants included children (18-36 months; n = 198) referred for evaluation of autism spectrum disorder (ASD) and community providers (n = 66) with differing levels of familiarity with ASD. Community providers administered the Paisley application to children who then completed a comprehensive psychological evaluation. Based on comprehensive evaluation, 75% of children met diagnostic criteria for ASD. Paisley scores were significantly higher for children diagnosed with ASD (15.06) versus those not diagnosed (9.34). The newly determined cutoff ASD-PEDS cutoff score of 13 had significantly higher specificity and positive predictive value than the originally proposed cutoff of 11. Results support the use of Paisley by community providers to identify autism risk in toddlers. Limitations and strengths of the work, as well as opportunities for future clinical validation, are described.
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Affiliation(s)
- Makayla G Honaker
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Nashville, Tennessee, USA
| | - Amy S Weitlauf
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Nashville, Tennessee, USA
| | - Amy R Swanson
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Nashville, Tennessee, USA
- Adaptive Technology Consulting, Nashville, Tennessee, USA
| | - Madison Hooper
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Nilanjan Sarkar
- Adaptive Technology Consulting, Nashville, Tennessee, USA
- Department of Mechanical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Joshua Wade
- Adaptive Technology Consulting, Nashville, Tennessee, USA
| | - Zachary E Warren
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Special Education, Vanderbilt University, Nashville, Tennessee, USA
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Khairetdinov OZ, Rubakova LI. Equivalence of the autism spectrum disorders diagnostics in children in telemedicine and face-to-face consultations: a literature review. CONSORTIUM PSYCHIATRICUM 2023; 4:55-64. [PMID: 38249532 PMCID: PMC10795948 DOI: 10.17816/cp12496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/31/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The use of remote forms of mental health care has become widespread during the period of epidemiological restrictions due to the COVID-19 pandemic. Methodological and organizational issues remain insufficiently developed, including the level of equivalence of the use of telemedicine technologies in the diagnosis of autistic spectrum disorders. AIM Study of the equivalence of diagnostic tools in the framework of telemedicine and face-to-face consultations in children with autistic spectrum disorders according to modern scientific literature. METHODS A descriptive review of scientific studies published between January 2017 and May 2023 was carried out. The papers presented in the electronic databases PubMed, Web of Science, and eLibrary were analyzed. Descriptive analysis was used to summarize the obtained data. RESULTS The conducted analysis convincingly indicates sufficient equivalence of remote tools used in different countries for level I screening, assessment scales, and structured procedures for diagnosing autistic spectrum disorders with a high level of specificity from 60.0 to 94.4%, sensitivity from 75 dog 98.4%, and satisfaction of patients and their legal representatives. CONCLUSION The widespread use of validated telemedicine diagnostic systems in clinical practice contributes to the early detection of autistic spectrum disorders, increasing the timeliness and effectiveness of medical, corrective psychological, pedagogical, and habilitation interventions.
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Affiliation(s)
- Oleg Z. Khairetdinov
- Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva
| | - Luciena I. Rubakova
- Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva
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38
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Dawson G. Could an Eye-Tracking Test Aid Clinicians in Making an Autism Diagnosis?: New Findings and a Look to the Future. JAMA 2023; 330:815-817. [PMID: 37668633 PMCID: PMC10773262 DOI: 10.1001/jama.2023.3092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Affiliation(s)
- Geraldine Dawson
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
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Jones W, Klaiman C, Richardson S, Aoki C, Smith C, Minjarez M, Bernier R, Pedapati E, Bishop S, Ence W, Wainer A, Moriuchi J, Tay SW, Klin A. Eye-Tracking-Based Measurement of Social Visual Engagement Compared With Expert Clinical Diagnosis of Autism. JAMA 2023; 330:854-865. [PMID: 37668621 PMCID: PMC10481242 DOI: 10.1001/jama.2023.13295] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/29/2023] [Indexed: 09/06/2023]
Abstract
