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Rubenstein E, Tewolde S, Levine AA, Droscha L, Meyer RM, Michals A, Skotko B. Medicare, Medicaid, and dual enrollment for adults with intellectual and developmental disabilities. Health Serv Res 2024; 59:e14287. [PMID: 38264862 PMCID: PMC11063084 DOI: 10.1111/1475-6773.14287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE Given high rates of un- and underemployment among disabled people, adults with intellectual and developmental disabilities rely on Medicaid, Medicare, or both to pay for healthcare. Many disabled adults are Medicare eligible before the age of 65 but little is known as to why some receive Medicare services while others do not. We described the duration of Medicare enrollment for adults with intellectual and developmental disabilities in 2019 and then compared demographics by enrollment type (Medicare-only, Medicaid-only, dual-enrolled). Additionally, we examined the percent in each enrollment type by state, and differences in enrollment type for those with Down syndrome. DATA SOURCES AND STUDY SETTING 2019 Medicare and Medicaid claims data for all adults (≥18 years) in the US with claim codes for intellectual disability, Down syndrome, or autism at any time between 2011 and 2019. STUDY DESIGN Administrative claims cohort. DATA COLLECTION AND ABSTRACTION METHODS Data were from the Transformed Medicaid Statistical Information System Analytic Files and Medicare Beneficiary Summary files. PRINCIPLE FINDINGS In 2019, Medicare insured 582,868 adults with identified intellectual disability, autism, or Down syndrome. Of 582,868 Medicare beneficiaries, 149,172 were Medicare only and 433,396 were dual-enrolled. Most Medicare enrollees were enrolled as child dependents (61.5%) Medicaid-only enrollees (N = 819,256) were less likely to be white non-Hispanic (58.5% white non-Hispanic vs. 72.9% white non-Hispanic in dual-enrolled), more likely to be Hispanic (19.6% Hispanic vs. 9.2% Hispanic in dual-enrolled) and were younger (mean 34.2 years vs. 50.5 years dual-enrolled). CONCLUSION There is heterogeneity in public insurance enrollment which is associated with state and disability type. Action is needed to ensure all are insured in the program that works for their healthcare needs.
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Affiliation(s)
- Eric Rubenstein
- Department of EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA
| | - Salina Tewolde
- Department of EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA
| | - A. Alex Levine
- Department of Health Policy Law and ManagementBoston University School of Public HealthBostonMassachusettsUSA
| | - Lillian Droscha
- Department of EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA
| | - Rachel Midori Meyer
- Department of EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA
| | - Amy Michals
- Biostatistics and Epidemiology Data Analytics CenterBoston University School of Public HealthBostonMassachusettsUSA
| | - Brian Skotko
- Massachusetts General HospitalBostonMassachusettsUSA
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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 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] [What about the content of this article? (0)] [Affiliation(s)] [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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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 DOI: 10.1002/aur.3107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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De La Garza E, Scott A, Hillerstrom H, Hendrix J, Rubenstein E. Caregivers' concerns and supports needed to care for adults with Down syndrome. Am J Med Genet C Semin Med Genet 2024; 196:e32041. [PMID: 37072379 PMCID: PMC10583264 DOI: 10.1002/ajmg.c.32041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 04/20/2023]
Abstract
Research regarding caregivers for individuals with Down syndrome mainly focuses on outcomes for the pediatric population and not on the experience of caregivers themselves. Our objective was to understand caregiver-reported experiences and concerns for themselves and the individual they care for through a survey of caregivers of adults with Down syndrome. We conducted a survey of N = 438 caregivers of adults with Down syndrome and asked about the perspectives of the respondents surrounding caregiving and demographics. The most common concerns among caregivers were planning for future needs (72.1%) and what happens when they (the caregiver) are gone (68.3%). Concerns they had for the individual they cared for were employment (63.2%) and friendships/relationships (63.2%). We found no significant difference in responses based on caregiver education level. Our survey identified six themes for the feedback about what clinical and research professionals should know to better serve individuals with Down syndrome, their families, and those who support them. Many caregivers discussed topics including healthcare, coordination, competence, and ability. More efforts for research into the caregiver experience for adults with Down syndrome are needed.
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Affiliation(s)
- Erica De La Garza
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Ashley Scott
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - James Hendrix
- LuMind IDSC, Eli Lily, Burlington, Massachusetts, USA
| | - Eric Rubenstein
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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Rubenstein E, Tewolde S, Michals A, Fox M, Wang N. Prevalence of Autism Among Medicaid-Enrolled Adults. JAMA Psychiatry 2023; 80:1284-1287. [PMID: 37792361 PMCID: PMC10551811 DOI: 10.1001/jamapsychiatry.2023.3708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/01/2023] [Indexed: 10/05/2023]
Abstract
Importance The reported prevalence of autism in children has consistently risen over the past 20 years. The concurrent implications for the adult Medicaid system, which insures autistic adults due to low income or disability, have not been studied. Objective To estimate the prevalence of adults identified as autistic in Medicaid claims data and to examine the prevalence by year, age, and race and ethnicity to understand enrollment patterns. Design, Setting, and Participants This cohort study used data from a longitudinal Medicaid claims cohort of enrollees aged 18 years or older with a claim for autism at any point from January 1, 2011, to December 31, 2019, and an approximately 1% random sample of all adult Medicaid enrollees. The data were analyzed between February 22 and June 22, 2023. Exposure Adults enrolled in Medicaid with a claim for autism. Main Outcome and Measures Prevalence of autism per 1000 Medicaid enrollees for each year was calculated using denominator data from the Centers for Medicare & Medicaid Services weighted to nondisabled population demographic characteristics. Prevalence by race and ethnicity were calculated for study year 2019. Results Across 9 years, 403 028 unique adults had autism claims in their Medicaid records (25.7% female, 74.2% male, 3.3% Asian, 16.8% Black, 12.2% Hispanic, 0.8% Native American, 0.8% Pacific Islander, 74.3% White, and 4.2% of multiple races). Across all ages, autism prevalence increased from 4.2 per 1000 enrollees in 2011 to 9.5 per 1000 enrollees in 2019. The largest increase over the 9 years was in the 25- to 34-year age group (195%), and the smallest increase was in the 55- to 64-year age group (45%). The prevalence of White enrollees was at least 2 times that of the prevalence of every other racial group in all age categories. Conclusions and Relevance The study findings suggest that despite difficulties in identifying autism in adults, there is a considerable and growing population of autistic adults enrolled in Medicaid. As children on the autism spectrum become autistic adults, Medicaid is an important insurance provider for an increasing number of autistic adults and can be a valuable resource for understanding the health of the autistic population.
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Affiliation(s)
- Eric Rubenstein
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Salina Tewolde
- Department of Epidemiology, Boston University School of Public Health, Boston University School of Public Health, Boston, Massachusetts
| | - Amy Michals
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Matthew Fox
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Na Wang
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
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Rubenstein E, Michals A, Wang N, Scott A, Tewolde S, Levine AA, Tripodis Y, Skotko BG. Medicaid Enrollment and Service Use Among Adults With Down Syndrome. JAMA Health Forum 2023; 4:e232320. [PMID: 37566429 PMCID: PMC10422190 DOI: 10.1001/jamahealthforum.2023.2320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/01/2023] [Indexed: 08/12/2023] Open
Abstract
Importance Down syndrome is the leading genetic cause of intellectual disability and automatically qualifies individuals for Social Security Insurance. Therefore, Medicaid is the major health insurance provider for a population at high risk for dementia, obesity, and premature mortality. Despite the importance of Medicaid for adults with Down syndrome, little is known about how this population uses Medicaid. Objective To describe enrollment in, health care use in, and cost to Medicaid for adults with Down syndrome compared with adults with intellectual disability and a random sample of adults enrolled in Medicaid. Design, Setting, and Participants In this cohort study, the data are from a claims cohort of adults aged 18 years or older enrolled in Medicaid at any point between January 1, 2011, and December 31, 2019. Participants were enrollees with 1 or more inpatient claim or 2 or more other claims with an International Classification of Diseases, Ninth Revision code or an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code for Down syndrome or intellectual disability as well as a random sample of those without developmental disability. Analyses were conducted from June 2022 to February 2023. Main Outcomes and Measures Data were linked across 2 data reporting systems. Main outcomes were enrollee demographic characteristics, enrollment characteristics, cost, and service use. Results This cohort study included 123 024 individuals with Down syndrome (820 273 person-years of coverage; mean [SD] age, 35 [14.7] years; median age, 33 years [IQR, 21-48 years]; 51.6% men; 14.1% Black individuals; 16.7% Hispanic individuals; and 74.6% White individuals), 1 182 246 individuals with intellectual disability (mean [SD] age, 37.1 [16.8] years; median age, 33 years [IQR, 22-50 years]; 56.5% men; 22.0% Black individuals; 11.7% Hispanic individuals; and 69.5% White individuals), and 3 176 371 individuals with no developmental disabilities (mean [SD] age, 38 [18.6] years; median age, 33 years [IQR, 21-52 years]; 43.8% men; 23.7% Black individuals; 20.7% Hispanic individuals; and 61.3% White individuals). Median enrollment in Medicaid for a person with Down syndrome was 8.0 years (IQR, 5.0-9.0 years; mean [SD], 6.6 [2.6] years). Costs were higher for the Down syndrome group (median, $26 278 per person-year [IQR, $11 145-$55 928 per person-year]) relative to the group with no developmental disabilities (median, $6173 per person-year [IQR, $868-$58 390 per person-year]). Asian, Black, Hispanic, Native American, and Pacific Islander adults with Down syndrome had fewer costs and claims per person-year compared with White adults with Down syndrome. Conclusion and Relevance This cohort study of individuals with Down syndrome enrolled in Medicaid found consistent enrollment and high use of health care in a population with high health care needs. Results were similar comparing individuals with Down syndrome and those with intellectual disability, with both groups differing from a sample of Medicaid enrollees with no developmental disabilities. Medicaid data are a useful tool for understanding the health and well-being of individuals with Down syndrome.
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Affiliation(s)
- Eric Rubenstein
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Amy Michals
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Na Wang
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Ashley Scott
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Salina Tewolde
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - A. Alex Levine
- Department of Health Policy Law and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Brian G. Skotko
- Down Syndrome Program, Massachusetts General Hospital, Boston, Massachusetts
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Cowley RA, Carroll AH, Pasko KBD, Rubenstein E, Tagouri YM, Weiner D. Evaluation and Treatment of Primary Spinal Epidural Lymphoma Presenting as Acute Myelopathy in a Young Adult: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00057. [PMID: 37590426 DOI: 10.2106/jbjs.cc.23.00111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
CASE Primary spinal epidural lymphoma (PSEL) presenting as myelopathy is extremely rare, particularly within young, healthy adults. This case report describes a 26-year-old man presenting with progressive thoracic myelopathy. Magnetic resonance imaging revealed spinal epidural masses spanning T5-T10 and T12-L2 with multilevel cord compression and edema. After evaluation, the patient underwent emergent posterior decompression to prevent progressive neurological decline. Histology was consistent with diffuse large B-cell lymphoma, germinal center type. At 3 months postoperatively, the patient regained full neurologic function. CONCLUSION Although rare, PSELs should be considered in patients presenting with myelopathy to facilitate timely diagnosis and treatment.
