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Mtutu RS, Alriksson-Schmidt AI, Jarl J. Oral contraceptive use in women with spina bifida in Sweden. Disabil Health J 2024; 17:101627. [PMID: 38637232 DOI: 10.1016/j.dhjo.2024.101627] [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: 11/22/2023] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Thanks to improved medical care, individuals with spina bifida (SB) live well into adulthood and go through the process of reproductive maturation and the development of sexual desires. However, access to reproductive counselling and contraceptive use has been reported to be lower for women with physical and intellectual disabilities compared to the general population. OBJECTIVE We investigated oral contraceptive use in women with SB, residing in Sweden and how use varies based on the level of lesion and demographic factors. METHODS This was a population-based case-control study using annual data from national registers from 2006 to 2015. The sample consisted of 7045 women aged 15-49 years, of which 1173 had a diagnosis of SB. χ2 tests and logistic regression were used to investigate the study objective. RESULTS The rate of oral contraceptive use in women with SB was 24.6 % compared to 34.5 % among the general population. After adjusting for potential confounders women with SB were found to have a lower probability of using oral contraceptives (OR 0.63 95 % CI 0.56-0.71) compared to women without SB. Among women with SB, those with diagnoses Q05.8 (Sacral SB without hydrocephalus) and Q05.9 (SB unspecified) had a higher likelihood of using oral contraceptives compared to other Q05 diagnoses. CONCLUSION Women with SB had a lower likelihood of being on oral contraceptives compared to the control group. Further research should investigate if the lower use indicates that oral contraceptives are not an inappropriate method of contraception for women with SB.
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Affiliation(s)
- R Samu Mtutu
- Department of Health Sciences, Lund University, Lund, Sweden.
| | | | - Johan Jarl
- Department of Clinical Sciences Malmö, Health Economics Unit, Lund University, Malmö, Sweden
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Johnston AW, Hensel DJ, Roth JD, Wiener JS, Misseri R, Szymanski KM. Prevalence of sexual abuse and intimate partner violence in adults with spina bifida. Disabil Health J 2024; 17:101617. [PMID: 38531731 DOI: 10.1016/j.dhjo.2024.101617] [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: 07/18/2023] [Revised: 03/12/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND People with disabilities and chronic medical conditions are known to be at higher risk of sexual abuse (SA) and intimate partner violence (IPV). People with spina bifida (SB) are vulnerable, but little is known about the prevalence of abuse in this population. OBJECTIVE To evaluate the prevalence and risk factors of SA and IPV in adults with SB. METHODS An anonymous international cross-sectional online survey of adults with SB asked about history of SA ("sexual contact that you did not want") and IPV ("hit, slapped, kicked, punched or hurt physically by a partner"). RESULTS Median age of the 405 participants (61% female) was 35 years. Most self-identified as heterosexual (85%) and were in a romantic relationship (66%). A total of 19% reported a history of SA (78% no SA, 3% preferred not to answer). SA was more frequently reported by women compared to men (27% vs. 5%, p < 0.001) and non-heterosexual adults compared to heterosexuals (41% vs. 15%, p < 0.001). Twelve percent reported a history of IPV (86% no IPV, 2% preferred not to answer). IPV was more frequently reported by women compared to men (14% vs. 9%, p = 0.02), non-heterosexuals compared to heterosexuals (26% vs. 10%, p = 0.002), and adults with a history of sexual activity versus those without (14% vs. 2%, p = 0.01). CONCLUSION People with SB are subjected to SA and IPV. Women and non-heterosexuals are at higher risk of both.
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Affiliation(s)
- Ashley W Johnston
- Division of Pediatric Urology, Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA
| | - Devon J Hensel
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Joshua D Roth
- Division of Pediatric Urology, Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA
| | - John S Wiener
- Division of Pediatric Urology, Duke University Medical Center, Durham, NC, USA
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA
| | - Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA.