Importance In the US, children with signs of autism often experience more than 1 year of delay before diagnosis and often experience longer delays if they are from racially, ethnically, or economically disadvantaged backgrounds. Most diagnoses are also received without use of standardized diagnostic instruments. To aid in early autism diagnosis, eye-tracking measurement of social visual engagement has shown potential as a performance-based biomarker. Objective To evaluate the performance of eye-tracking measurement of social visual engagement (index test) relative to expert clinical diagnosis in young children referred to specialty autism clinics. Design, Setting, and Participants In this study of 16- to 30-month-old children enrolled at 6 US specialty centers from April 2018 through May 2019, staff blind to clinical diagnoses used automated devices to measure eye-tracking-based social visual engagement. Expert clinical diagnoses were made using best practice standardized protocols by specialists blind to index test results. This study was completed in a 1-day protocol for each participant. Main Outcomes and Measures Primary outcome measures were test sensitivity and specificity relative to expert clinical diagnosis. Secondary outcome measures were test correlations with expert clinical assessments of social disability, verbal ability, and nonverbal cognitive ability. Results Eye-tracking measurement of social visual engagement was successful in 475 (95.2%) of the 499 enrolled children (mean [SD] age, 24.1 [4.4] months; 38 [8.0%] were Asian; 37 [7.8%], Black; 352 [74.1%], White; 44 [9.3%], other; and 68 [14.3%], Hispanic). By expert clinical diagnosis, 221 children (46.5%) had autism and 254 (53.5%) did not. In all children, measurement of social visual engagement had sensitivity of 71.0% (95% CI, 64.7% to 76.6%) and specificity of 80.7% (95% CI, 75.4% to 85.1%). In the subgroup of 335 children whose autism diagnosis was certain, sensitivity was 78.0% (95% CI, 70.7% to 83.9%) and specificity was 85.4% (95% CI, 79.5% to 89.8%). Eye-tracking test results correlated with expert clinical assessments of individual levels of social disability (r = -0.75 [95% CI, -0.79 to -0.71]), verbal ability (r = 0.65 [95% CI, 0.59 to 0.70]), and nonverbal cognitive ability (r = 0.65 [95% CI, 0.59 to 0.70]). Conclusions and Relevance In 16- to 30-month-old children referred to specialty clinics, eye-tracking-based measurement of social visual engagement was predictive of autism diagnoses by clinical experts. Further evaluation of this test's role in early diagnosis and assessment of autism in routine specialty clinic practice is warranted. Trial Registration ClinicalTrials.gov Identifier: NCT03469986.
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Affiliation(s)
- Warren Jones
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Center for Translational Social Neuroscience, Emory University, Atlanta, Georgia
| | - Cheryl Klaiman
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Shana Richardson
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Christa Aoki
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | | | - Mendy Minjarez
- Seattle Children’s Autism Center and Department of Psychiatry, University of Washington, Seattle
| | - Raphael Bernier
- Seattle Children’s Autism Center and Department of Psychiatry, University of Washington, Seattle
| | - Ernest Pedapati
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | | | | | - Ami Klin
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Center for Translational Social Neuroscience, Emory University, Atlanta, Georgia
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Jones W, Klaiman C, Richardson S, Lambha M, Reid M, Hamner T, Beacham C, Lewis P, Paredes J, Edwards L, Marrus N, Constantino JN, Shultz S, Klin A. Development and Replication of Objective Measurements of Social Visual Engagement to Aid in Early Diagnosis and Assessment of Autism. JAMA Netw Open 2023; 6:e2330145. [PMID: 37669054 PMCID: PMC10481232 DOI: 10.1001/jamanetworkopen.2023.30145] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/11/2023] [Indexed: 09/06/2023] Open
Abstract
Importance Autism spectrum disorder is a common and early-emerging neurodevelopmental condition. While 80% of parents report having had concerns for their child's development before age 2 years, many children are not diagnosed until ages 4 to 5 years or later. Objective To develop an objective performance-based tool to aid in early diagnosis and assessment of autism in children younger than 3 years. Design, Setting, and Participants In 2 prospective, consecutively enrolled, broad-spectrum, double-blind studies, we developed an objective eye-tracking-based index test for children aged 16 to 30 months, compared its performance with best-practice reference standard diagnosis of autism (discovery study), and then replicated findings in an independent sample (replication study). Discovery and replication studies were conducted in specialty centers for autism diagnosis and treatment. Reference standard diagnoses were made using best-practice standardized protocols by specialists blind to eye-tracking results. Eye-tracking tests were administered by staff blind to clinical results. Children were enrolled from April 27, 2013, until September 26, 2017. Data were analyzed from March 28, 2018, to January 3, 2019. Main Outcomes and Measures Prespecified primary end points were the sensitivity and specificity of the eye-tracking-based index test compared with the reference standard. Prespecified secondary end points measured convergent validity between eye-tracking-based indices and reference standard assessments of social disability, verbal ability, and nonverbal ability. Results Data were collected from 1089 children: 719 children (mean [SD] age, 22.4 [3.6] months) in the discovery study, and 370 