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Affiliation(s)
- R Adams Cowley
- Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Austin H Carroll
- Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Kory B D Pasko
- Georgetown University School of Medicine, Washington, District of Columbia
| | | | | | - David Weiner
- Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
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Rubenstein E, Kyprianou N, Kumar PS, Kriova AM, Sokoloff A, Hillerstrom H, Hendrix J. Healthcare and Behavior Changes for Adults With Down Syndrome 1-Year Into COVID-19. Am J Intellect Dev Disabil 2023; 128:273-281. [PMID: 37470258 PMCID: PMC10512186 DOI: 10.1352/1944-7558-128.4.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/02/2022] [Indexed: 07/21/2023]
Abstract
Individuals with Down syndrome (DS) have been disproportionately harmed by the COVID-19 pandemic and may have been more likely to have sacrificed opportunity and activity to avoid potential exposures. Our objective was to describe the experience one to one and half years into the COVID-19 pandemic for adults with DS, as reported by their caregivers in an online survey conducted between April 2021 and September of 2021. In our sample of 438 adults with DS, caregivers reported that adults with DS lost activities, struggled with employment, had negative behavioral changes, lost skills, and developed more mental health conditions. For adults with DS, one in five caregivers reported less healthcare usage, one in four reported delayed routine care, and 86.5% reported lost activities. As the pandemic continues, targeted support for adults with DS is needed to prevent further skill loss and mental health conditions.
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Affiliation(s)
- Eric Rubenstein
- Eric Rubenstein, Nichole Kyprianou, Prisha Sujin Kumar, and Anna-Mariya Kriova, Boston University School of Public Health
| | - Nichole Kyprianou
- Eric Rubenstein, Nichole Kyprianou, Prisha Sujin Kumar, and Anna-Mariya Kriova, Boston University School of Public Health
| | - Prisha Sujin Kumar
- Eric Rubenstein, Nichole Kyprianou, Prisha Sujin Kumar, and Anna-Mariya Kriova, Boston University School of Public Health
| | - Anna-Mariya Kriova
- Eric Rubenstein, Nichole Kyprianou, Prisha Sujin Kumar, and Anna-Mariya Kriova, Boston University School of Public Health
| | | | - Hampus Hillerstrom
- Eric Rubenstein, Nichole Kyprianou, Prisha Sujin Kumar, and Anna-Mariya Kriova, Boston University School of Public Health
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Kirova AM, Jakab T, Bartsch G, Corazzini S, Sokoloff A, Delahunty E, Seymour R, Rubenstein E. Developing and implementing a public health co-research program for Special Olympics athletes. Res Involv Engagem 2023; 9:44. [PMID: 37337242 DOI: 10.1186/s40900-023-00450-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/19/2023] [Indexed: 06/21/2023]
Abstract
Individuals with intellectual and developmental disabilities are often the subject of research while rarely being included in formulating research questions, planning studies, and making decisions related to protocols and analyses. In turn, most research regarding people with intellectual and developmental disabilities is not carried out by researchers with disabilities themselves. We developed a co-research training program where individuals with intellectual and developmental disabilities were taught about research. The program was designed using best practices and existing materials resources. We recruited four participants from Special Olympics Massachusetts and conducted the training in the Fall of 2021. We evaluated the program with surveys, qualitative interviews, and tracking continued involvement of co-researchers in research projects. Participants were partners in the evaluation process. The training program was six sessions and included lessons about why research is important, how to conduct research, and an experiential learning project where co-researchers conducted a study of their coaches. The program was well received by participants, and one year later they were still involved with research projects. A co-researcher training focused on public health for Special Olympics athletes is feasible and beneficial for athletes, researchers, and Special Olympics programs. However, there are still barriers like a lack of funding and time, that need to be addressed to ensure wide program success.
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Affiliation(s)
| | - Tyler Jakab
- School of Public Health, Boston University, Boston, MA, USA
| | - Graham Bartsch
- School of Public Health, Boston University, Boston, MA, USA
| | | | | | | | | | - Eric Rubenstein
- School of Public Health, Boston University, Boston, MA, USA.
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Kyprianou N, Hendrix J, Hillerstrom H, Grimm R, Kirova AM, Rubenstein E. Caregivers' perception of adults with Down syndrome willingness to participate in research. J Intellect Disabil Res 2023; 67:352-361. [PMID: 36543755 PMCID: PMC11079918 DOI: 10.1111/jir.12999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/15/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Historically, individuals with Down syndrome have been excluded from clinical research. Our objective was to assess the degree of interest adults with Down syndrome have in participating in research from the perspective of the caregivers who care for them. METHODS We conducted an online survey of N = 390 caregivers of adults with Down syndrome and asked about interest in research participation and demographics. RESULTS Caregivers were mostly family members, older than 55 years, and White. Caregivers reported that the adult with Down syndrome that they cared for would be more comfortable participating in research that was physiological, such as research involving fit bits (70.2% would participate), exercise (63.3%) or diet apps (53.9%), whereas they would be less likely to participate in clinical trials involving more invasive procedures such as injections (10.9%) and laboratory exams like MRIs (32.0%). We found little difference by age or gender of the adult with Down syndrome or by caregiver education level. CONCLUSIONS Our survey identified high interest for less invasive studies, illustrating acceptability of observational and lifestyle studies. More effort may be needed to understand fear and barriers to participation and to create tools and methods to increase interest in more invasive studies.
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Affiliation(s)
- Nichole Kyprianou
- Boston University School of Public Health, 715 Albany St, Boston MA 02118, USA
| | - James Hendrix
- LuMind IDSC, 20 Burlington Mall Road, Suite 200, Burlington MA, 01803, USA
| | - Hampus Hillerstrom
- LuMind IDSC, 20 Burlington Mall Road, Suite 200, Burlington MA, 01803, USA
| | - Rachel Grimm
- National Down Syndrome Society, 600 14 Street NW, Washington DC, 2005, USA
| | - Anna-Mariya Kirova
- Boston University School of Public Health, 715 Albany St, Boston MA 02118, USA
| | - Eric Rubenstein
- Boston University School of Public Health, 715 Albany St, Boston MA 02118, USA
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Bock E, Brochu P, Rubenstein E. Homelessness and Disability in Public-School Students. Pediatrics 2023; 151:190906. [PMID: 36974607 DOI: 10.1542/peds.2022-059885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE To quantify students with disabilities experiencing homelessness in the Northeastern and Mid-Atlantic US state and district public schools and compare them with those without disabilities. METHODS Data were compiled from state departments of education and federal homelessness data and were merged by using the Local Education Agency identifier. We calculated the proportion of students with and without disabilities experiencing homelessness and corresponding relative risk 95% confidence intervals. We examined changes in homelessness in Massachusetts counties compared with the 2018 to 2019 school year. RESULTS Across the 7 states and Washington, DC, 4.7% of students with disabilities experienced homelessness, 58% greater than the percentage of students without disabilities (95% confidence interval 1.57-1.59). The highest proportion of students with disabilities experiencing homelessness was in Washington, DC, and New York, with the lowest proportion in Connecticut. There was little change comparing 2018 to 2019 with 2019 to 2020 statistics in Massachusetts. CONCLUSIONS Quantifying students with disabilities experiencing homelessness provides policymakers with valuable information to be able to act to better support these students. Variations by state/district and time highlight the need for continued data collection and aggregation.
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Gautier F, Neumann L, Rubenstein E, Bernat A, Adle-Biasette H, Nassarmadji K, Bigot W, Mouly S, Sene D, Comarmond C. Une pachyméningite révélatrice d’une maladie associée aux IgG4 et à la présence d’ANCA anti-MPO : à propos d’un cas et revue de la littérature. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Rubenstein E, Bock E, Brochu P, Byrne T. Quantifying the intersection of disability and homelessness in Massachusetts public schools in 2018-2019. Child Care Health Dev 2022; 48:569-577. [PMID: 35018667 DOI: 10.1111/cch.12961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/08/2021] [Accepted: 01/08/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Homelessness has a major impact on the educational and health trajectories of children. Youth with disabilities may be especially vulnerable to experiencing homelessness, but little epidemiological work has been done to characterize dual disparity. Our goal was to describe the relationship between homelessness and disability among students (age 3-21) receiving public education in Massachusetts in 2018-2019. We evaluated the proportion of students with and without disabilities experiencing homelessness by county and school district. METHODS We used publicly available data from the United States and Massachusetts Department's of Education. These data used the McKinney Vento Homelessness Assistance Act definition of homelessness which is a lack of fixed, adequate, and regular housing, and disability was determined by the presence of an individualized education program or individualized family service plan. We calculated percentages of students with and without disabilities experiencing homelessness at the state, county, and district level and calculated and mapped risk of homelessness comparing students and without disability. We also determined the occurrence of disability among those experiencing homelessness. RESULTS In Massachusetts public schools, 3.5% of students with disabilities experienced homelessness compared with 2.4% of students without disabilities (relative risk 1.50, 95% CI: 1.47, 1.53). A greater proportion of students with disabilities experienced homelessness compared with students without disabilities in all counties. In sum, 24.8% of students experiencing homelessness had a reported disability. CONCLUSIONS In Massachusetts public schools, a greater proportion of students with disabilities experience homelessness compared with students without disabilities, and disability is common among students experiencing homelessness. We hypothesize potential mechanisms, such as the financial cost of disability, that may lead to this finding. Findings support the need for additional funding and interventions for school districts and communities to better serve vulnerable students with disabilities experiencing homelessness.
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Affiliation(s)
- Eric Rubenstein
- School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Emily Bock
- School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Paige Brochu
- School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Thomas Byrne
- School of Social Work, Boston University, Boston, Massachusetts, USA
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García MH, Petersen JM, Parker SE, Rubenstein E, Werler MM. Medication use during pregnancy among women with congenital physical disabilities. Birth Defects Res 2022; 114:785-796. [PMID: 35652163 DOI: 10.1002/bdr2.2048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Medication use during pregnancy is common, with up to 90% of pregnant women taking at least one medication. Women with congenital physical disabilities often report co-occurring conditions during pregnancy that may warrant pharmaceutical treatment, however, research is limited. We aim to describe medication use during pregnancy including: pain, psychotropic, and antibacterial medication, among women with and without congenital physical disabilities. METHODS We used data from the Slone Birth Defects Study (1976-2015), a case-control study that collected information on pre-pregnancy health conditions and exposures among participating mothers. Women with congenital physical disabilities (n = 132) included women with spina bifida, cerebral palsy, muscular dystrophy, limb deficiencies, and other skeletal/connective tissue conditions and were matched by interview year and study site to women without congenital physical disabilities (n = 528). Proportions and difference in proportions for each medication were compared between groups. Simple proportions were also calculated for duration and multiple medication use variables. RESULTS Women with congenital physical disabilities more frequently reported use of pain (acetaminophen and opioids), psychotropic (antidepressants), and antibacterial medications during pregnancy. Women with congenital physical disabilities used pain and psychotropic medications for longer, frequent durations, and more frequently reported haven taken multiple medications during pregnancy. CONCLUSION Women with congenital physical disabilities report higher medication use during pregnancy compared to women without physical disabilities. Patterns may be attributable to co-occurring conditions or increased risk of pregnancy complications in this population. Further research is needed to describe the patterns of medication use for clinical decisions regarding treatment of pregnant women with disabilities.