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Sharma A, Pantalone DW, Kohn B, Pereida ET, Nadwodny N, Faja S. Perceptions of Individuals with Autism Spectrum Disorder on How Health Care Providers Address Sexual Health. J Dev Behav Pediatr 2024:00004703-990000000-00179. [PMID: 38904653 DOI: 10.1097/dbp.0000000000001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 04/29/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE Medical providers report barriers that prevent them from discussing sexual health with patients with autism spectrum disorder (ASD). No investigations have examined the perspectives of adults with ASD about their sexual health care experiences. METHODS Twenty-five verbal young adults diagnosed with ASD and 40 young adults without ASD participated. An 8-item self-report survey assessed frequency of health care visits, age when sexual health was first discussed, and frequency/content of discussions with providers. RESULTS The likelihood of discussing sexual health topics did not differ by group, χ2s < 3.25; ps > 0.07, except sexual victimization, which the ASD group reported having discussed less than the non-ASD group (32 vs 9%), χ2 (1, N = 57) = 4.36, p = 0.04. Groups did not differ in their reported comfort level discussing sex/sexual health, having a primary care provider, or frequency of visits. The non-ASD group was significantly more likely to have received sexual health counseling (81%) than ASD group (52%), χ2 (1, N = 58) = 5.33, p = 0.02. Participants in both groups reported having received sexual health information from similar sources except the ASD group was more likely to receive information from parents than the non-ASD group (68% vs 30%), χ2 (1, N = 65) = 8.99, p = 0.003. CONCLUSION Participants in the ASD and non-ASD groups reported similar comfort levels with sexual health discussions and access to health providers. Yet, the ASD group received less counseling related to sexual health-particularly sexual victimization screening-suggesting that critical information may be missing. Future studies should determine how to help providers overcome barriers to providing young adults with ASD sexual health aligned with their needs.
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Affiliation(s)
- Aanchal Sharma
- Laboratories of Cognitive Neuroscience, Boston Children's Hospital, Boston, MA
- Division of Developmental Medicine, Harvard Medical School, Boston, MA
| | - David W Pantalone
- Department of Psychology, University of Massachusetts Boston, Boston, MA
- The Fenway Institute, Fenway Health, Boston, MA
| | - Brooke Kohn
- Laboratories of Cognitive Neuroscience, Boston Children's Hospital, Boston, MA
| | - Erin T Pereida
- Laboratories of Cognitive Neuroscience, Boston Children's Hospital, Boston, MA
- Department of Psychology, University of Massachusetts Boston, Boston, MA
| | - Nicole Nadwodny
- Laboratories of Cognitive Neuroscience, Boston Children's Hospital, Boston, MA
- Department of Psychology, University of Massachusetts Boston, Boston, MA
| | - Susan Faja
- Laboratories of Cognitive Neuroscience, Boston Children's Hospital, Boston, MA
- Division of Developmental Medicine, Harvard Medical School, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
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4
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Turchi RM, Kuo DZ, Rusher JW, Seltzer RR, Lehmann CU, Grout RW. Considerations for Alternative Decision-Making When Transitioning to Adulthood for Youth With Intellectual and Developmental Disabilities: Policy Statement. Pediatrics 2024; 153:e2024066841. [PMID: 38804066 DOI: 10.1542/peds.2024-066841] [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] [Received: 03/27/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 05/29/2024] Open
Abstract
With advances in medical care, more youth with intellectual and/or developmental disabilities (IDD) are transitioning into adulthood. Patient- and family-centered, integrated care is warranted around this time of transition. Support teams (including the youth, caregivers, teachers, and pediatricians) should engage in transition planning, ideally starting between 12 and 14 years of age, to identify and develop resources to support the maturing youth's capacity for independent decision-making. Care teams should consider the varied levels of alternative decision-making support, which may include supported decision-making, medical proxy decision-making, power of attorney, and/or establishment of legal guardianship arrangements, to support the youth's health and well-being optimally. Ultimately, if independent decision-making is not appropriate, the goal for youth with IDD should be the least restrictive alternative, while preserving human rights and human dignity and promoting their autonomy. These considerations review alternative decision-making support, concepts, and legal requirements available for youth with IDD and their care teams. Pediatricians can support youth with IDD and their families in the transition process and decision-making autonomy by actively engaging the youth in care decisions, supporting needs for augmentative communication, fostering their expression of preferences and understanding of care decisions, and linking them to resources such as the medical-legal partnership model.