children (mean [SD] age, 25.4 [6.0] months) in the replication study. In discovery, 224 (31.2%) were female and 495 (68.8%) male; in replication, 120 (32.4%) were female and 250 (67.6%) male. Based on reference standard expert clinical diagnosis, there were 386 participants (53.7%) with nonautism diagnoses and 333 (46.3%) with autism diagnoses in discovery, and 184 participants (49.7%) with nonautism diagnoses and 186 (50.3%) with autism diagnoses in replication. In the discovery study, the area under the receiver operating characteristic curve was 0.90 (95% CI, 0.88-0.92), sensitivity was 81.9% (95% CI, 77.3%-85.7%), and specificity was 89.9% (95% CI, 86.4%-92.5%). In the replication study, the area under the receiver operating characteristic curve was 0.89 (95% CI, 0.86-0.93), sensitivity was 80.6% (95% CI, 74.1%-85.7%), and specificity was 82.3% (95% CI, 76.1%-87.2%). Eye-tracking test results correlated with expert clinical assessments of children's individual levels of ability, explaining 68.6% (95% CI, 58.3%-78.6%), 63.4% (95% CI, 47.9%-79.2%), and 49.0% (95% CI, 33.8%-65.4%) of variance in reference standard assessments of social disability, verbal ability, and nonverbal cognitive ability, respectively. Conclusions and Relevance In two diagnostic studies of children younger than 3 years, objective eye-tracking-based measurements of social visual engagement quantified diagnostic status as well as individual levels of social disability, verbal ability, and nonverbal ability in autism. These findings suggest that objective measurements of social visual engagement can be used to aid in autism diagnosis and assessment.
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Affiliation(s)
- Warren Jones
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Center for Translational Social Neuroscience, Emory University, Atlanta, Georgia
| | - Cheryl Klaiman
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Shana Richardson
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Meena Lambha
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Morganne Reid
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Taralee Hamner
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Chloe Beacham
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Peter Lewis
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Jose Paredes
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Laura Edwards
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Natasha Marrus
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, Missouri
- Intellectual and Developmental Disabilities Research Center, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - John N. Constantino
- Intellectual and Developmental Disabilities Research Center, Washington University in St Louis School of Medicine, St Louis, Missouri
- Now with Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia
- Now with Division of Behavioral and Mental Health, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Sarah Shultz
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Ami Klin
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Center for Translational Social Neuroscience, Emory University, Atlanta, Georgia
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Ashby D, Yin L, Jones F, Wright AL, Williams H, Williams C, Deavenport-Saman A, Vanderbilt D, Solomon O. "She Is Stand-Offish Like That": Black Adults' Recognition of Child Behaviors Associated with Autism Spectrum Disorder. J Dev Behav Pediatr 2023; 44:e486-e492. [PMID: 37556597 DOI: 10.1097/dbp.0000000000001205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/09/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE The purpose of this study is to identify the sociocultural factors in the Black community that contribute to a delay in identification of Black children with autism spectrum disorder (ASD). METHODS Four focus groups with parents of typically developing children were conducted at 2 Black Churches using a community-partnered participatory research approach and the socioecological model. Participants completed sociodemographic surveys, viewed CDC Autism Training Videos of Black children with ASD, and reported on their behavioral observations. Focus groups were audio recorded and transcribed. Thematic data analysis was conducted using NVivo software. RESULTS At the individual level, participants interpreted ASD-associated behaviors as a problem of timing of developmental milestones in the course of normative development rather than a sign of a disorder and positive and negative characteristics. At the interpersonal level, the role of grandparents and extended family was important for monitoring child development. At the organizational level, racial concordance with health care providers was seen as critical because of historical mistrust. At the community level, fear of racism and child protective services and inequitable care emerged. At the policy level, there were concerns about access to affordable, high-quality care. CONCLUSION This study provides insight into the sociocultural factors in the faith-based Black community that may contribute to a delay in identification of Black children with ASD. Health care professionals need additional training to effectively serve Black children and families in the face of historical mistrust and health care inequity.