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Affiliation(s)
- Michelle Huezo García
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Julie M Petersen
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Samantha E Parker
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Eric Rubenstein
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Martha M Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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15
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Wiggins LD, Tian LH, Rubenstein E, Schieve L, Daniels J, Pazol K, DiGuiseppi C, Barger B, Moody E, Rosenberg S, Bradley C, Hsu M, Rosenberg CR, Christensen D, Crume T, Pandey J, Levy SE. Features that best define the heterogeneity and homogeneity of autism in preschool-age children: A multisite case-control analysis replicated across two independent samples. Autism Res 2022; 15:539-550. [PMID: 34967132 PMCID: PMC9048225 DOI: 10.1002/aur.2663] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/15/2021] [Accepted: 12/09/2021] [Indexed: 11/12/2022]
Abstract
The heterogeneous nature of children with symptoms of autism spectrum disorder (ASD) makes it difficult to identify risk factors and effective treatment options. We sought to identify behavioral and developmental features that best define the heterogeneity and homogeneity in 2-5-year-old children classified with ASD and subthreshold ASD characteristics. Children were enrolled in a multisite case-control study of ASD. Detailed behavioral and developmental data were gathered by maternal telephone interview, parent-administered questionnaires, child cognitive evaluation, and ASD diagnostic measures. Participants with a positive ASD screen score or prior ASD diagnosis were referred for comprehensive evaluation. Children in the ASD group met study criteria based on this evaluation; children who did not meet study criteria were categorized as having subthreshold ASD characteristics. There were 1480 children classified as ASD (81.6% boys) and 594 children classified as having subthreshold ASD characteristics (70.2% boys) in the sample. Factors associated with dysregulation (e.g., aggression, anxiety/depression, sleep problems) followed by developmental abilities (e.g., expressive and receptive language skills) most contributed to heterogeneity in both groups of children. Atypical sensory response contributed to homogeneity in children classified as ASD but not those with subthreshold characteristics. These findings suggest that dysregulation and developmental abilities are clinical features that can impact functioning in children with ASD and other DD, and that documenting these features in pediatric records may help meet the needs of the individual child. Sensory dysfunction could be considered a core feature of ASD and thus used to inform more targeted screening, evaluation, treatment, and research efforts. LAY SUMMARY: The diverse nature of autism spectrum disorder (ASD) makes it difficult to find risk factors and treatment options. We identified the most dissimilar and most similar symptom(s) in children classified as ASD and as having subthreshold ASD characteristics. Factors associated with dysregulation and developmental abilities contributed to diversity in both groups of children. Sensory dysfunction was the most common symptom in children with ASD but not those with subthreshold characteristics. Findings can inform clinical practice and research.
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Affiliation(s)
- Lisa D. Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lin H. Tian
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric Rubenstein
- Department of Epidemiology, Boston University, Boston, Massachusetts, USA
| | - Laura Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Julie Daniels
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Karen Pazol
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Brian Barger
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Eric Moody
- Institute for Disabilities, University of Wyoming, Laramie, Wyoming, USA
| | - Steven Rosenberg
- Anschutz Medical Campus, University of Colorado, Boulder, Colorado, USA
| | - Chyrise Bradley
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Melanie Hsu
- The Autism Research Program, Kaiser Permanente Northern California, Oakland, California, USA
| | | | - Deborah Christensen
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tessa Crume
- Anschutz Medical Campus, University of Colorado, Boulder, Colorado, USA
| | - Juhi Pandey
- Center for Autism Research, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Susan E. Levy
- Center for Autism Research, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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16
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Ransohoff JI, Sujin Kumar P, Flynn D, Rubenstein E. Reproductive and pregnancy health care for women with intellectual and developmental disabilities: A scoping review. Research Intellect Disabil 2022; 35:655-674. [PMID: 35064736 PMCID: PMC10119781 DOI: 10.1111/jar.12977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/22/2021] [Accepted: 01/09/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Women with intellectual and developmental disabilities face poorer reproductive and pregnancy outcomes partially due to health care inequity. Our objective was to conduct a scoping review of reproductive and pregnancy related health care among women with intellectual and developmental disabilities. METHODS We systematically reviewed three databases for keywords pertaining to pregnancy, reproductive health, and intellectual and developmental disabilities. Two reviewers screened abstracts and extracted full text. We synthesised included papers, identifying common themes. RESULTS Thirty-six papers met review criteria. Women with intellectual and developmental disabilities had lower fertility rates and were less likely to receive adequate sexual education compared to peers. While most women received prenatal care, uptake was lower and received later than women without intellectual and developmental disabilities. CONCLUSIONS Pregnancy-related health care is often lacking for women with intellectual and developmental disabilities. There are gaps inhibiting our understanding which prevents action to reduce health disparities.
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Affiliation(s)
| | - Prisha Sujin Kumar
- School of Public Health Boston University Boston Massachusetts USA
- Boston University Medical Campus Boston University Boston Massachusetts USA
| | - David Flynn
- Boston University Medical Campus Boston University Boston Massachusetts USA
| | - Eric Rubenstein
- School of Public Health Boston University Boston Massachusetts USA
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17
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Abstract
The field of global autism research lost a pioneer, champion, and innovator with the passing of Dr Li-Ching Lee in May 2021. Dr Lee served as the editor for a special issue in Autism on global autism research (2017, Volume 21, Issue 5) and her substantial impact on autism research and autistic individuals and their families in low- and middle-income countries warrants a place in this special issue. While a giant in the professional arena, her large impact on science is minor compared to the compassion, kindness, and love she brought to her family, friends, and her professional communities at Johns Hopkins, across institutions, her native Taiwan, and the areas in which she conducted her research. Dr Lee was immensely humble and intensely focused on harnessing epidemiology to positively impact the lives of people with autism and developmental disabilities. Her humility and professional dedication was coupled with a desire to keep her own challenges and triumphs private including her courageous efforts to stave off cancer while accomplishing so much in support of others.
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Affiliation(s)
| | | | | | | | - Lydia Stewart
- Center for Promotion of Child Development through Primary Care, USA
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18
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García MH, Parker SE, Petersen JM, Rubenstein E, Werler MM. Birth outcomes among women with congenital neuromuscular disabilities. Disabil Health J 2021; 15:101259. [PMID: 34980574 DOI: 10.1016/j.dhjo.2021.101259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Women with disabilities are at an increased risk for adverse birth outcomes; however, research among women with congenital neuromuscular disabilities (CNMD) is limited. OBJECTIVE To describe characteristics and compare birth outcomes among mothers with and without cNMD. METHODS Data were from the Slone Birth Defects Study (case-control, conducted from 1976 to 2015), which collected information on demographic, reproductive, and lifestyle characteristics. cNMD included spina bifida, cerebral palsy, muscular dystrophy, contractures, or arthrogryposis and were identified by participant report. Those with cNMD were matched to participants without cNMD by interview year and study site. We use modified Poisson regression to estimate relative risks (RR) for low birthweight, macrosomia, preterm birth, and small/large-for-gestational age (SGA/LGA). Given the case-control design and overrepresentation of infants with congenital anomalies, data were weighted to reflect a 3% national prevalence of infants with congenital anomalies. RESULTS Mothers with cNMD (n = 125) were more likely to be white, nulliparous, have a cesarean section, have an unplanned pregnancy, report a pre-pregnancy BMI ≥25 kg/m2, smoke during pregnancy, and report genitourinary infections. Mothers with cNMD had infants with shorter gestational length (mean difference: -7.44 days, 95% CI: -13.94, -0.95) compared to mothers without cNMD. cNMD was associated with higher risk of preterm birth (RR = 3.98, 95% CI: 1.33, 11.95) and SGA (RR = 2.14, 95% CI: 0.74, 6.15). CONCLUSION Mothers with cNMD were more likely to deliver preterm and have an SGA infant. These findings highlight disparities faced by mothers with cNMD and stress the need to provide optimal perinatal and reproductive care.
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Affiliation(s)
- Michelle Huezo García
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02118, USA.
| | - Samantha E Parker
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Julie M Petersen
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Eric Rubenstein
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Martha M Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02118, USA
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19
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Rubenstein E, Ehrenthal DB, Mallinson DC, Bishop L, Kuo HH, Durkin MS. Birth outcomes affecting infants of mothers with intellectual and developmental disabilities. Paediatr Perinat Epidemiol 2021; 35:706-716. [PMID: 33956997 PMCID: PMC8545714 DOI: 10.1111/ppe.12765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/17/2021] [Accepted: 02/16/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Women with intellectual and developmental disabilities (IDD) face increased risk of adverse maternal pregnancy outcomes, yet less is known about infant outcomes. OBJECTIVES To examine birth outcomes of infants born to mothers with IDD and assess associations with demographics and IDD-type. METHODS We used data from the Big Data for Little Kids project, which links Wisconsin birth records to Medicaid claims for live births covered by Medicaid from 2007 to 2016. We identified IDD using maternal prepregnancy Medicaid claims and ran Poisson regression (with a log link function) with robust variance clustered by mother to compare prevalence of outcomes between singleton births with and without mothers with IDD. We adjusted the associations for demographic factors and estimated prevalence ratios (PR) as the effect measure. We assessed outcomes by IDD-type (intellectual disability, genetic conditions, cerebral palsy, and autism spectrum disorder) to explore differences by categories of IDD. RESULTS Of 267,395 infants, 1696 (0.6%) had mothers with IDD. A greater percentage of infants with mothers with IDD were born preterm (12.8% vs 7.8%; PR 1.64, 95% confidence interval [CI] 1.42, 1.89), small for gestational age (8.5% vs 5.4%; PR 1.42, 95% CI 1.25, 1.61), and died within 12 months of birth (3.2% vs 0.7%; PR 4.93, 95% CI 3.73, 6.43) compared to infants of mothers without IDD. Prevalence ratios were robust to adjustment for demographics factors. Estimates did not meaningfully differ when comparing different IDD-types. CONCLUSIONS A greater porportion of infants born to mothers with IDD who were covered by Medicaid had poor outcomes compared to other infants. Prevalence of poor infant outcomes was greater for mothers with IDD even after accounting for demographic differences. It is imperative to understand why infants of mothers with IDD are at greater risk so interventions and management can be developed.