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Affiliation(s)
- Renee M Turchi
- Department of Pediatrics, Drexel University College of Medicine & St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Dennis Z Kuo
- Department of Pediatrics, University of Rochester, Rochester, New York
| | - John W Rusher
- Department of Pediatrics, University of North Carolina School of Medicine in Chapel Hill, Chapel Hill, North Carolina
| | - Rebecca R Seltzer
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Randall W Grout
- Division of Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Regenstrief Institute, and Eskenazi Health, Indianapolis, Indiana
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5
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Hall LM, Nnoromele CC, Lalla AT, Hentschel CB, Slocum C. Considerations for Contraception Following Spinal Cord Injury: A Systematic Review. Top Spinal Cord Inj Rehabil 2024; 30:1-8. [PMID: 38799610 PMCID: PMC11123607 DOI: 10.46292/sci23-00081] [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: 05/29/2024]
Abstract
Introduction Counseling and education on women's health, specifically contraception, following spinal cord injury (SCI) is an important component of care for women with SCI. While a plethora of available contraceptive options exists, research in this area is scarce. Objectives This systematic review assesses the quality and quantity of research on contraception for individuals with SCI. Methods Literature searches of three medical databases were performed to identify articles that addressed contraception and family planning for women with SCI. Articles were then screened in a two-stage selection process and evaluated for content. Results Of 165 articles, 21 were identified that fit the inclusion criteria. The majority (66%) of articles were literature reviews or professional practice guidelines. Fourteen (66%) included information on short-acting hormonal oral contraception, 11 (52%) included information on long-acting reversible contraception, 15 (71%) included information on barrier methods, 6 (29%) included information on fertility awareness, 9 (43%) included information on permanent contraception, and one (5%) included information on emergency contraception. Discussion This systematic review demonstrates a paucity of evidence-based information on contraception tailored to women with SCI. It highlights a need for research and comprehensive guidelines on primary and emergency contraception in this population.
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Affiliation(s)
- Lauren M. Hall
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Chinenye C. Nnoromele
- Shirley Ryan Ability Lab, Chicago, Illinois
- Department of Physical Medicine and Rehabilitation, Northwestern Memorial Hospital, Chicago, Illinois
| | - Amber Trujillo Lalla
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Claudia B. Hentschel
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Chloe Slocum
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
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6
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Chung RJ, Lee JB, Hackell JM, Alderman EM. Confidentiality in the Care of Adolescents: Technical Report. Pediatrics 2024; 153:e2024066327. [PMID: 38646698 DOI: 10.1542/peds.2024-066327] [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: 02/23/2024] [Indexed: 04/23/2024] Open
Abstract
Confidentiality is a foundational element of high-quality, accessible, and equitable health care. Despite strong grounding in federal and state laws, professional guidelines, and ethical standards, health care professionals and adolescent patients face a range of complexities and barriers to seeking and providing confidential care to adolescents across different settings and circumstances. The dynamic needs of adolescents, the oftentimes competing interests of key stakeholders, the rapidly evolving technological context of care, and variable health care billing and claims requirements are all important considerations in understanding how to optimize care to focus on and meet the needs of the adolescent patient. The following assessment of the evolving evidence base offers a view of the current state and best practices while pointing to numerous unmet needs and opportunities for improvement in the care experiences of youth as well as their health outcomes.
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Affiliation(s)
- Richard J Chung
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Janet B Lee
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Jesse M Hackell
- Department of Pediatrics, New York Medical College, Valhalla, New York
| | - Elizabeth M Alderman
- Division of Adolescent Medicine, Department of Pediatrics, Albert Einstein College of Medicine and The Children's Hospital at Montefiore, Bronx, New York
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7
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Wheeler K, Favela A, Hamrick J, Dillard MK, Marzban F, Banda D. A Pilot Program for Teaching Sexuality and Relationships to Adults with Autism and Developmental Disabilities. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023:17446295231225520. [PMID: 38156616 DOI: 10.1177/17446295231225520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Background: People often have an innate interest in both platonic and romantic relationships. In fact, feelings toward sexuality and sexuality education do not differ between various individuals. Yet, autistic individuals have been shown to score significantly lower on measures of sexual awareness than their typically developing counterparts. Aims: The current project sought to investigate the benefits of a specially tailored socio-sexuality curriculum on the interpersonal relationship knowledge of 12 autistic young adults. Methods and Procedures: The eight-session sexuality education intervention was carefully tailored from an existing, online guide from the Organization for Autism Research. Pre- and post-test data were collected via the Assessment of Functional Living Skills Interpersonal Relationships domain. T-tests were conducted to determine significance. Outcomes and Results: Results from paired-sample t-tests indicated significant gains in interpersonal relationship knowledge from pre- to post-intervention. Conclusions and Implications: When provided with specifically tailored sexuality education, young autistic adults can experience socially valid, significant gains on interpersonal relationship knowledge.
