Benefits and Risks: A Systematic Review of Information and Communication Technology Use by Autistic People

Background

Communication via the internet is a regular feature of everyday interactions for most people, including autistic people. Researchers have investigated how autistic people use information and communication technology (ICT) since the early 2000s. However, no systematic review has been conducted to summarize findings.

Objective

This study aims to review existing evidence presented by studies about how autistic people use ICT to communicate and provide a framework for understanding contributions, gaps, and opportunities for this literature.

Methods

Guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses(PRISMA) statement, we conducted a comprehensive review across five databases, searching for studies investigating how autistic youth and adults use ICT to communicate. Authors reviewed the articles for inclusion and assessed methodological quality.

Results

Thirty-two studies met the eligibility criteria, including 19 quantitative studies, 12 qualitative studies, and 1 mixed methods study, with data from 3026 autistic youth (n = 9 studies) and adults (n = 23 studies). Ratings suggest that the evidence base is emergent. Underrepresented groups in the sample included autistic women, transgendered autistic people, non-White autistic people, low income autistic people, and minimally speaking and/or autistic adults with co-occurring intellectual disability. Three main themes emerged, including variation in ICT communication use among autistic youth and adults, benefits and drawbacks experienced during ICT communication use, and the engagement of autistic youth and adults in the online autism community.

Conclusions

Further exploration of the positive social capital that autistic people gain participating in online autism communities would allow for the development of strengths-based interventions. Additional research on how autistic people navigate sexuality and ICTs is needed to identify mechanisms for reducing vulnerability online. Additional scholarship about underrepresented groups is needed to investigate and confirm findings regarding ICT communication use for gender, racial, and socioeconomic minority groups.

Lay summary

What was the purpose of this study?: People use the internet to communicate (talk and connect) with one another. Some research has found that autistic people may prefer to communicate using the internet instead of in person. Over the past 20 years, there has been research about how autistic people use the internet. To understand what research has discovered so far, we collected published research about how autistic youth and adults use the internet to communicate.What did the researchers do?: We used scientific best practices as described in the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to collect research about how autistic people us the internet to communicate. We included research that uses words (qualitative research) and numbers (quantitative research). First, we searched several places that list research studies to find research on autistic people and the internet. Then, we removed research that did not fit what we were looking for (our criteria). Finally, we then read the full articles, collected their most important findings, and looked for patterns.What do these findings add to what is already known?: Thirty-two studies met our criteria, including 19 studies that used closed-ended survey questions that tested relationships between variables, 12 studies that used open-ended interviews and looked for patterns and connections among participants, and 1 mixed methods study. In total, 3026 autistic youth of ages 10-17 years (number of participants = 9 studies) and adults (number of participants = 23 studies) participated in these 32 studies. We rated each of the 32 studies for quality and learned that the evidence base is preliminary, meaning that more rigorous high-quality studies are needed before we can be confident in the findings. We found three main themes: (1) differences in the ways that autistic youth and adults used the internet to communicate, (2) benefits and drawbacks experienced when using the internet to communicate, and (3) the engagement of autistic youth and adults in the online autism community. Some of the benefits of social media for autistic people include more control over how they talk and engage with others online and a greater sense of calm during interactions. However, findings suggest some drawbacks for autistic people, including continued feelings of loneliness and the desire for in-person friendships. Social media provides opportunities for autistic people to find others on the autism spectrum and form a stronger identity as part of the autism community. The study also showed that there is little research about autistic women, autistic transgender people, autistic racial/ethnic minorities, or autistic people from lower socioeconomic status (SES) groups.What are potential weaknesses of this study?: We only included research in scientific articles, and there may be useful information on this topic in books, student research, or online.How will these findings help young adults on the autism spectrum now or in the future?: This study can help identify gaps and opportunities for new research, support the importance of online autistic communities, and suggest possible training opportunities about how to support autistic people when they use the internet for communication.