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Affiliation(s)
- Eric Rubenstein
- Waisman Center, University of Wisconsin- Madison, Madison, Wi, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Deborah B. Ehrenthal
- Department of Population Health Science, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - David C. Mallinson
- Department of Population Health Science, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Lauren Bishop
- Waisman Center, University of Wisconsin- Madison, Madison, Wi, USA
- Sandra Rosenbaum Department of Social Work, University of Wisconsin-Madison, Madison, WI, USA
| | - Hsiang-Hui Kuo
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Maureen S. Durkin
- Waisman Center, University of Wisconsin- Madison, Madison, Wi, USA
- Department of Population Health Science, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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20
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Abstract
Internet-based online surveys are a crucial tool for researchers to learn about the understudied and often overlooked population of autistic adults. The recruitment and administration of online surveys can be cheaper, quicker, and have a wider reach compared with more traditional in-person methods. As online surveys become more prevalent, it is important to place strengths in the context of limitations and biases that can arise when recruiting and administering surveys online. In this perspective, we discuss two common issues that often appear in studies that use online tools to recruit and administer surveys to autistic adults and nonautistic volunteers: selection bias and sample identifiability. Selection bias is the distortion in effect estimates (e.g., relative risk, risk ratio, incidence rate) resulting from the factors that influence why a person chose to participate or how the researcher recruits and selects participants in a study. Sampling identifiability is the ability (or inability) to quantify and define the population of interest. We use a case example of an online survey study of suicidal ideation in autistic adults and describe how issues in selection bias and sample identifiability arise and may lead to challenges unique to studying autistic adults. We conclude with recommendations to improve the quality and utility of online survey research in autistic adults. Using online resources to recruit and collect data on autistic adults is an incredible tool with great potential; yet, authors need to consider the limitations, potential biases, and tools to overcome systematic error at each stage of the study. LAY SUMMARY What is the purpose of this article?: Our purpose was to describe challenges in conducting and analyzing data from surveys of autistic adults, recruited and completed online.What is already known on the topic?: Health outcomes for autistic adults are understudied by crucial areas of autism research. While researchers are interested in the outcomes of autistic adults, this type of research is difficult because many autistic adults are not formally diagnosed, so not available to recruit for studies through clinic registries. Furthermore, study participation can be a long, inconvenient, and stressful process. It is not surprising then that we are seeing internet surveys of autistic adults become a popular tool to reach this population. We wanted to offer an overview and recommendations of these issues to researchers and people who read research about topics pertaining to autistic adults.What are the perspectives of the authors?: We are epidemiologists at Boston University and the University of Wisconsin-Madison. We both conduct research centered in improving health and well-being for autistic people across the life span. As people who study research methods, we have seen a lot of new research using survey methods. This research is intriguing, but all too often the articles need more information so we can be sure that the research is high quality. We want to share ways to improve this type of research and to help people in understanding the strengths and limitations of online survey research.What do the authors recommend?: We offer a few considerations for researchers working in this area. (1) Make the steps you took to do the research as clear as possible. (2) Be specific about who you intend to study and who you ended up studying. (3) Present the demographics and characteristics of the participants. (4) If possible, consider using data analysis methods to account for selection bias and sample identifiability issues. (5) Do not make statements that are not supported for your study results. (6) Acknowledge that we are at the beginning of studying autistic adults. (7) Advocate for more funding for research in autistic adults.How will these recommendations help autistic adults now or in the future?: Online surveys are an important tool for researchers to generate hypotheses and connect with a wider range of participants. However, online surveys have unique methodological challenges. We hope that this perspective raises the topic of bias and misinterpretation in online surveys and researchers continue to produce valid and meaningful work that is crucial to improving lives of autistic adults.
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Affiliation(s)
- Eric Rubenstein
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sarah Furnier
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
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21
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Rubenstein E, Kante A, Ouakrat R, Amador-Borrero B, Lazureanu P, Kladoum N, Champion K, Lopes A, Comarmond C, Mouly S, Sene D. Intérêt du dosage du récepteur soluble de l’IL2 comme marqueur d’activité de la sarcoïdose. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Rubenstein E, Amador-Borrero B, Lazureanu P, Kladoum N, Lopes A, Champion K, Comarmond C, Mouly S, Sene D. Hypothermie paroxystique dans une forme pseudotumorale de neuro-Behçet. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Wiggins LD, Rubenstein E, Windham G, Barger B, Croen L, Dowling N, Giarelli E, Levy S, Moody E, Soke G, Fields V, Schieve L. Evaluation of sex differences in preschool children with and without autism spectrum disorder enrolled in the study to explore early development. Res Dev Disabil 2021; 112:103897. [PMID: 33610079 PMCID: PMC8215620 DOI: 10.1016/j.ridd.2021.103897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 01/30/2021] [Accepted: 02/05/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND AIMS Research in school-aged children, adolescents, and adults with autism spectrum disorder (ASD) has found sex-based differences in behavioral, developmental, and diagnostic outcomes. These findings have not been consistently replicated in preschool-aged children. We examined sex-based differences in a large sample of 2-5-year-old children with ASD symptoms in a multi-site community-based study. METHODS AND PROCEDURES Based on a comprehensive evaluation, children were classified as having ASD (n = 1480, 81.55 % male) or subthreshold ASD characteristics (n = 593, 70.15 % male). Outcomes were behavior problems, developmental abilities, performance on ASD screening and diagnostic tests, and parent-reported developmental conditions diagnosed before study enrollment. OUTCOMES AND RESULTS We found no statistically significant sex differences in behavioral functioning, developmental functioning, performance on an ASD screening test, and developmental conditions diagnosed before study enrollment among children with ASD or subthreshold ASD characteristics. Males in both study groups had more parent reported restricted interests and repetitive behaviors than females, but these differences were small in magnitude and not clinically meaningful. CONCLUSIONS AND IMPLICATIONS Preschool males and females who showed risk for ASD were more similar than different in the outcomes assessed in our study. Future research could examine sex-based differences in ASD phenotypes as children age.
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Affiliation(s)
- Lisa D Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Eric Rubenstein
- Boston University, Department of Epidemiology, Boston, MA, United States
| | - Gayle Windham
- California Department of Public Health, Environmental Health Investigations Branch, Richmond, CA, United States
| | - Brian Barger
- Georgia State University, School of Public Health, Atlanta, GA, United States
| | - Lisa Croen
- Kaiser Permanente Northern California, Division of Research, Autism Research Program, Oakland, CA, United States
| | - Nicole Dowling
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Ellen Giarelli
- College of Nursing and Health Professionals, Drexel University, Philadelphia, PA, United States
| | - Susan Levy
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Eric Moody
- University of Wyoming, Wyoming Institute for Disabilities College of Health Sciences, Laramie, WY, United States
| | - Gnakub Soke
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Victoria Fields
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Laura Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
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24
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Bishop L, McLean KJ, Rubenstein E. Epilepsy in adulthood: Prevalence, incidence, and associated antiepileptic drug use in autistic adults in a state Medicaid system. Autism 2021; 25:831-839. [PMID: 32757616 PMCID: PMC7862416 DOI: 10.1177/1362361320942982] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
LAY ABSTRACT Epilepsy is more common in autistic children compared to children without autism, but we do not have good estimates of how many autistic adults have epilepsy. We used data from a full population of 7513 autistic adults who received Medicaid in Wisconsin to figure out the proportion of autistic adults who have epilepsy, as compared to 18,429 adults with intellectual disability. We also wanted to assess how often epilepsy is first diagnosed in adulthood. Finally, we wanted to see whether antiepileptic drugs are being used to treat epilepsy in autistic adults. We found that 34.6% of autistic adults with intellectual disability and 11.1% of autistic adults without intellectual disability had epilepsy, compared to 27.0% of adults with intellectual disability alone. Autistic women and autistic adults with intellectual disability were more likely than autistic men and autistic adults without intellectual disability to have both previous and new diagnoses of epilepsy. Finally, we found that antiepileptic medications are commonly prescribed to autistic people who do not have epilepsy potentially to treat mental health conditions or behavior problems, and that antiepileptic medications are not always prescribed to autistic people with epilepsy even though they are indicated as a first-line epilepsy treatment. The findings of this study highlight the need to effectively treat and prevent epilepsy in autistic adults.
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25
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Affiliation(s)
- Eric Rubenstein
- Waisman Center, University of Wisconsin-Madison, Madison.,Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison
| | - Sigan Hartley
- Waisman Center, University of Wisconsin-Madison, Madison.,School of Human Ecology, University of Wisconsin-Madison, Madison
| | - Lauren Bishop
- Waisman Center, University of Wisconsin-Madison, Madison.,School of Social Work, University of Wisconsin-Madison, Madison
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26
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Rubenstein E, Ehrenthal DB, Mallinson DC, Bishop L, Kuo HH, Durkin M. Pregnancy complications and maternal birth outcomes in women with intellectual and developmental disabilities in Wisconsin Medicaid. PLoS One 2020; 15:e0241298. [PMID: 33108397 PMCID: PMC7591078 DOI: 10.1371/journal.pone.0241298] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/12/2020] [Indexed: 11/25/2022] Open
Abstract
Background Women with intellectual and developmental disabilities (IDD) may face greater risk for poor pregnancy outcomes. Our objective was to examine risk of maternal pregnancy complications and birth outcomes in women with IDD compared to women without IDD in Wisconsin Medicaid, from 2007–2016. Methods Data were from the Big Data for Little Kids project, a data linkage that creates an administrative data based cohort of mothers and children in Wisconsin. Women with ≥1 IDD claim the year before delivery were classified as having IDD. Common pregnancy complications and maternal birth outcomes were identified from the birth record. We calculated risk ratios (RR) using log-linear regression clustered by mother. We examined outcomes grouped by IDD-type and explored interaction by race. Results Of 177,691 women with live births, 1,032 (0.58%) had an IDD claim. Of 274,865 deliveries, 1,757 were to mothers with IDD (0.64%). Women with IDD were at greater risk for gestational diabetes (RR: 1.28, 95% CI: 1.0, 1.6), gestational hypertension (RR: 1.22, 95% CI: 1.0, 1.5), and caesarean delivery (RR 1.32, 95% CI: 1.2, 1.4) compared to other women. Adjustment for demographic covariates did not change estimates. Women with intellectual disability were at highest risk of gestational hypertension. Black women with IDD were at higher risk of gestational hypertension than expected under a multiplicative model. Conclusions Women with IDD have increased risk of pregnancy complications and adverse outcomes in Wisconsin Medicaid. Results were robust to adjustment. Unique patterns by IDD types and Black race warrant further exploration.