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Affiliation(s)
- Katherine Wheeler
- The Burkhart Center for Autism Education and Research, TX, USA
- Texas Tech University, Lubbock, TX, USA
| | - Alexis Favela
- The Burkhart Center for Autism Education and Research, TX, USA
- Texas Tech University, Lubbock, TX, USA
| | - Jennifer Hamrick
- The Burkhart Center for Autism Education and Research, TX, USA
- Texas Tech University, Lubbock, TX, USA
| | - Mary Kathryn Dillard
- The Burkhart Center for Autism Education and Research, TX, USA
- Texas Tech University, Lubbock, TX, USA
| | - Fatemeh Marzban
- The Burkhart Center for Autism Education and Research, TX, USA
- Texas Tech University, Lubbock, TX, USA
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Streur CS, Kreschmer JM, Ernst SD, Quint EH, Rosen MW, Wittmann D, Kalpakjian CZ. "They had the lunch lady coming up to assist": The experiences of menarche and menstrual management for adolescents with physical disabilities. Disabil Health J 2023; 16:101510. [PMID: 37544804 PMCID: PMC11008706 DOI: 10.1016/j.dhjo.2023.101510] [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: 03/10/2023] [Revised: 06/30/2023] [Accepted: 07/13/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Menarche is a pivotal time in an adolescent's life but can be experienced differently by those with physical disabilities. Parents typically serve as the primary educators and support for their daughters during this time. Little is known about the parent's perspective of their daughter's experience preparing for menarche and learning to manage menses. OBJECTIVE We sought to understand the parent's perspective of the experience of their daughter with a physical disability around menarche and their preferences for health care provider support. METHODS Individual semi-structured interviews were conducted with 21 parents of a daughter with a physical disability ages 7-26. Interviews were coded by 2 reviewers using Grounded Theory, with disagreements resolved by consensus. RESULTS Six themes emerged regarding the parent's perception of the experiences, including 1) variation in emotional responses to menarche, 2) parent's perception of their daughter's experience with menses and menstrual symptoms, 3) cross-section of disability and menstrual management, 4) menstrual management at school, 5) parental knowledge correlating to daughter's preparation for menarche, and 6) desires for health care provider support. CONCLUSIONS All parents reported that their daughters faced challenges during menarche, ranging from emotional distress to dealing with the inaccessibility of hygiene products. Managing periods at schools was particularly burdensome. Parents who were better educated about what to expect were better able to prepare their daughters, but had difficulties finding informed, supportive providers. Health care providers should provide both anticipatory guidance and holistic, respectful, and equitable options for the management of menstrual symptoms.
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Affiliation(s)
- Courtney S Streur
- Departments of Urology and Pediatrics, University of Michigan, United States.
| | - Jodi M Kreschmer
- Department of Physical Medicine and Rehabilitation, University of Michigan, United States
| | - Susan D Ernst
- Department of Obstetrics and Gynecology, University of Michigan, United States
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan, United States
| | - Monica W Rosen
- Department of Obstetrics and Gynecology, University of Michigan, United States
| | | | - Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, United States
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9
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Houtrow AJ. Advancing sexual health care in spina bifida multidisciplinary clinics and beyond. Dev Med Child Neurol 2023; 65:1002-1003. [PMID: 36698252 DOI: 10.1111/dmcn.15527] [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] [Received: 12/27/2022] [Accepted: 01/05/2023] [Indexed: 01/27/2023]
Abstract
This commentary is on the original article by Lutz et al. on pages 1105–1111 of this issue.