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Affiliation(s)
| | - Larry Yin
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
- University Center for Excellence in Developmental Disabilities at Children's Hospital Los Angeles, Los Angeles, CA
- USC Keck School of Medicine, Los Angeles, CA
| | | | - Aziza-Lucas Wright
- South Central Prevention Coalition
- Charles R. Drew University of Medicine and Science
| | | | | | - Alexis Deavenport-Saman
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
- University Center for Excellence in Developmental Disabilities at Children's Hospital Los Angeles, Los Angeles, CA
- USC Keck School of Medicine, Los Angeles, CA
| | - Douglas Vanderbilt
- USC Keck School of Medicine, Los Angeles, CA
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
| | - Olga Solomon
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
- University Center for Excellence in Developmental Disabilities at Children's Hospital Los Angeles, Los Angeles, CA
- USC Keck School of Medicine, Los Angeles, CA
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Miller HL, Thomi M, Patterson RM, Nandy K. Effects of Intersectionality Along the Pathway to Diagnosis for Autistic Children With and Without Co-occurring Attention Deficit Hyperactivity Disorder in a Nationally-Representative Sample. J Autism Dev Disord 2023; 53:3542-3557. [PMID: 35749001 PMCID: PMC9789199 DOI: 10.1007/s10803-022-05604-0] [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: 05/04/2022] [Indexed: 12/26/2022]
Abstract
Children with complex behavioral profiles (e.g., ASD + ADHD) may experience delays in obtaining a final diagnosis. Low-resource or underrepresented groups may be at even greater risk for delayed diagnosis. We assessed the effect of sociodemographic factors, symptom complexity and co-occurring conditions, and identifier of first symptoms on diagnostic trajectories among children aged 3-17 years diagnosed with ASD (n = 52) or ASD + ADHD (n = 352) from a nationally-representative sample. Race/ethnicity and gender disparities were evident in both groups. Race, symptom complexity, and co-occuring conditions predicted age of final diagnosis and wait time between first concern and final diagnosis, both of which were staggeringly high. Results suggest a complex influence of sociodemographic factors on the diagnostic pathway, and risk of health disparities as a function of intersectionality.
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Affiliation(s)
- Haylie L Miller
- School of Kinesiology, University of Michigan, 830 N. University Ave., SKB 4120, Ann Arbor, MI, 48109, USA.
- Department of Physical Therapy, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA.
| | - Morgan Thomi
- Graduate School of Biomedical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA
| | - Rita M Patterson
- Department of Osteopathic Manipulative Medicine/Family Medicine, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA
| | - Karabi Nandy
- Department of Biostatistics & Epidemiology, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
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43
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Constantino JN, Abbacchi AM, May BK, Klaiman C, Zhang Y, Lowe JK, Marrus N, Klin A, Geschwind DH. Prospects for Leveling the Playing Field for Black Children With Autism. J Am Acad Child Adolesc Psychiatry 2023; 62:949-952. [PMID: 37196781 PMCID: PMC10948275 DOI: 10.1016/j.jaac.2023.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/04/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023]
Abstract
Among the many race-based health disparities that have persistently plagued the US population,1 the disproportionate burden of adverse neurodevelopmental outcomes to Black children affected by autism spectrum disorder (ASD) is particularly devastating given its major lifelong consequences. Recently, in 3 successive reports from the Autism and Developmental Disabilities Monitoring (ADDM) program of the US Centers for Disease Control and Prevention (CDC) (birth cohort years 2014, 2016, and 2018), we and our collaborators reported that although the prevalence of community-diagnosed ASD had equalized for Black and non-Hispanic White (NHW) children in the United States, there has persisted a pronounced racial disparity in the proportion of ASD-affected children with comorbid intellectual disability (ID), on the order of 50% for Black children with ASD vs 20% for White children with ASD.2 Here, we provide data to support the following: much earlier diagnosis is possible; early diagnosis alone is not likely to close the ID comorbidity disparity; and judicious efforts over care as usual are necessary to ensure that Black children have access to timely implementation of developmental therapy, for which we observed promising associations with improved cognitive and adaptive outcomes in our sample.