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Affiliation(s)
- Eric Rubenstein
- Waisman Center, University of Wisconsin Madison, Madison, WI, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America
- * E-mail:
| | - Deborah B. Ehrenthal
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - David C. Mallinson
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- Center for Demography and Ecology, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Lauren Bishop
- Waisman Center, University of Wisconsin Madison, Madison, WI, United States of America
- Sandra Rosesnbaum School of Social Work, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Hsiang-Huo Kuo
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Maureen Durkin
- Waisman Center, University of Wisconsin Madison, Madison, WI, United States of America
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
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Ellis Weismer S, Rubenstein E, Wiggins L, Durkin MS. A Preliminary Epidemiologic Study of Social (Pragmatic) Communication Disorder Relative to Autism Spectrum Disorder and Developmental Disability Without Social Communication Deficits. J Autism Dev Disord 2020; 51:2686-2696. [PMID: 33037562 DOI: 10.1007/s10803-020-04737-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 12/20/2022]
Abstract
The goal of this preliminary investigation was to compare demographic and clinical characteristics in a sample of children with likely Social (Pragmatic) Communication Disorder (SCD) (N = 117) to those in children with possible (N = 118) and some (N = 126) SCD traits, other developmental delay (DD) (N = 91) and autism spectrum disorder (ASD) (N = 642). We used data from the Study to Explore Early Development (SEED), a multi-site case-control study. Items reflecting SCD DSM-5 criteria were selected from an autism diagnostic measure, with SCD categories identified by creating quartiles. Our results suggest that SCD may fall along a continuum involving elevated deficits (in comparison to DD with no SCD) in social communication and restricted and repetitive behavior that do not reach the clinical threshold for ASD.
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Affiliation(s)
- Susan Ellis Weismer
- Department of Communication Sciences and Disorders and Waisman Center, University of Wisconsin-Madison, 1500, Highland Avenue, Madison, WI, USA.
| | - Eric Rubenstein
- Department of Family Medicine, Department of Population Health Sciences, and Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI, USA.,Department of Epidemiology, Boston University, Boston, MA, USA
| | - Lisa Wiggins
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, 1600 Clifton, Road, Atlanta, GA, USA
| | - Maureen S Durkin
- Department of Population Health Sciences and Pediatrics, Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI, USA
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Wiggins LD, Rubenstein E, Daniels J, DiGuiseppi C, Yeargin-Allsopp M, Schieve LA, Tian LH, Sabourin K, Moody E, Pinto-Martin J, Reyes N, Levy SE. A Phenotype of Childhood Autism Is Associated with Preexisting Maternal Anxiety and Depression. J Abnorm Child Psychol 2020; 47:731-740. [PMID: 30128718 DOI: 10.1007/s10802-018-0469-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study explored whether ASD phenotypes in the child were associated with a history of anxiety or depression in the mother. We hypothesized that an ASD profile in children characterized by mild delays and increased rates of dysregulation would be associated with preexisting maternal anxiety or depression. Participants were 672 preschool children with ASD and their mothers. Children were classified as ASD after a comprehensive developmental evaluation. Mothers reported whether a healthcare provider ever diagnosed them with anxiety or depression before the birth of their child. Four child ASD phenotypes were derived from latent class analysis: Mild Language Delay with Cognitive Rigidity (Type 1), Significant Developmental Delay with Repetitive Motor Behaviors (Type 2), General Developmental Delay (Type 3), and Mild Language and Motor Delay with Dysregulation (i.e., aggression, anxiety, depression, emotional reactivity, inattention, somatic complaints, and sleep problems) (Type 4). Type 2 ASD served as the referent category in statistical analyses. Results showed that 22.6% of mothers reported a diagnosis of anxiety or depression before the birth of their child. Maternal anxiety or depression was associated with 2.7 times the odds (95% confidence interval: 1.4, 5.3) of Type 4 or Dysregulated ASD in the child; maternal anxiety and depression was associated with 4.4 times the odds (95% confidence interval: 1.4, 14.0) of Type 4 or Dysregulated ASD in the child. Our findings suggest an association between Dysregulated ASD in the child and anxiety and depression in the mother. These findings can enhance screening methods and inform future research efforts.
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Affiliation(s)
- Lisa D Wiggins
- NCBDDD, Centers for Disease Control and Prevention, 4770 Buford Highway MS E-86, Atlanta, GA, 30341, USA.
| | | | | | | | - Marshalyn Yeargin-Allsopp
- NCBDDD, Centers for Disease Control and Prevention, 4770 Buford Highway MS E-86, Atlanta, GA, 30341, USA
| | - Laura A Schieve
- NCBDDD, Centers for Disease Control and Prevention, 4770 Buford Highway MS E-86, Atlanta, GA, 30341, USA
| | - Lin H Tian
- NCBDDD, Centers for Disease Control and Prevention, 4770 Buford Highway MS E-86, Atlanta, GA, 30341, USA
| | | | - Eric Moody
- University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | | | - Nuri Reyes
- University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Susan E Levy
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Washburn K, Rubenstein E, DuBois L, Sadowsky M, Forquer M, Stanish H, Shriver T. From Development To Global Implementation Of Special Olympics Fitness Programs For People With Intellectual Disabilities. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000676740.33212.e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Richards KA, Runnebohm A, Dolan M, Vitali H, Rubenstein E. Modification of the Endoplasmic Reticulum Translocon Impairs Protein Translocation. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.00546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Broshar CL, Buchanan B, Mehrtash A, Runnebohm A, Snow B, Scanameo L, Hochstrasser M, Rubenstein E. The Relationship between ER Stress and Protein Quality Control at the Translocon. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.00497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rubenstein E, Durkin MS, Harrington RA, Kirby RS, Schieve LA, Daniels J. Relationship Between Advanced Maternal Age and Timing of First Developmental Evaluation in Children with Autism. J Dev Behav Pediatr 2019; 39:601-609. [PMID: 30004996 PMCID: PMC6195454 DOI: 10.1097/dbp.0000000000000601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Mothers of advanced maternal age (AMA) at childbirth (age ≥35 years) may have different perceptions of autism spectrum disorder (ASD) risk, independent of sociodemographic factors, that may affect ASD identification. We aimed to estimate associations between AMA and both age of a child's first evaluation noting developmental concerns and time from first evaluation to first ASD diagnosis. METHODS We used data for 8-year-olds identified with ASD in the 2008 to 2012 Autism and Developmental Disabilities Monitoring Network. We estimated differences in age at first evaluation noting developmental concerns and time to first ASD diagnosis by AMA using quantile and Cox regression. RESULTS Of 10,358 children with ASD, 19.7% had mothers of AMA. AMA was associated with higher educational attainment and previous live births compared with younger mothers. In unadjusted analyses, AMA was associated with earlier first evaluation noting developmental concerns (median 37 vs 40 mo) and patterns in time to first evaluation (hazard ratio: 1.12, 95% confidence interval: 1.06-1.18). Associations between AMA and evaluation timing diminished and were no longer significant after adjustment for socioeconomic and demographic characteristics. Children's intellectual disability did not modify associations between AMA and timing of evaluations. CONCLUSION Advanced maternal age is a sociodemographic factor associated with younger age of first evaluation noting developmental concerns in children with ASD, but AMA was not independently associated likely, because it is a consequence or cofactor of maternal education and other sociodemographic characteristics. AMA may be a demographic factor to consider when aiming to screen and evaluate children at risk for ASD.
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Affiliation(s)
- Eric Rubenstein
- Waisman Center, University of Wisconsin-Madison, Madison, WI
| | - Maureen S Durkin
- Department of Population Health Science, Waisman Center, University of Wisconsin-Madison, Madison, WI
| | - Rebecca A Harrington
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Russell S Kirby
- Department of Community and Family Health, University of South Florida, Tampa, FL
| | - Laura A Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Julie Daniels
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, NC
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Rubenstein E, DuBois L, Sadowsky M, Washburn K, Forquer M, Stanish H, Shriver T. Evaluating the potential of Special Olympics fitness models as a health intervention for adults with intellectual disabilities. Disabil Health J 2019; 13:100850. [PMID: 31704231 DOI: 10.1016/j.dhjo.2019.100850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/28/2019] [Accepted: 10/17/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND People with intellectual disabilities (ID) have high prevalence of cardiovascular disease (CVD) risk factors; yet, few behavioral health interventions are designed and implemented for people with ID. OBJECTIVE This study examined Special Olympics Inc. (SOI) fitness models as a potential intervention to reduce CVD risk in people with ID. METHODS Data from SOI fitness models implemented in 2016-2018 were assessed. Special Olympics Programs received funding, resources, and technical assistance from SOI to conduct fitness models centered on inclusive physical activity and goal setting. Weight, body mass index, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured at baseline and 4-12 weeks into the model. Multi-level multivariable quintile linear regression assessed change. RESULTS 383 participants with ID (athletes) and 281 partners without ID met inclusion criteria. Mean weight loss among athletes was 0.67 kg and 132 (31.9%) lost ≥ 1 kg. Blood pressure decreased in SBP quintile 4 (-7.52 mm Hg, 95% confidence interval [CI]: 11.8, -4.0), SBP quintile 5 (-9.52 mm Hg, 95% CI: 13.5, -5.6), and DBP quintile 5 (-7.49 mm Hg, 95% CI: 13.1, -1.9). Partners had similar results. Strongest effects were in a 'high-risk' group that was in the quintile 4 or 5 in all baseline measures. CONCLUSION In fitness models developed to improve fitness for people with ID, there was a reduction in weight and blood pressure. SOI fitness models show promise and potential as a health intervention. This work enables further examination of indicators for successful implementation and evaluation of health.
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Affiliation(s)
- Eric Rubenstein
- Research and Evaluation, Special Olympics International, Washington D.C., USA; Waisman Center, Department of Family Medicine, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI, 53705, USA.
| | - Lindsay DuBois
- Research and Evaluation, Special Olympics International, Washington D.C., USA
| | - Molly Sadowsky
- Research and Evaluation, Special Olympics International, Washington D.C., USA
| | - Kyle Washburn
- Fitness, Special Olympics International, Washington D.C., USA
| | - Monica Forquer
- Fitness, Special Olympics International, Washington D.C., USA
| | - Heidi Stanish
- Fitness, Special Olympics International, Washington D.C., USA; Department of Exercise and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
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Rubenstein E, Bishop L. Is the Autism Boom Headed for Medicaid? Patterns in the Enrollment of Autistic Adults in Wisconsin Medicaid, 2008-2018. Autism Res 2019; 12:1541-1550. [PMID: 31317639 PMCID: PMC7006836 DOI: 10.1002/aur.2173] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/28/2019] [Accepted: 06/24/2019] [Indexed: 12/12/2022]
Abstract
Our primary objective was to describe demographic characteristics and enrollment patterns in a unique 11-year full sample of adult Wisconsin Medicaid beneficiaries with identified autism spectrum disorder (ASD) or intellectual disability (ID). We obtained de-identified Medicaid claims data for adults with a recorded ASD or ID diagnosis aged 21 and older with any Medicaid fee-for-service claims between January 1, 2008 and December 31, 2018. We assessed enrollment, age, number of visits, and paid amount per year using generalized linear models with a random intercept for each beneficiary. We identified claims for 4,775 autistic adults without ID, 2,738 autistic adults with ID, 14,945 adults with ID, and 3,484 adults with Down syndrome. The age distribution of the diagnostic group with ASD diagnoses was right skewed with a majority of beneficiaries less than age 30. The ASD without ID diagnostic group had the least visits and paid amount per person per year compared to other groups. In each age category, the ASD with ID diagnostic group had the most paid amount per person per year compared to other groups. It is urgent that we identify the health and health service needs of autistic adults from young adulthood through old age. Our findings have implications for ensuring adequate health coverage across the lifespan and highlight the importance of a strong and accessible health care system for autistic people. Autism Res 2019, 12: 1541-1550. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Medicaid provides health insurance to disabled people who meet income requirements. We assessed patterns of enrollment and service use among autistic adults and adults with developmental disabilities in Wisconsin Medicaid. We found a consistent influx of new young autistic adults without intellectual disability into the Medicaid system, with fewer visits and lower paid amounts compared to other developmental disability groups. The changing population of autistic people using Medicaid has implications for providing health care to autistic adults in the future.