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Affiliation(s)
- Amy J Houtrow
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
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10
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Qi W, Li H, Lian Q, Zuo X, Yu C, Lou C, Tu X. Knowledge level and access barriers related to sexual and reproductive health information among youth with disabilities in China: a cross-sectional study. Reprod Health 2023; 20:84. [PMID: 37280677 DOI: 10.1186/s12978-023-01625-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/19/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Youth with disabilities have the same right to sexual and reproductive health (SRH) as their peers without disabilities. However, their needs and rights are often ignored. Little is known about the knowledge, needs and access barriers related to SRH information among youth with different types of disabilities in China. METHODS A cross-sectional survey was carried out among 473 unmarried youth aged 15-24 with visual, hearing, physical disabilities in both urban and rural areas in China. RESULTS Out of a maximum possible score of 100, respondent's median score ranged from 30 to 50 for knowledge related to sexual physiology, STIs/HIV/AIDS and contraception. For these three categories of knowledge, respondents with hearing and physical disabilities or from rural areas scored lower than their counterparts with visual disabilities or from urban areas. The multivariate analyses showed that the residential area and education level were strong correlates of knowledge among respondents with visual and hearing disabilities. Other significant correlates were age for respondents with visual impairment and physical impairment, and single child status in the family and father's education level for respondents with hearing impairment. Sources of and barriers and preferences in accessing SRH information differed by type of disabilities, residential areas and gender. In general, school teachers were the primary and most preferred sources of SRH knowledge, followed by the Internet, peers/friends and parents. Unaware of where to get accurate information and feeling embarrassed to seek information were the two most frequently mentioned barriers in accessing SRH information. CONCLUSION Respondents had poor knowledge of SRH and limited access to SRH information, especially those from rural areas. Efforts should be made to promote school and family-based sexuality education tailored for youth with different types of disabilities.
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Affiliation(s)
- Wenjuan Qi
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, 779 Old Hu Min Road, Shanghai, 200237, China
- Shanghai Municipal Center for Disease Control & Prevention, 1380 West Zhongshan Road, Shanghai, 200336, China
| | - Hongyan Li
- UNESCO Beijing Office, 5-153 Jianguomenwai DRC, Beijing, 100600, China
| | - Qiguo Lian
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, 779 Old Hu Min Road, Shanghai, 200237, China
| | - Xiayun Zuo
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, 779 Old Hu Min Road, Shanghai, 200237, China
| | - Chunyan Yu
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, 779 Old Hu Min Road, Shanghai, 200237, China
| | - Chaohua Lou
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, 779 Old Hu Min Road, Shanghai, 200237, China
| | - Xiaowen Tu
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, 779 Old Hu Min Road, Shanghai, 200237, China.
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11
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Noritz G, Davidson L, Steingass K. Providing a Primary Care Medical Home for Children and Youth With Cerebral Palsy. Pediatrics 2022; 150:e2022060055. [PMID: 36404756 DOI: 10.1542/peds.2022-060055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cerebral palsy (CP) is the most common motor disorder of childhood, with prevalence estimates ranging from 1.5 to 4 in 1000 live births. This clinical report seeks to provide primary care physicians with guidance to detect children with CP; collaborate with specialists in treating the patient; manage associated medical, developmental, and behavioral problems; and provide general medical care to their patients with CP.
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Affiliation(s)
- Garey Noritz
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; and
| | - Lynn Davidson
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Katherine Steingass
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; and
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12
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Maggio MG, Calatozzo P, Cerasa A, Pioggia G, Quartarone A, Calabrò RS. Sex and Sexuality in Autism Spectrum Disorders: A Scoping Review on a Neglected but Fundamental Issue. Brain Sci 2022; 12:1427. [PMID: 36358354 PMCID: PMC9688284 DOI: 10.3390/brainsci12111427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/16/2022] [Accepted: 10/21/2022] [Indexed: 11/19/2023] Open
Abstract
ASD consists of a set of permanent neurodevelopmental conditions, which are studded with social and communication differences, limited interests, and repetitive behaviors. Individuals with ASD have difficulty reading eye gestures and expressions, and may also have stereotyped or repetitive language, excessive adherence to routines, fixed interests, and rigid thinking. However, sexuality in adolescents and young adults with ASD is still a poorly studied and neglected issue. This review aims to evaluate sexual function and behavior in individuals with ASD to foster a greater understanding of this important, although often overlooked, issue. This review was conducted by searching peer-reviewed articles published between 01 June 2000 and 31 May 2022 using the following databases: PubMed, Embase, Cochrane Database, and Web of Science. A comprehensive search was conducted using the terms: "Autism" OR "ASD" AND "Sexuality" OR "Romantic relation" OR "sexual behavior" AND/OR "sexual awareness". After an accurate revision of 214 full manuscripts, 11 articles satisfied the inclusion/exclusion criteria. This review found that, although individuals with ASD may have sexual functioning, their sexuality is characterized by higher prevalence rates of gender dysphoria and inappropriate sexual behavior. Furthermore, sexual awareness is reduced in this patient population, and the prevalence of other variants of sexual orientation (i.e., homosexuality, asexuality, bisexuality, etc.) is higher in adolescents with ASD than in non-autistic peers. Sexual health and education should be included in the care path of patients with ASD in order to improve their quality of life and avoid/reduce inappropriate and risky behaviors.