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Affiliation(s)
| | - Anna M Abbacchi
- Washington University School of Medicine, St. Louis, Missouri
| | - Brandon K May
- Washington University School of Medicine, St. Louis, Missouri
| | - Cheryl Klaiman
- Marcus Autism Center, School of Medicine, Emory University, Atlanta, Georgia
| | - Yi Zhang
- Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer K Lowe
- David Geffen School of Medicine, University of California, Los Angeles, California
| | - Natasha Marrus
- Washington University School of Medicine, St. Louis, Missouri
| | - Ami Klin
- Marcus Autism Center, School of Medicine, Emory University, Atlanta, Georgia
| | - Daniel H Geschwind
- David Geffen School of Medicine, University of California, Los Angeles, California
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Pelton MK, Crawford H, Bul K, Robertson AE, Adams J, de Beurs D, Rodgers J, Baron‐Cohen S, Cassidy S. The role of anxiety and depression in suicidal thoughts for autistic and non-autistic people: A theory-driven network analysis. Suicide Life Threat Behav 2023; 53:426-442. [PMID: 36974940 PMCID: PMC10947106 DOI: 10.1111/sltb.12954] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Autistic adults experience more frequent suicidal thoughts and mental health difficulties than non-autistic adults, but research has yet to explain how these experiences are connected. This study explored how anxiety and depression contribute to suicidal thoughts according to the Interpersonal Theory of Suicide for autistic and non-autistic adults. METHODS Participants (autistic adults n = 463, 61% female; non-autistic n = 342, 64% female) completed online measures of anxiety, depression, thwarted belonging, and perceived burdensomeness. Network analysis explored whether: (i) being autistic is a risk marker for suicide; and (ii) pathways to suicidal thoughts are consistent for autistic and non-autistic adults. RESULTS Being autistic connected closely with feeling like an outsider, anxiety, and movement, which connected to suicidal thoughts through somatic experiences, low mood, and burdensomeness. Networks were largely consistent for autistic and non-autistic people, but connections from mood symptoms to somatic and thwarted belonging experiences were absent for autistic adults. CONCLUSION Autistic people experience more life stressors than non-autistic people leading to reduced coping, low mood, and suicidal thoughts. Promoting belonging, reducing anxiety, and understanding the role of movement could inform suicide prevention for autistic people. Research should accurately capture autistic lived experience when modeling suicide to ensure suicide prevention meets autistic needs.
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Affiliation(s)
- Mirabel K. Pelton
- Institute for Health and Wellbeing, Centre for Intelligent HealthcareCoventry UniversityCoventryUK
| | - Hayley Crawford
- Mental Health and Wellbeing Unit, Warwick Medical SchoolUniversity of WarwickCoventryUK
| | - Kim Bul
- Institute for Health and Wellbeing, Centre for Intelligent HealthcareCoventry UniversityCoventryUK
| | - Ashley E. Robertson
- School of Psychology & NeuroscienceUniversity of Glasgow, University AvenueGlasgowUK
| | - Jon Adams
- Autistic Advocate and ResearcherPortsmouthUK
| | | | - Jacqui Rodgers
- Population Health Sciences InstituteSir James Spence Institute, Newcastle University, Royal Victoria InfirmaryNewcastleUK
| | - Simon Baron‐Cohen
- Autism Research Centre, Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - Sarah Cassidy
- School of PsychologyUniversity of Nottingham, University ParkNottinghamUK
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Dababnah S, Reyes C, Kim I, Badawi DG, Chung Y, Shaia WE. Pilot Trial of a Peer-to-Peer Psychoeducational Intervention for Parents of Black Children Awaiting a Developmental Evaluation. J Dev Behav Pediatr 2023; 44:e370-e378. [PMID: 37099652 PMCID: PMC10258154 DOI: 10.1097/dbp.0000000000001182] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/07/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVE This study examined the short-term impact on child, family, and parent outcomes of a peer-to-peer psychoeducational intervention, Parents Taking Action (PTA) for Black families of children awaiting developmental-behavioral pediatric evaluations. METHODS We targeted parents and other primary caregivers of Black children aged 8 years or younger awaiting a developmental or autism evaluation at an academic tertiary care hospital. Using a single-arm design, we recruited participants directly from the appointment waitlist and used flyers in local pediatric and subspecialty clinics. Eligible participants received a version of PTA adapted for Black children in two 6-week modules delivered synchronously online. In addition to initial baseline demographic data, we collected 4 standardized measures of parent stress and depression, family outcomes (e.g., advocacy), and child behavior at preintervention, midintervention, and postintervention. We calculated effect sizes and used linear mixed models to examine changes over time. RESULTS Fifteen participants completed PTA, the majority of whom were Black mothers with annual household incomes <$50,000. All children were Black and mostly boys, with an average age of 4.6 years. Parent depression, the family outcome total score, and 3 family outcomes (understanding child's strengths, needs, and abilities; knowing rights and advocating for child; and helping child develop and learn) significantly improved pre-post intervention, with medium to large effect sizes. Furthermore, the family outcome total score and "knowing rights and advocating for child" outcome significantly increased by midintervention ( d = 0.62-0.80). CONCLUSION Peer-delivered interventions can result in positive outcomes for families awaiting diagnostic evaluations. Further research is needed to confirm findings.