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Affiliation(s)
- Eric Rubenstein
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Lauren Bishop
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin
- School of Social Work, University of Wisconsin-Madison, Madison, Wisconsin
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Rubenstein E, Croen L, Lee LC, Moody E, Schieve LA, Soke GN, Thomas K, Wiggins L, Daniels J. Community-based service use in preschool children with autism spectrum disorder and associations with insurance status. Res Autism Spectr Disord 2019; 66:101410. [PMID: 32831903 PMCID: PMC7430759 DOI: 10.1016/j.rasd.2019.101410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND ASD-related services can improve outcomes for children, but less is known about service outside of school settings during preschool age. We aimed to describe amount and category of community-based service use among 3-5-year-old children with ASD and examine differences by health insurance. METHODS We used cross-sectional data on 792 children with ASD diagnoses in the Study to Explore Early Development, a community-based study of neurodevelopment with enrollment between 2012-2016. Mothers reported current child service use and insurance status at study entry. We used log-Poisson and logistic regression to compare service use by insurance group. RESULTS Nearly 40% of children were not receiving community-based services at study entry. Children with public insurance had fewer total services than children with private or both insurances. After adjustment for sociodemographic confounders, insurance status was not associated with types of different categories of community-based services. However, children with public insurance alone were least likely to receive community-based behavioral therapy and most likely to receive psychotropic medication compared to other insurances. CONCLUSION Many preschool-aged children do not receive community-based services, with receipt associated with insurance type. Increasing access and availability for evidence-based service, especially for beneficiaries of public insurance, may improve service use and outcomes.
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Affiliation(s)
- Eric Rubenstein
- University of Wisconsin Madison, Waisman Center, 1500 Highland Ave, Madison WI, 53705
| | - Lisa Croen
- Division of Research, Kaiser Permanente of Northern California, 2000 Broadway, Oakland, CA 94612
| | - Li-Ching Lee
- Bloomberg School of Public Health, Johns Hopkins University, 315 N Wolfe St, Baltimore, MD 21231
| | - Eric Moody
- Wyoming Institute of Disabilities, University of Wyoming, 1000 E. University Ave. Laramie, WY 82071
| | - Laura A. Schieve
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, 1600 Clifton Road, Atlanta, GA 30329
| | - Gnakub N. Soke
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, 1600 Clifton Road, Atlanta, GA 30329
| | - Kathleen Thomas
- Cecil G. Sheps Center for Health Services Research, University of North Carolina Chapel Hill, 725 Martin Luther King Jr. Blvd. Chapel Hill, NC 27599-7590
| | - Lisa Wiggins
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, 1600 Clifton Road, Atlanta, GA 30329
| | - Julie Daniels
- University of North Carolina Gillings School of Global Public Health, Department of Biostatistics, 137 East Franklin Street Room 6702 CB# 8030 Chapel Hill, NC 27514
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Bishop-Fitzpatrick L, Rubenstein E. The Physical and Mental Health of Middle Aged and Older Adults on the Autism Spectrum and the Impact of Intellectual Disability. Res Autism Spectr Disord 2019; 63:34-41. [PMID: 31768189 PMCID: PMC6876625 DOI: 10.1016/j.rasd.2019.01.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND People on the autism spectrum may have more physical and mental health conditions in midlife and old age compared to the general population. This study describes the physical and mental health of a unique sample of all middle aged and older Wisconsin Medicaid beneficiaries with an autism spectrum disorder diagnosis and tests differences between those with and without co-occurring intellectual disability. METHOD Using de-identified Medicaid claims data for 143 adults with a recorded autism spectrum disorder diagnosis aged 40-88 years with any Wisconsin Medicaid claims in 2012 through 2015, we extracted diagnoses for physical and mental health conditions from fee-for-service claims. Logistic regression analyses-controlling for sex, race, and age-compared the adjusted odds of physical and mental health conditions for those with and without intellectual disability. RESULTS Many physical and mental health conditions, including immune conditions (70.6%), cardiovascular disease (49.0%) and its risk factors (46.2%), sleep disorders (85.3%), gastrointestinal disorders (49.7%), neurologic conditions (55.9%), and psychiatric disorders (72.0%) were highly prevalent in our full sample. Although there were many similarities between those individuals with and without co-occurring intellectual disability, middle aged and older adults on the autism spectrum had higher prevalence of epilepsy and lower prevalence of depression and anxiety compared to those without co-occurring intellectual disability. CONCLUSIONS Findings suggest that people on the autism spectrum have a high prevalence of physical and mental health conditions in midlife and old age, regardless of intellectual disability status.
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Affiliation(s)
- Lauren Bishop-Fitzpatrick
- Waisman Center, University of Wisconsin-Madison
- School of Social Work, University of Wisconsin-Madison
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Rubenstein E, Maria A, Rigau V, Goulabchand R, Ferreira-Da Mota E, Amadou K, Rullier P, Pers Y, Combe B, Rivière S, Partouche L, Dufour S, Mahr A, Le Quellec A, Guilpain P. Pathologies malignes chez 36 patients présentant une artérite à cellules géantes et/ou une pseudo-polyarthrite rhizomélique : description et confrontation anatomo-clinique. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.03.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lin TL, Newell LF, Stuart RK, Michaelis LC, Rubenstein E, Pentikis HS, Callahan T, Alvarez D, Liboiron BD, Mayer LD, Wang Q, Banerjee K, Louie AC. A phase 2 study to assess the pharmacokinetics and pharmacodynamics of CPX-351 and its effects on cardiac repolarization in patients with acute leukemias. Cancer Chemother Pharmacol 2019; 84:163-173. [PMID: 31098682 PMCID: PMC6562048 DOI: 10.1007/s00280-019-03856-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/02/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE Daunorubicin can induce left ventricular dysfunction and QT interval prolongation. This study assessed the effects of CPX-351, a liposomal encapsulation of cytarabine and daunorubicin, on cardiac repolarization. METHODS Twenty-six adults with acute leukemia were treated with CPX-351 for 1-2 induction cycles and ≤ 4 consolidation cycles. The primary endpoint was mean change in QTcF from baseline. RESULTS Mean QTcF changes were < 10 ms at all time points. No clinically meaningful effects on heart rate, QRS interval, PR interval, or QTcB were observed. Estimated mean half-lives for total cytarabine and daunorubicin were > 30 h. Thirteen (50%) patients achieved remission. The most common adverse events were febrile neutropenia, fatigue, and nausea. CONCLUSIONS The cytarabine and daunorubicin in CPX-351 liposomes were metabolized and excreted similarly to conventional formulation; however, plasma pharmacokinetics were altered. CPX-351 did not prolong the QT interval, suggesting that CPX-351 may induce less cardiotoxicity than previously reported for conventional daunorubicin. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT02238925.
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Affiliation(s)
- Tara L Lin
- University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, USA.
| | - Laura F Newell
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Robert K Stuart
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | | | - Eric Rubenstein
- Oncology and Hematology Specialists, Franciscan Health, Indianapolis, IN, USA
| | | | | | | | | | | | - Qi Wang
- Celator/Jazz Pharmaceuticals, Palo Alto, CA, USA
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Levy SE, Pinto-Martin JA, Bradley CB, Chittams J, Johnson SL, Pandey J, Pomykacz A, Ramirez A, Reynolds A, Rubenstein E, Schieve LA, Shapira SK, Thompson A, Young L, Kral TVE. Relationship of Weight Outcomes, Co-Occurring Conditions, and Severity of Autism Spectrum Disorder in the Study to Explore Early Development. J Pediatr 2019; 205:202-209. [PMID: 30314662 PMCID: PMC6348122 DOI: 10.1016/j.jpeds.2018.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/25/2018] [Accepted: 09/04/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess contributing factors to increased obesity risk, by comparing children with autism spectrum disorder (ASD), developmental delays/disorders, and general population controls in weight status, and to examine associations between weight status and presence of co-occurring medical, behavioral, developmental, or psychiatric conditions across groups and ASD severity among children with ASD. STUDY DESIGN The Study to Explore Early Development is a multisite cross-sectional study of children, 2-5 years of age, classified as children with ASD (n = 668), children with developmental delays/disorders (n = 914), or general population controls (n = 884). Using an observational cohort design, we compared the 3 groups. Children's heights and weights were measured during a clinical visit. Co-occurring conditions (medical, behavioral, developmental/psychiatric) were derived from medical records, interviews, and questionnaires. ASD severity was measured by the Ohio State University Global Severity Scale for Autism. RESULTS The odds of overweight/obesity were 1.57 times (95% CI 1.24-2.00) higher in children with ASD than general population controls and 1.38 times (95% CI 1.10-1.72) higher in children with developmental delays/disorders than general population controls. The aORs were elevated for children with ASD after controlling for child co-occurring conditions (ASD vs general population controls: aOR = 1.51; 95% CI 1.14-2.00). Among children with ASD, those with severe ASD symptoms were 1.7 times (95% CI 1.1-2.8) more likely to be classified as overweight/obese compared with children with mild ASD symptoms. CONCLUSIONS Prevention of excess weight gain in children with ASD, especially those with severe symptoms, and in children with developmental delays/disorders represents an important target for intervention.