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Affiliation(s)
- Maria Grazia Maggio
- Department of Biomedical and Biotechnological Science, University of Catania, 95123 Catania, Italy
| | - Patrizia Calatozzo
- Studio di Psicoterapia Relazionale e Riabilitazione Cognitiva, 98124 Messina, Italy
| | - Antonio Cerasa
- Institute for Biomedical Research and Innovation, National Research Council of Italy (IRIB-CNR), 98164 Messina, Italy
- Sant’Anna Institute, 88900 Crotone, Italy
- Pharmacotechnology Documention and Transfer Unit, Preclinical and Traslation Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, 87036 Calabria, Italy
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation, National Research Council of Italy (IRIB-CNR), 98164 Messina, Italy
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Contraception and Reproductive Health Care for Adolescent and Young Adult Women with Epilepsy. J Pediatr 2022; 241:229-236. [PMID: 34728232 DOI: 10.1016/j.jpeds.2021.10.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/16/2021] [Accepted: 10/27/2021] [Indexed: 11/21/2022]
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14
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Davidson LF, Doyle MH. Health-care Transition: A Vital Part of Care, Growth, and Change for Pediatric Patients. Pediatr Rev 2021; 42:684-693. [PMID: 34850176 DOI: 10.1542/pir.2020-000422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Preparing all youth for the transition to adult-oriented care, adulthood itself, and a greater responsibility for their own health and health-care is an essential part of pediatric care. This process, typically described as health-care transition, can occur throughout ongoing pediatric health-care to prepare patients for transfer to an adult clinician and integration into adult care. Gaps remain in practice and in outcomes research regarding health-care transition. This review discusses recent literature, details best practices, and recommends guidance and tools to assist pediatric clinicians in providing a smooth transition process and a successful transfer to adult care for youth with and without special health-care needs.
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Affiliation(s)
- Lynn F Davidson
- Division of Academic General Pediatrics, Children's Hospital at Montefiore, Pediatric Hospital of Albert Einstein College of Medicine, Bronx, NY
| | - Maya H Doyle
- Department of Social Work, School of Health Sciences, Quinnipiac University, Hamden, CT
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Enujioke SC, Leland B, Munson E, Ott MA. Sexuality Among Adolescents With Intellectual Disability: Balancing Autonomy and Protection. Pediatrics 2021; 148:e2021050220. [PMID: 34711677 DOI: 10.1542/peds.2021-050220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 11/24/2022] Open
Abstract
Adolescents and young adults living with intellectual disability (ID) have made significant advancements integrating into multiple aspects of western society, but there has been less progress with regards to sexual health. While advocating for individuals with ID to live life to the fullest, pediatricians have practical concerns regarding the ability to consent to sex as well as avoid coercion and manipulation in sexual encounters. This has led to tension between supporting the autonomy of a patient with ID while protecting them from harm. We present a case of a young adult with moderate ID who is engaging in a sexual relationship with her boyfriend without parental knowledge. The pediatrician must decide the most appropriate course of action to support the patient's autonomy but also ensure that the patient is a willing participant and understands the risks of engaging in sexual activity. This case highlights 4 main themes: (1) practical concerns when approaching sexual health in the adolescent with ID, (2) advocating for the rights of those with ID to live life to the fullest, (3) the critical inclusion of individuals with ID in decisions directly affecting them and their peer group, and (4) decision-making capacity and respect for autonomy in individuals with ID. This case highlights the delicate balance providers face when providing care to adolescents and young adults with ID: supporting autonomy to make decisions while reducing harm to a vulnerable population.
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Affiliation(s)
| | - Brian Leland
- Pediatric Critical Care, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
- Charles Warren Fairbanks Center for Medical Ethics, Indianapolis, Indiana
| | - Emily Munson
- Indiana Disability Rights, Indianapolis, Indiana
| | - Mary A Ott
- Divisions of Adolescent Medicine
- Department of Philosophy, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
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