SAT0196 A DOUBLE BLIND, PLACEBO CONTROLLED, SINGLE ASCENDING DOSE (SAD) AND MULTIPLE ASCENDING DOSE (MAD) STUDY OF ALPN-101, A FIRST-IN-CLASS DUAL ICOS/CD28 ANTAGONIST, IN HEALTHY VOLUNTEERS (HV)

Background:

ALPN-101 (ICOSL vIgD-Fc) is an Fc fusion protein of a human inducible T cell costimulatory ligand (ICOSL) variant immunoglobulin domain (vIgD™) designed to inhibit simultaneously the CD28 and ICOS inflammation pathways (1). ALPN-101 is effective in preclinical studies of lupus, arthritis, and Sjögren’s, and shows greater activity than single pathway inhibitors (2,3,4). It is in development for the treatment of multiple rheumatic and other inflammatory diseases.

Objectives:

To evaluate the safety, pharmacokinetics (PK), and pharmacodynamics (PD) of ALPN-101 in HV

Methods:

This was a first-in-human study of ALPN-101 (NCT03748836). 72 HV were allocated 4:2 to single intravenous (IV) or subcutaneous (SC) doses of ALPN-101: placebo at 0.001 – 10 mg/kg; 24 HV were allocated 6:2 to repeated IV doses of up to 1 mg/kg weekly x 4. Subjects were followed for 28 (SAD) or 49 (MAD) days to assess safety, PK, target saturation (TS) on T cells, circulating cytokines and PD, the latter based on suppression of IgG responses to keyhole limpet hemocyanin (KLH).

Results:

ALPN-101 was generally well-tolerated, with no treatment related serious adverse events, no cytokine release, no clinical immunogenicity, and no adverse trends in safety laboratories. Overall, adverse events were reported in 74.2% of subjects on ALPN-101 and 66.7% of subjects on placebo. All events were mild or moderate and resolved without sequelae. Dose-dependent increase in ALPN-101 exposure was observed from 0.012 to 10 mg/kg. The estimated t1/2was 2-8.6 days over 0.3 – 10 mg/kg. SC bioavailability was ~60% at 3 mg/kg. Minimal to modest accumulation was observed with repeat IV dosing. The TS at Cmaxincreased with dose between 0.001–0.03 mg/kg; thereafter the duration of high level TS (>95%) increased with dose (Figure 1). The duration of suppression of IgG anti-KLH response paralleled the duration of high level TS (Figure 2).

Figure 1.

Mean + SD Target Saturation of ALPN-101 on Circulating CD4+T Lymphocytes

Figure 2.

Mean + SD Serum Anti-KLH IgG Change Relative to Baseline

Conclusion:

ALPN-101 was well tolerated when administered as single doses up to 10 mg/kg or as repeated doses of up to 1 mg/kg weekly for 4 weeks, exhibiting dose-dependent PK, TS and PD including the inhibition of antibody responses to KLH immunization. These findings support future studies to evaluate the efficacy of ALPN-101 in multiple rheumatic and other inflammatory diseases.

References:

[1]Levin SD et al. Frontiers in Immunology 2020; 10:3086

[2]Evans L et al. Arthritis and Rheumatology 2019:71: Supplement: Abstract 1531

[3]Dillon S et al. Arthritis and Rheumatology 2018:70: Supplement: Abstract 136

[4]Dillon S et al. Arthritis and Rheumatology 2019:71: Supplement: Abstract 2416

Disclosure of Interests:

Jing Yang Shareholder of: Alpine Immune Sciences, Inc., Employee of: Alpine Immune Sciences, Inc., Jan Hillson Shareholder of: Alpine Immune Sciences, Inc., Employee of: Alpine Immune Sciences, Inc., Jason Lickliter Consultant of: AUD 2500 from QBiotics for participation in an expert review panel for development of their oncology phase 1 trial (in Nov 2015), Kristi Manjarrez Shareholder of: Alpine Immune Sciences, Inc., Employee of: Alpine immune sciences, Inc., Almudena Tercero Shareholder of: Alpine Immune Sciences, Inc., Employee of: Alpine Immune Sciences, Inc., Jennifer Wiley Shareholder of: Alpine Immune Sciences, Inc., Employee of: Alpine Immune Sciences, Inc., Gary Means Shareholder of: Alpine Immune Sciences, Inc., Employee of: Alpine Immune Sciences, Inc., Russell Sanderson Shareholder of: Alpine Immune Sciences, Inc., Employee of: Alpine Immune Sciences, Inc., Kay Carley Shareholder of: Alpine Immune Sciences, Inc., Employee of: Alpine Immune Sciences, Inc., Stanford L. Peng Shareholder of: Alpine Immune Sciences, Inc., Employee of: CMO and President of Alpine Immune Sciences, Inc.

Network Measures of Collaborative Support for Young Adults With Autism

OBJECTIVES

The treatment of autism requires complex, multimodal interventions, provided by parents and providers across settings. As young adults with autism spectrum disorder (ASD) transition into adulthood, new stakeholders are added to support planning for postsecondary employment. In this article, we investigate the use of dynamic social network measures that describe the resources of young adults throughout transition.

METHODS

A longitudinal, dynamic social network survey (Social Dynamics of Intervention [SoDI]) was conceptualized, designed, and conducted as a feasibility test, measuring changes in collaboration among parents and school staff members who provided interventions for children with ASD in 2 urban public schools. Using the SoDI, we tracked the following over time: the team who provided interventions, their locations, the interventions they provided, the autism trainings they attended, and the density of the team's problem-solving network for the child.

RESULTS

Using the SoDI, we successfully identified stakeholders across settings who provided interventions for each child. Results indicated variation in the density of problem-solving and trust related to ASD intervention across teams as well as variation in intervention and autism knowledge networks during the school year. Adaptations of the SoDI for mapping pre- and posttransition resources and social connectivity across stakeholders for young adults with ASD are proposed in the Discussion section.

CONCLUSIONS

Dynamic social network approaches can be used to capture changes in intervention, autism knowledge, and social connectivity, providing informative descriptive data about how vocational rehabilitation policies might increase employment supports during the transition process for young adults with ASD.

Electronic Mail and Scientific Communication

A new type of scientific research group is emerging-the extended research group (a large number of geographically dispersed researchers working together in a coordinated fashion). This article describes the roles that various modes of communication (such as face-to-face discussion and EMail), types of information communicated, and types of social ties played in the communication behavior of one such group, computer analysts and programmers working on a specialized language model called Soar, which stands for "state operator and result. " The authors show that the Soar group used different communication modes to acquire different types of information and that EMail enhanced rather than reduced the impact of traditional scientific communication networks.

Predicting the impact of an electronic health record on practice patterns using computational modeling and simulation

The overall purpose of this research study is to discover and apply new knowledge regarding methods to predict the impact of an electronic health record (EHR) on clinical practice guidelines in complex systems such as hospitals. Specifically, the aims of this study are: 1) to build, simulate and validate the accuracy of a computational model representing the current practice patterns in a sample of patients diagnosed with heart failure (HF) and treated in a community hospital; and 2) using computational modeling and simulation, develop a method to predict the effects of best practice guidelines on practice patterns after implementation of an EHR.

A longitudinal social network analysis of the editorial boards of medical informatics and bioinformatics journals

OBJECTIVE

The goal of this research is to learn how the editorial staffs of bioinformatics and medical informatics journals provide support for cross-community exposure. Models such as co-citation and co-author analysis measure the relationships between researchers; but they do not capture how environments that support knowledge transfer across communities are organized.

METHODS

In this paper, we propose a social network analysis model to study how editorial boards integrate researchers from disparate communities. We evaluate our model by building relational networks based on the editorial boards of approximately 40 journals that serve as research outlets in medical informatics and bioinformatics. We track the evolution of editorial relationships through a longitudinal investigation over the years 2000 through 2005.