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Affiliation(s)
- Susan E. Levy
- Center for Autism Research, Children’s Hospital of Philadelphia,Department of Pediatrics, University of Pennsylvania
| | - Jennifer A. Pinto-Martin
- Department of Biobehavioral Health Sciences, School of Nursing at University of Pennsylvania, Philadelphia, PA
| | - Chyrise B. Bradley
- Department of Epidemiology, Gillings School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jesse Chittams
- Office of Nursing Research, School of Nursing at University of Pennsylvania, Philadelphia, PA
| | - Susan L. Johnson
- Section of Nutrition/Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Juhi Pandey
- Center for Autism Research, Children’s Hospital of Philadelphia
| | - Alison Pomykacz
- Center for Autism Research, Children’s Hospital of Philadelphia
| | - AnnJosette Ramirez
- Department of Epidemiology, Thomas Jefferson University, Philadelphia, PA
| | - Ann Reynolds
- Department of Pediatrics at the University of Colorado School of Medicine, Aurora, CO
| | - Eric Rubenstein
- Waisman Center and the University of Wisconsin-Madison, Madison, WI
| | - Laura A. Schieve
- National Center Birth Defects and Developmental Disability, Centers for Disease Control and Prevention, Atlanta, GA
| | - Stuart K. Shapira
- National Center Birth Defects and Developmental Disability, Centers for Disease Control and Prevention, Atlanta, GA
| | - Aleda Thompson
- Office of Nursing Research, School of Nursing at University of Pennsylvania, Philadelphia, PA
| | - Lisa Young
- Department of Biobehavioral Health Sciences, School of Nursing at University of Pennsylvania, Philadelphia, PA
| | - Tanja V. E. Kral
- Department of Biobehavioral Health Sciences, School of Nursing at University of Pennsylvania, Philadelphia, PA
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Rubenstein E, Wiggins LD, Schieve LA, Bradley C, DiGuiseppi C, Moody E, Pandey J, Pretzel RE, Howard AG, Olshan AF, Pence BW, Daniels J. Associations between parental broader autism phenotype and child autism spectrum disorder phenotype in the Study to Explore Early Development. Autism 2019; 23:436-448. [PMID: 29376397 PMCID: PMC6027594 DOI: 10.1177/1362361317753563] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The autism spectrum disorder phenotype varies by social and communication ability and co-occurring developmental, behavioral, and medical conditions. Etiology is also diverse, with myriad potential genetic origins and environmental risk factors. Examining the influence of parental broader autism phenotype-a set of sub-clinical characteristics of autism spectrum disorder-on child autism spectrum disorder phenotypes may help reduce heterogeneity in potential genetic predisposition for autism spectrum disorder. We assessed the associations between parental broader autism phenotype and child phenotype among children of age 30-68 months enrolled in the Study to Explore Early Development (N = 707). Child autism spectrum disorder phenotype was defined by a replication of latent classes derived from multiple developmental and behavioral measures: Mild Language Delay with Cognitive Rigidity, Mild Language and Motor Delay with Dysregulation (e.g. anxiety/depression), General Developmental Delay, and Significant Developmental Delay with Repetitive Motor Behaviors. Scores on the Social Responsiveness Scale-Adult measured parent broader autism phenotype. Broader autism phenotype in at least one parent was associated with a child having increased odds of being classified as mild language and motor delay with dysregulation compared to significant developmental delay with repetitive motor behaviors (odds ratio: 2.44; 95% confidence interval: 1.16, 5.09). Children of parents with broader autism phenotype were more likely to have a phenotype qualitatively similar to broader autism phenotype presentation; this may have implications for etiologic research.
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Affiliation(s)
| | | | | | | | | | - Eric Moody
- University of Colorado-Anschutz Medical Campus, USA
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Rubenstein E, Young JC, Croen LA, DiGuiseppi C, Dowling NF, Lee LC, Schieve L, Wiggins LD, Daniels J. Brief Report: Maternal Opioid Prescription from Preconception Through Pregnancy and the Odds of Autism Spectrum Disorder and Autism Features in Children. J Autism Dev Disord 2019; 49:376-382. [PMID: 30132098 PMCID: PMC6331251 DOI: 10.1007/s10803-018-3721-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Opioid use during pregnancy is associated with suboptimal pregnancy outcomes. Little is known about child neurodevelopmental outcomes. We examined associations between maternal opioid prescriptions preconception to delivery (peri-pregnancy) and child's risk of ASD, developmental delay/disorder (DD) with no ASD features, or ASD/DD with autism features in the Study to Explore Early Development, a case-control study of neurodevelopment. Preconception opioid prescription was associated with 2.43 times the odds of ASD [95% confidence interval (CI) 0.99, 6.02] and 2.64 times the odds of ASD/DD with autism features (95% CI 1.10, 6.31) compared to mothers without prescriptions. Odds for ASD and ASD/DD were non-significantly elevated for first trimester prescriptions. Work exploring mechanisms and timing between peri-pregnancy opioid use and child neurodevelopment is needed.
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Affiliation(s)
- Eric Rubenstein
- Waisman Center, University of Wisconsin-Madison, Rm 529, 1500 Highland Avenue, Madison, WI, 53705, USA.
| | - Jessica C Young
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Lisa A Croen
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus School of Public Health, 13001 E. 17th Place, Aurora, CO, 80045, USA
| | - Nicole F Dowling
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Li-Ching Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Laura Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Lisa D Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Julie Daniels
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
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Rubenstein E, Maldini C, Gonzalez Chiappe S, Chevret S, Mahr A. Sensibilité de la biopsie d’artère temporale pour le diagnostic d’artérite à cellules géantes (Horton) : revue systématique de la littérature et méta-analyse. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Rubenstein E, Schieve L, Wiggins L, Rice C, Van Naarden Braun K, Christensen D, Durkin M, Daniels J, Lee LC. Trends in documented co-occurring conditions in children with autism spectrum disorder, 2002-2010. Res Dev Disabil 2018; 83:168-178. [PMID: 30227350 PMCID: PMC6741291 DOI: 10.1016/j.ridd.2018.08.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 08/28/2018] [Indexed: 06/01/2023]
Abstract
BACKGROUND Autism spectrumdisorder (ASD) commonly presents with co-occurring medical conditions (CoCs). Little is known about patterns in CoCs in a time of rising ASD prevalence. AIMS To describe trends in number and type of documented CoCs in 8-year-old children with ASD. METHODS We used Autism and Developmental Disabilities Monitoring Network (ADDM) data, a multi-source active surveillance system monitoring ASD prevalence among 8-year-old children across the US. Data from surveillance years 2002, 2006, 2008, and 2010 were used to describe trends in count, categories, and individual CoCs. RESULTS Mean number of CoCs increased from 0.94 CoCs in 2002 to 1.06 CoCs in 2010 (p < 0.001). The percentage of children with ASD with any CoC increased from 44.5% to 56.4% (p < 0.001). CoCs with the greatest increases were in general developmental disability (10.4% to 14.5%), language disorder (18.9% to 23.6%), and motor developmental disability (10.5% to 15.6%). Sex modified the relationship between developmental (P = 0.02) and psychiatric (P < 0.001) CoCs and surveillance year. Race/ethnicity modified the relationship between neurological conditions (P = 0.04) and surveillance year. CONCLUSIONS The increase in the percentage of children with ASD and CoCs may suggest the ASD phenotype has changed over time or clinicians are more likely to diagnose CoCs.
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Affiliation(s)
- Eric Rubenstein
- Department of Epidemiology, University of North Carolina at Chapel Hill, 116A South Merrit Mill, Chapel Hill, NC 27516, United States.
| | - Laura Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS E-86, Atlanta, GA 30333, United States
| | - Lisa Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS E-86, Atlanta, GA 30333, United States
| | - Catherine Rice
- Department of Psychiatry, Emory University School of Medicine, 1551 Shoup Court, Atlanta, GA 30322, United States
| | - Kim Van Naarden Braun
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS E-86, Atlanta, GA 30333, United States
| | - Deborah Christensen
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS E-86, Atlanta, GA 30333, United States
| | - Maureen Durkin
- Department of Population Health Sciences, University of Wisconsin, 610 Walnut Street, Madison, WI 53726, United States
| | - Julie Daniels
- Department of Epidemiology, University of North Carolina at Chapel Hill, 116A South Merrit Mill, Chapel Hill, NC 27516, United States
| | - Li-Ching Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States
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Rubenstein E, Young JC, Croen LA, DiGuiseppi C, Dowling NF, Lee LC, Schieve L, Wiggins LD, Daniels J. Correction to: Brief Report: Maternal Opioid Prescription from Preconception Through Pregnancy and the Odds of Autism Spectrum Disorder and Autism Features in Children. J Autism Dev Disord 2018; 49:383-384. [PMID: 30238179 DOI: 10.1007/s10803-018-3746-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The original version of this article unfortunately contained a mistake in Table 2. The "Time of use" should be the column header with the corresponding row with "N = 126" belonging to the "Peri-pregnancy" row. The "Preconception" row should be the row with "N = 17", "Trimester 1" should be the "N = 29" row, "Trimester 2" should be the "N = 25" row, and "Trimester 3" should be the "N = 47" row.
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Affiliation(s)
- Eric Rubenstein
- Waisman Center, University of Wisconsin-Madison, Rm 529, 1500 Highland Avenue, Madison, WI, 53705, USA.
| | - Jessica C Young
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Lisa A Croen
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus School of Public Health, 13001 E. 17th Place, Aurora, CO, 80045, USA
| | - Nicole F Dowling
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Li-Ching Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Laura Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Lisa D Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Julie Daniels
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
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Rubenstein E, Bishop-Fitzpatrick L. A matter of time: The necessity of temporal language in research on health conditions that present with autism spectrum disorder. Autism Res 2018; 12:20-25. [PMID: 30184325 DOI: 10.1002/aur.2010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/24/2018] [Accepted: 07/30/2018] [Indexed: 12/20/2022]
Abstract
Relatively consistent findings from recent studies using population-level data identify heightened physical and psychiatric morbidity in autistic people compared to the general population. Health problems that commonly present with autism spectrum disorder (ASD) are generally discussed in the literature as "co-occurring" or "comorbid" regardless of their known or hypothesized causal mechanisms. In this commentary, we introduce a new temporally focused terminology to describe health conditions that present with ASD. Emphasizing the temporal development of health conditions in research will help the field understand whether conditions are (1) "truly co-occurring" (share an etiologic origin with ASD in utero and are a defining characteristic of a subphenotype), (2) "resulting" (caused by ASD related disparity or the health effect of behaviors developed to cope with ASD symptoms), or (3) "associated" (conditions more common in individuals with ASD with etiology not yet known or hypothesized, or an artifact of diagnostic process or trends). Whether a health condition is "truly co-occurring", "resulting", or "associated" has implications for how we design interventions to prevent and treat health conditions in people on the autism spectrum. Ultimately, we think that using clear and temporally focused language can set us on a path to better deduce etiology and develop effective prevention and intervention efforts for health conditions that impact the lives of autistic individuals. We hope that this approach to temporal language to describe health conditions that present with ASD promotes thought and discussion in research, advocate, and autistic communities. Autism Research 2019, 12: 20-25. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Research finds autistic people have more health problems than the general population but we do not understand why. In this commentary, we argue researchers need to use language describing the timing of health problems in autistic people, specifying whether problems truly co-occur (share a cause), result from autism-related disparities, or are more common in autistic people for an unknown reason. Clarifying language can provide more specificity in research and improve efforts to prevent and treat health problems in autistic people.