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Affiliation(s)
- Sarah Dababnah
- University of Maryland, Baltimore, School of Social Work
| | - Charina Reyes
- University of Maryland, Baltimore, School of Medicine
| | - Irang Kim
- Tulane University, School of Social Work
| | | | - Yoonzie Chung
- University of Maryland, Baltimore, School of Social Work
| | - Wendy E. Shaia
- University of Maryland, Baltimore, School of Social Work
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Mendez AI, Tokish H, McQueen E, Chawla S, Klin A, Maitre NL, Klaiman C. A Comparison of the Clinical Presentation of Preterm Birth and Autism Spectrum Disorder: Commonalities and Distinctions in Children Under 3. Clin Perinatol 2023; 50:81-101. [PMID: 36868715 PMCID: PMC10842306 DOI: 10.1016/j.clp.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Premature infants and infants later diagnosed with autism spectrum disorder (ASD) share many commonalities in clinical presentations. However, prematurity and ASD also have differences in clinical presentation. These overlapping phenotypes can lead to misdiagnoses of ASD or missing a diagnosis of ASD in preterm infants. We document these commonalities and differences in various developmental domains with the hope of aiding in the accurate early detection of ASD and timely intervention implementation in children born premature. Given the degree of similarities in presentation, evidence-based interventions designed specifically for preterm toddlers or toddlers with ASD may ultimately aid both populations.
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Affiliation(s)
- Adriana I Mendez
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, USA; Marcus Autism Center, 1920 Briarcliff Road, Atlanta, GA 30329, USA; Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322, USA; Children's Healthcare of Atlanta, 1405 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Hannah Tokish
- Marcus Autism Center, 1920 Briarcliff Road, Atlanta, GA 30329, USA; Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322, USA; Children's Healthcare of Atlanta, 1405 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Emma McQueen
- Marcus Autism Center, 1920 Briarcliff Road, Atlanta, GA 30329, USA; Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322, USA; Children's Healthcare of Atlanta, 1405 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Shivaang Chawla
- Marcus Autism Center, 1920 Briarcliff Road, Atlanta, GA 30329, USA; Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322, USA; Children's Healthcare of Atlanta, 1405 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Ami Klin
- Marcus Autism Center, 1920 Briarcliff Road, Atlanta, GA 30329, USA; Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322, USA; Children's Healthcare of Atlanta, 1405 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Nathalie L Maitre
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322, USA; Children's Healthcare of Atlanta, 1405 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Cheryl Klaiman
- Marcus Autism Center, 1920 Briarcliff Road, Atlanta, GA 30329, USA; Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322, USA; Children's Healthcare of Atlanta, 1405 Clifton Road Northeast, Atlanta, GA 30322, USA.
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Klin A. Translating advances in developmental social neuroscience into greater access to early diagnosis in autism spectrum disorder. Medicina (B Aires) 2023; 83 Suppl 2:32-36. [PMID: 36820480 PMCID: PMC10842589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Early identification and diagnosis of autism spectrum disorder (ASD) is necessary to promote access to early treatment, a critical factor in optimizing children's lifetime outcomes. And yet, diagnosis is often late, delaying interventions to a time in which symptoms have aggravated and communication skills already show impairing differences. This review illustrates progress in developmental social neuroscience that shows promise in generating novel tools for objective and cost-effective early diagnosis of ASD. We focus on research of social visual engagement, which is the way infants and toddlers look at and learn from their social environment. Moment-by-moment quantification of social visual engagement is yielding measures that are beginning to approximate best-practice procedures used by experienced clinicians in the assessment of young children. This progress and potential solutions have public health import ance because experienced clinicians are limited in number, and specialized clinical assessment services tend to be lengthy, costly, and plagued by extended wait time, all of which contributing to limited access, particularly in the case of low-resource families. The research reviewed here illustrates a wider effort to advance biomarker-based measurements intended to develop better and more efficient tools and procedures for screening, diagnosing and monitoring treatment response in children with ASD. The advent of such tools could increase access to early diagnostic services and promote efficiencies in early treatment delivery, with the ultimate goal of ensuring that children with ASD are afforded the services they need to thrive.