RESULTS

Our findings suggest that there are research journals that support the collocation of editorial board members from the bioinformatics and medical informatics communities. Network centrality metrics indicate that editorial board members are located in the intersection of the communities and that the number of individuals in the intersection is growing with time.

CONCLUSIONS

Social network analysis methods provide insight into the relationships between the medical informatics and bioinformatics communities. The number of editorial board members facilitating the publication intersection of the communities has grown, but the intersection remains dependent on a small group of individuals and fragile.

Organizational network analysis: a method to model information in public health work

Public health agencies are composed of complex information processing networks. The dynamic interactions of these networks affect performance in complex ways that are not easily understood. We explored how organizational network analysis can support management in public health. Managers participated in interpreting our findings and developed strategies to address the problems uncovered. The method is a means for informaticians and practitioners to build collaborative knowledge and improve public health systems using empirical evidence.

Guidelines for constructing a statewide hospital syndromic surveillance network

INTRODUCTION

The process to initiate a comprehensive and inexpensive statewide hospital emergency department-based syndromic surveillance system (HEDSS) in Connecticut can serve as a template for others.

OBJECTIVES

With limited financial resources, the Connecticut Department of Public Health (CDPH) determined the requirements necessary to establish and routinely conduct hospital emergency department (HED)-based syndromic surveillance.

METHODS

A statewide survey assessed ability and willingness of Connecticut hospitals to participate in HED syndromic surveillance. The New York City HED-based system protocol and analysis programs, available without financial charge, were modified for use in Connecticut. This system is based on hospitals sending daily standardized files of chief complaint data through encrypted e-mail or an FTP protocol to CDPH with subsequent categorization into syndromes using a SAS program. Anticipating regional surveillance needs during the Republican National Convention in New York City (RNC), CDPH initiated HEDSS in August 2004.

RESULTS

Most Connecticut HEDs were willing and able to participate on a voluntary basis. Beginning in July 2004, hospital recruitment began. By the time of the RNC, 11 of 32 Connecticut hospitals participated in HEDSS. Since then, an additional six HEDs have joined.

CONCLUSION

Establishing a voluntary statewide HEDSS was possible using an existing, readily available protocol with minimum financial resources and consensus from a statewide workgroup over a several-month time period.

Using OrgAhead, a computational modeling program, to improve patient care unit safety and quality outcomes

As part of ongoing research to investigate the impact of patient characteristics, organization characteristics and patient unit characteristics on safety and quality outcomes, we used a computational modeling program, OrgAhead, to model patient care units' achievement of patient safety (medication errors and falls) and quality outcomes. We tuned OrgAhead using data we collected from 32 units in 12 hospitals in Arizona. Validation studies demonstrated acceptable levels of correspondence between actual and virtual patient units. In this paper, we report how we used OrgAhead to develop testable hypotheses about the kinds of innovations that nurse managers might realistically implement on their patient care units to improve quality and safety outcomes. Our focus was on unit-level innovations that are likely to be easier for managers to implement. For all but the highest performing unit (for which we encountered a ceiling effect), we were able to generate practical strategies that improved performance of the virtual units that could be implemented by actual units to improve safety and quality outcomes. Nurse managers have responded enthusiastically to the additional decision support for quality improvement.

Applying organizational network analysis techniques to study information use in a public health agency

We are applying organizational network analysis to explore information use in a public health department. The technique is grounded in social science theory, and employs calculations derived from graph theory to generate statistical and graphical models from relational data matrices. For this pilot we will develop network models to characterize how information use in routine work contributes to the agency's performance goals. This is the first step in ongoing work that will extend network analysis with computational methods, to predict the potential effects that improving information use has on the agency's performance.