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Affiliation(s)
| | - Lauren Bishop-Fitzpatrick
- The Waisman Center, Madison, Wisconsin.,School of Social Work, University of Wisconsin, Madison, Wisconsin
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46
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Rubenstein E, Chawla D. Broader autism phenotype in parents of children with autism: a systematic review of percentage estimates. J Child Fam Stud 2018; 27:1705-1720. [PMID: 29731598 PMCID: PMC5933863 DOI: 10.1007/s10826-018-1026-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The broader autism phenotype (BAP) is a collection of sub-diagnostic autistic traits more common in families of individuals with autism spectrum disorder (ASD) than in the general population. BAP is a latent construct that can be defined using different domains, measured using multiple instruments, and reported using different techniques. Therefore, estimates of BAP may vary greatly across studies. Our objective was to systematically review studies that reported occurrence of BAP in parents of children with ASD in order to quantify and describe heterogeneity in estimates. We systematically searched PubMed and Scopus using PRISMA guidelines for studies quantifying percentage of parents of children with ASD who had BAP We identified 41 studies that measured BAP in parents of children with ASD. These studies used eight different instruments, four different forms of data collection, and had a wide range of sample sizes (N=4 to N=3299). Percentage with BAP ranged from 2.6% to 80%. BAP was more prevalent in fathers than mothers. Parental BAP may be an important tool for parsing heterogeneity in ASD etiology and for developing parent-mediated ASD interventions. However, the variety in measurement instruments and variability in study samples limits our ability to synthesize estimates. To improve measurement of BAP and increase consistency across studies, universal methods should be accepted and adopted across studies. A more consistent approach to BAP measurement may enable efficient etiologic research that can be meta-analyzed and may allow for a larger evidence base that can be used to account for BAP when developing parent-mediated interventions.
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Affiliation(s)
- Eric Rubenstein
- University of North Carolina Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC
- University of Wisconsin-Madison, Waisman Center, Madison, WI
| | - Devika Chawla
- University of North Carolina Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC
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47
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Rubenstein E, Schieve L, Bradley C, DiGuiseppi C, Moody E, Thomas K, Daniels J. The prevalence of gluten free diet use among preschool children with autism spectrum disorder. Autism Res 2018; 11:185-193. [PMID: 29155492 PMCID: PMC5773346 DOI: 10.1002/aur.1896] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/20/2017] [Accepted: 11/03/2017] [Indexed: 01/08/2023]
Abstract
Our objective was to estimate prevalence of current or ever use of a gluten free diet (GFD) in children aged 30-68 months with autism spectrum disorder (ASD) and population controls (POP); and to identify characteristics associated with ever having used GFD among children with ASD. We used data from the Study to Explore Early Development (SEED), a multi-site, case-control study of children with ASD. Caregivers reported GFD use by their children through structured questionnaires about diet patterns, gastrointestinal (GI) issues, and ASD-specific treatments. Prevalence was estimated and compared using log-Poisson regression, adjusting for confounders. In children with ASD, we examined whether child or mother's GI conditions or child's phenotypic traits were associated with ever trying a GFD. In SEED, 71 children with ASD (11.1% prevalence after adjustment) were on a GFD at time of the study and 130 (20.4%) had ever used a GFD, a greater percentage than in POP children (N = 11, 0.9% current use). Of current users with ASD, 50.7% had a dietary intervention that was prescribed by a medical professional. Among children with ASD, child GI conditions and developmental regression were positively and independently associated with having ever used a GFD. Current use and ever use of a GFD were prevalent in children with ASD identified in SEED. GFD usage was associated with GI issues and child phenotype. Clinicians may consider advising parents on how best to use these diets in the context of the child's GI presentation and current scientific knowledge about effectiveness in relation to ASD symptoms. Autism Res 2018, 11: 185-193. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY Gluten free diets (GFDs) are commonly used as an alternative therapy for autism spectrum disorder (ASD); however, the effectiveness is still uncertain which makes it important to know who tries this type of diet. We found that one in five preschool aged children with ASD had ever used a GFD. Children with gastrointestinal conditions and developmental regression were more likely to have tried a GFD.
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Affiliation(s)
- Eric Rubenstein
- University of North Carolina-Chapel Hill Gillings School of Global Public Health
- University of Wisconsin-Madison, Waisman Center
| | - Laura Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Chyrise Bradley
- University of North Carolina-Chapel Hill Gillings School of Global Public Health
| | - Carolyn DiGuiseppi
- University of Colorado Anschutz Medical Campus, Colorado School of Public Health
| | - Eric Moody
- University of Colorado Anschutz Medical Campus, Colorado School of Public Health
| | - Kathleen Thomas
- University of North Carolina-Chapel Hill Cecil G. Sheps Center for Health Services Research
| | - Julie Daniels
- University of North Carolina-Chapel Hill Gillings School of Global Public Health
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48
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Rubenstein E, Daniels J, Schieve LA, Christensen DL, Van Naarden Braun K, Rice CE, Bakian AV, Durkin MS, Rosenberg SA, Kirby RS, Lee LC. Trends in Special Education Eligibility Among Children With Autism Spectrum Disorder, 2002-2010. Public Health Rep 2017; 133:85-92. [PMID: 29257937 DOI: 10.1177/0033354917739582] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Although data on publicly available special education are informative and offer a glimpse of trends in autism spectrum disorder (ASD) and use of educational services, using these data for population-based public health monitoring has drawbacks. Our objective was to evaluate trends in special education eligibility among 8-year-old children with ASD identified in the Autism and Developmental Disabilities Monitoring Network. METHODS We used data from 5 Autism and Developmental Disabilities Monitoring Network sites (Arizona, Colorado, Georgia, Maryland, and North Carolina) during 4 surveillance years (2002, 2006, 2008, and 2010) and compared trends in 12 categories of special education eligibility by sex and race/ethnicity. We used multivariable linear risk regressions to evaluate how the proportion of children with a given eligibility changed over time. RESULTS Of 6010 children with ASD, more than 36% did not receive an autism eligibility in special education in each surveillance year. From surveillance year 2002 to surveillance year 2010, autism eligibility increased by 3.6 percentage points ( P = .09), and intellectual disability eligibility decreased by 4.6 percentage points ( P < .001). A greater proportion of boys than girls had an autism eligibility in 2002 (56.3% vs 48.8%). Compared with other racial/ethnic groups, Hispanic children had the largest increase in proportion with autism eligibility from 2002 to 2010 (15.4%, P = .005) and the largest decrease in proportion with intellectual disability (-14.3%, P = .004). CONCLUSION Although most children with ASD had autism eligibility, many received special education services under other categories, and racial/ethnic disparities persisted. To monitor trends in ASD prevalence, public health officials need access to comprehensive data collected systematically, not just special education eligibility.
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Affiliation(s)
- Eric Rubenstein
- 1 Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Julie Daniels
- 1 Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Laura A Schieve
- 2 National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Deborah L Christensen
- 2 National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kim Van Naarden Braun
- 2 National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Catherine E Rice
- 3 Emory University School of Medicine, Atlanta, GA, USA.,4 Emory Autism Center, Atlanta, GA, USA
| | - Amanda V Bakian
- 5 Division of Child Psychiatry, Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Maureen S Durkin
- 6 Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Steven A Rosenberg
- 7 Department of Epidemiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Russell S Kirby
- 8 Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Li-Ching Lee
- 9 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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49
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Rubenstein E, Edmondson Pretzel R, Windham GC, Schieve LA, Wiggins LD, DiGuiseppi C, Olshan AF, Howard AG, Pence BW, Young L, Daniels J. The Broader Autism Phenotype in Mothers is Associated with Increased Discordance Between Maternal-Reported and Clinician-Observed Instruments that Measure Child Autism Spectrum Disorder. J Autism Dev Disord 2017; 47:3253-3266. [PMID: 28748335 PMCID: PMC5728366 DOI: 10.1007/s10803-017-3248-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Autism spectrum disorder (ASD) diagnosis relies on parent-reported and clinician-observed instruments. Sometimes, results between these instruments disagree. The broader autism phenotype (BAP) in parent-reporters may be associated with discordance. Study to Explore Early Development data (N = 712) were used to address whether mothers with BAP and children with ASD or non-ASD developmental disabilities were more likely than mothers without BAP to 'over-' or 'under-report' child ASD on ASD screeners or interviews compared with clinician observation or overall impression. Maternal BAP was associated with a child meeting thresholds on a maternal-reported screener or maternal interview when clinician ASD instruments or impressions did not (risk ratios: 1.30 to 2.85). Evidence suggests acknowledging and accounting for reporting discordances may be important when diagnosing ASD.
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Affiliation(s)
- Eric Rubenstein
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA.
| | - Rebecca Edmondson Pretzel
- University of North Carolina at Chapel Hill Center for Intellectual and Developmental Disabilities, 101 Renee Lynne Ct, Carrboro, NC, 27510, USA
| | - Gayle C Windham
- Division of Environmental and Occupational Disease Control, California Department of Public Health, 850 Marina Bay Pkwy, Bldg. P, Richmond, CA, 94804, USA
| | - Laura A Schieve
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Lisa D Wiggins
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, Campus Box B119, 13001 E. 17th Place, Aurora, CO, 80045, USA
| | - Andrew F Olshan
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Annie G Howard
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, 137 East Franklin Street Room 6702 CB# 8030, Chapel Hill, NC, 27514, USA
| | - Brian W Pence
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Lisa Young
- University of Pennsylvania School of Nursing, 420 Guardian Drive, Philadelphia, PA, 19104, USA
| | - Julie Daniels
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
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50
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Blake JM, Rubenstein E, Tsai PC, Rahman H, Rieth SR, Ali H, Lee LC. Lessons learned while developing, adapting and implementing a pilot parent-mediated behavioural intervention for children with autism spectrum disorder in rural Bangladesh. Autism 2017; 21:611-621. [PMID: 28366007 DOI: 10.1177/1362361316683890] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Low- and middle-income countries often have limited resources, underdeveloped health systems and scarce knowledge of autism spectrum disorder. The objectives of this preliminary study were to develop and adapt intervention materials and to train a native clinician to implement a community-based parent-mediated behavioural intervention in rural Gaibandha, Bangladesh. Intervention materials to support parents' use of behavioural strategies were developed and refined by US behavioural intervention experts and Bangladesh field experts. Study investigators trained a native child psychologist in developmental milestones and behavioural intervention techniques. The native clinician delivered a 1-day group education session attended by 10 families of children aged 7-9 years with autism spectrum disorder, followed by two one-on-one training sessions with each family to train and practice individualized strategies for targeted challenging behaviours. Preliminary qualitative results indicate the importance of materials that are culturally appropriate and at an adequate literacy level. All families expressed strong desires to have learned the behavioural strategies when their child was younger and vocalized their need for further support and tools to help their children. This study is a preliminary step to creating sustainable and low-cost autism spectrum disorder interventions in rural Bangladesh, and possibly for families in regions with similar cultural and socioeconomic status backgrounds.
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Affiliation(s)
- Jasmine M Blake
- 1 Johns Hopkins Bloomberg School of Public Health, USA.,2 University of Maryland School of Medicine, USA
| | | | | | | | - Sarah R Rieth
- 5 San Diego State University, USA.,6 Child and Adolescent Services Research Center, USA
| | - Hasmot Ali
- 1 Johns Hopkins Bloomberg School of Public Health, USA.,4 Johns Hopkins University - Bangladesh, Bangladesh
| | - Li-Ching Lee
- 1 Johns Hopkins Bloomberg School of Public Health, USA
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