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Affiliation(s)
- Ami Klin
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, Georgia 30329-4010, USA
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30329-4010, USA
- Center for Translational Social Neuroscience, Emory University, 954 Gatewood Road, Atlanta, Georgia 30329-4252, USA. E-mail:
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Malone KM, Pearson JN, Palazzo KN, Manns LD, Rivera AQ, Mason Martin DL. The Scholarly Neglect of Black Autistic Adults in Autism Research. AUTISM IN ADULTHOOD 2022; 4:271-280. [PMID: 36777371 PMCID: PMC9908289 DOI: 10.1089/aut.2021.0086] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Black autistic individuals, regardless of age, have not been centered in autism research. Instead, they often exist on the margins-on the periphery of autism research. In fact, Black autistic adults are largely absent from the literature. Most participants in autism research are majority-white autistic individuals and families. In this conceptual article, we use intersectionality and Dis/ability Studies and Critical Race Theory theories to contextualize Black autistic adults' experiences. Second, we argue that systemic disparities and methodological concerns are two contributors to the scholarly neglect of Black autistic adults in autism research. Third, we provide guidelines to support researchers in moving from neglect to inclusive research with Black autistic adults.
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Affiliation(s)
- Kayla M. Malone
- Applied Developmental Science and Special Education, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jamie N. Pearson
- Special Education, North Carolina State University, Raleigh, North Carolina, USA
| | - Kayla N. Palazzo
- Applied Developmental Science and Special Education, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Special Education, North Carolina State University, Raleigh, North Carolina, USA
- Educational equity, North Carolina State University, Raleigh, North Carolina, USA
| | - Lonnie D. Manns
- Special Education, North Carolina State University, Raleigh, North Carolina, USA
- Educational equity, North Carolina State University, Raleigh, North Carolina, USA
| | - Amelia Q. Rivera
- Special Education, North Carolina State University, Raleigh, North Carolina, USA
- Educational equity, North Carolina State University, Raleigh, North Carolina, USA
| | - DeVoshia L. Mason Martin
- Special Education, North Carolina State University, Raleigh, North Carolina, USA
- Educational equity, North Carolina State University, Raleigh, North Carolina, USA
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Weitlauf AS, Vehorn A, Miceli A, Pinnock T, Dada Y, Hine J, Warren Z. Black Families' Experiences of Developmental Screening: Review of Well-Child Visits to Inform Enhanced Autism Spectrum Disorder Risk Assessment. J Dev Behav Pediatr 2022; 43:503-510. [PMID: 36443922 PMCID: PMC9713582 DOI: 10.1097/dbp.0000000000001129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Black families face barriers to early diagnosis of autism spectrum disorder (ASD). Most work emphasizes systemic delays to diagnosis rather than how existing screening procedures may affect identification. Our goal was to examine pediatric care visits in which screening was most likely to occur to document behaviors of parents and providers. METHODS We examined 18- to 36-month primary care visits in our electronic health record system (n = 99) of thirty-nine 4- and 8-year-old Black children later diagnosed with ASD. We extracted qualitative and quantitative data and engaged in consensus coding. We captured whether formal screening occurred, the content of concerns of parents and providers, and referral patterns for follow-up care or evaluation. RESULTS Consistent with existing work, we found differences in parent and provider concerns and discrepancies in referral rates. Parents often endorsed concerns about language, sleeping or eating habits, behavior, or motor skills rather than ASD, but specific mention of ASD as a concern increased over time. Referrals for follow-up care were more likely when providers, not parents alone, expressed concerns about patient development. CONCLUSION Pediatric providers cannot place the burden on families to raise autism concerns. Although some level of developmental risk was noted at most visits for children later diagnosed with ASD, referrals were only made when providers were also concerned, and most of these were for speech-language evaluation. Ongoing work is necessary to better understand how existing care systems interact with diverse families to inform the creation of inclusive screening practices that mitigate diagnostic delays.