Hospital admissions syndromic surveillance--Connecticut, September 200-November 2003

On September 11, 2001, the Connecticut Department of Public Health (CDPH) initiated daily, statewide syndromic surveillance based on unscheduled hospital admissions (HASS). The system's objectives were to monitor for outbreaks caused by Category A biologic agents and evaluate limits in space and time of identified outbreaks. Thirty-two acute-care hospitals were required to report their previous day's unscheduled admissions for 11 syndromes (pneumonia, hemoptysis, respiratory distress, acute neurologic illness, nontraumatic paralysis, sepsis and nontraumatic shock, fever with rash, fever of unknown cause, acute gastrointestinal illness, and possible cutaneous anthrax, and suspected illness clusters). Admissions for pneumonia, gastrointestinal illness, and sepsis were reported most frequently; admissions for fever with rash, possible cutaneous anthrax, and hemoptysis were rare. A method for determining the difference between random and systemic variation was used to identify differences of >/=3 standard deviations for each syndrome from a 6-month moving average. HASS was adapted to meet changing surveillance needs (e.g., surveillance for anthrax, smallpox, and severe acute respiratory syndrome). HASS was sensitive enough to reflect annual increases in hospital-admission rates for pneumonia during the influenza season and to confirm an outbreak of gastrointestinal illness. Follow-up of HASS neurologic-admissions reports has led to diagnosis of West Nile virus encephalitis cases. Report validation, syndrome-criteria standardization among hospitals, and expanded use of outbreak-detection algorithms will enhance the system's usefulness.

Using computational modeling to improve patient care unit safety and quality outcomes

As part of ongoing research to investigate the impact of patient characteristics, organization characteristics and patient unit characteristics on safety and quality outcomes, we are using a computational modeling program, OrgAhead, to model patient care units' achievement of patient safety (medication errors and falls) and quality outcomes. We tuned OrgAhead using data we collected from 16 units in 5 hospitals. Subsequent validation studies demonstrated acceptable levels of correspondence between actual and virtual patient units. In this paper, we report on our initial efforts to use OrgAhead to develop testable hypotheses about the kinds of innovations that nurse managers might realistically implement on their patient care units to improve quality and safety outcomes. Our focus is on unit-level innovations that are likely to be easier for managers to implement. For all but the highest performing unit (for which we encountered a ceiling effect), we were able to generate practical strategies that improved performance of the virtual units by 6-8 percentage points. Nurse Managers have responded enthusiastically to the additional decision support for quality improvement

Using computational modeling to study the impact of workplace characteristics on patient safety outcomes

How do patient characteristics, organization characteristics and patient care unit characteristics interact to affect quality, safety, and cost outcomes? What changes can nurse managers make on their units that will optimize outcomes for their patients? To answer these questions, we are collecting data from 35 nursing units in 12 hospitals in Arizona, and using the results as a basis for computational modeling. Although it has been used in clinical research, until now computational modeling has had little application to healthcare or nursing organizations. In this poster session, we describe our application of Orgahead, a computational modeling program.

Testing pregnant women for HIV: a survey of obstetricians and review of patient prenatal/obstetric medical records--Connecticut 1996-1997

High rates of prenatal testing are needed to identify all HIV-infected pregnant women and prevent transmission to their offspring. To evaluate HIV testing of pregnant women in Connecticut, a survey was conducted in 1998 of licensed obstetricians and a review was performed of 992 randomly sampled prenatal and obstetric medical records for births occurring in 1996. Results of the survey indicated that 78.8% of respondents routinely offered HIV counseling and 76.4% routinely offered HIV testing to pregnant patients in 1997. However, only 44% reported that greater than half of their patients were being tested. Providers who had an HIV testing policy that included HIV-testing unless the patient refused had the highest rate (80.8%; P < 0.05). The review of medical records revealed that only 28.8% of women who delivered in 1996 had an HIV test performed during prenatal care. Maternal characteristics associated (P < 0.05) with testing included Hispanic ethnicity (51.8% tested), younger age (53.6%, < 20 years old), having Medicaid (48.0%), hospital clinic services (44.6%), and history of intravenous drug use (IDU) (76.9%). Testing rate varied by hospital from 0% to 82.8%. These results indicate that considerable modification of provider and hospital practices and policies is needed to raise HIV screening rates.