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Affiliation(s)
- Amy S. Weitlauf
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alison Vehorn
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alexandra Miceli
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Theodora Pinnock
- Department of Pediatrics, Meharry Medical College, Nashville, Tennessee
| | - Yewande Dada
- Department of Pediatrics, Meharry Medical College, Nashville, Tennessee
| | - Jeffrey Hine
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Zachary Warren
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Special Education, Vanderbilt University, Nashville, Tennessee
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50
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Barbaresi W, Cacia J, Friedman S, Fussell J, Hansen R, Hofer J, Roizen N, Stein REK, Vanderbilt D, Sideridis G. Clinician Diagnostic Certainty and the Role of the Autism Diagnostic Observation Schedule in Autism Spectrum Disorder Diagnosis in Young Children. JAMA Pediatr 2022; 176:1233-1241. [PMID: 36251287 PMCID: PMC9577880 DOI: 10.1001/jamapediatrics.2022.3605] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/25/2022] [Indexed: 01/25/2023]
Abstract
Importance Autism spectrum disorder (ASD) affects 1 in 44 children. The Autism Diagnostic Observation Schedule (ADOS) is a semi-structured observation developed for use in research but is considered a component of gold standard clinical diagnosis. The ADOS adds time and cost to diagnostic assessments. Objective To evaluate consistency between clinical diagnosis (index ASD diagnosis) and diagnosis incorporating the ADOS (reference standard ASD diagnosis) and to examine clinician and child factors that predict consistency between index diagnoses and reference standard diagnoses. Design, Setting, and Participants This prospective diagnostic study was conducted between May 2019 and February 2020. Developmental-behavioral pediatricians (DBPs) made a diagnosis based on clinical assessment (index ASD diagnosis). The ADOS was then administered, after which the DBP made a second diagnosis (reference standard ASD diagnosis). DBPs self-reported diagnostic certainty at the time of the index diagnoses and reference standard diagnoses. The study took place at 8 sites (7 US and 1 European) that provided subspecialty assessments for children with concerns for ASD. Participants included children aged 18 months to 5 years, 11 months, without a prior ASD diagnosis, consecutively referred for possible ASD. Among 648 eligible children, 23 refused, 376 enrolled, and 349 completed the study. All 40 eligible DBPs participated. Exposures ADOS administered to all child participants. Main Outcomes and Measures Index diagnoses and reference standard diagnoses of ASD (yes/no). Results Among the 349 children (279 [79.7%] male; mean [SD] age, 39.9 [13.4] months), index diagnoses and reference standard diagnoses were consistent for 314 (90%) (ASD = 250; not ASD = 64) and changed for 35. Clinician diagnostic certainty was the most sensitive and specific predictor of diagnostic consistency (area under curve = 0.860; P < .001). In a multilevel logistic regression, no child or clinician factors improved prediction of diagnostic consistency based solely on clinician diagnostic certainty at time of index diagnosis. Conclusions and Relevance In this prospective diagnostic study, clinical diagnoses of ASD by DBPs with vs without the ADOS were consistent in 90.0% of cases. Clinician diagnostic certainty predicted consistency of index diagnoses and reference standard diagnoses. This study suggests that the ADOS is generally not required for diagnosis of ASD in young children by DBPs and that DBPs can identify children for whom the ADOS may be needed.
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Affiliation(s)
- William Barbaresi
- Division of Developmental Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jaclyn Cacia
- Division of Developmental and Behavioral Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sandra Friedman
- University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora
| | - Jill Fussell
- University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock
| | - Robin Hansen
- University of California, Davis, School of Medicine, MIND Institute, Sacramento
| | - Johannes Hofer
- Research Institute for Developmental Medicine, Johannes Kepler University, Institute for Neurology of the Senses and Language, Hospital of St John of God, Linz, Austria
| | - Nancy Roizen
- University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio
| | - Ruth E. K. Stein
- Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Bronx, New York
| | - Douglas Vanderbilt
- Division of Developmental-Behavioral Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
- Division of General Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California
| | - Georgios Sideridis
- Division of Developmental Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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