The Prevalence of Parent-Reported Autism Spectrum Disorder Among US Children

: media-1vid110.1542/5839990273001PEDS-VA_2017-4161Video Abstract OBJECTIVES: To estimate the national prevalence of parent-reported autism spectrum disorder (ASD) diagnosis among US children aged 3 to 17 years as well as their treatment and health care experiences using the 2016 National Survey of Children's Health (NSCH).

METHODS

The 2016 NSCH is a nationally representative survey of 50 212 children focused on the health and well-being of children aged 0 to 17 years. The NSCH collected parent-reported information on whether children ever received an ASD diagnosis by a care provider, current ASD status, health care use, access and challenges, and methods of treatment. We calculated weighted prevalence estimates of ASD, compared health care experiences of children with ASD to other children, and examined factors associated with increased likelihood of medication and behavioral treatment.

RESULTS

Parents of an estimated 1.5 million US children aged 3 to 17 years (2.50%) reported that their child had ever received an ASD diagnosis and currently had the condition. Children with parent-reported ASD diagnosis were more likely to have greater health care needs and difficulties accessing health care than children with other emotional or behavioral disorders (attention-deficit/hyperactivity disorder, anxiety, behavioral or conduct problems, depression, developmental delay, Down syndrome, intellectual disability, learning disability, Tourette syndrome) and children without these conditions. Of children with current ASD, 27% were taking medication for ASD-related symptoms, whereas 64% received behavioral treatments in the last 12 months, with variations by sociodemographic characteristics and co-occurring conditions.

CONCLUSIONS

The estimated prevalence of US children with a parent-reported ASD diagnosis is now 1 in 40, with rates of ASD-specific treatment usage varying by children's sociodemographic and co-occurring conditions.

Mothers’ socialisation goals and evaluations of desirable and undesirable everyday situations in two diverse cultural groups

Long-term socialisation goals and evaluations of infant behaviour in a variety of everyday contexts were studied among 45 mothers who had immigrated from Central America to the United States, and 41 mothers from European American backgrounds. In accord with expectations based on broad cultural constructs, mothers from Central America emphasised long-term socialisation goals related to Proper Demeanour. In addition, when describing and evaluating everyday situations, they were likely to attribute the desirability or undesirability of these situations to the child's own appropriate and cooperative behaviour, and were likely to highlight mutual enjoyment when describing preferred play situations. In contrast, Euro-American mothers emphasised long-term socialisation goals related to Self-Maximisation, and when describing undesirable everyday situations, stressed the role of external factors not under the child's control, presumably to preserve the child's self-esteem. However, it was also found that the Central American mothers endorse selected aspects of individualism related to promoting their children's economic and personal potential in the United States. These findings point not only to the multidimensional nature of individualism, but also to the heterogeneity of beliefs among Latino populations. The importance of studying within-group variation with regard to the individualism/sociocentrism construct is highlighted.

Feeding Practices and Expectations among Middle-Class Anglo and Puerto Rican Mothers of 12-Month-Old Infants

Beliefs and practices regarding infant feeding were examined among middle-class Puerto Rican and Anglo mothers of 12-month-old infants. In particular, Anglo mothers in Connecticut and Puerto Rican mothers in San Juan were interviewed regarding their expectations for the attainment of selected feeding-related milestones and observed in an actual feeding situation with their infants. Results indicate that the two groups of mothers demonstrate coherent clusters of beliefs and practices with regard to infant feeding at 12 months. In particular, Anglo mothers reported earlier attainment of self-feeding milestones and a greater emphasis on child-rearing goals related to self-maximization, whereas Puerto Rican mothers reported later attainment of self-feeding and a greater emphasis on child-rearing goals related to proper demeanor. Findings are interpreted as providing evidence for the existence of coherent patterns of beliefs and behaviors within each group, with Puerto Rican mothers’ patterns differing from those more commonly found among Anglo, middle-class mothers.

Long-term socialisation goals and the construction of infants’ social networks among middle class Anglo and Puerto Rican mothers

This study examined the relation between mothers’ long-term socialisation goals and the social networks they construct for their infants. Middle class Anglo (n = 32) and Puerto Rican (n = 28) mothers were interviewed regarding: (a) their long-term socialisation goals; (b) how often their infants’ typically have contact with friends and family members; and (c) specific family circumstances which might influence contact with relatives, including geographic distance, maternal employment status, and child care arrangements. Study results indicated that mothers’ long-term socialisation goals were correlated with the type and frequency of social contacts they structured for their infants. Moreover, limited evidence was found for the influence of group membership on frequency of contact with relatives, despite individual variations in family circumstances. Results are interpreted as illuminating one aspect of the interface between cultural beliefs and socialisation practices within the constructs of individualism/sociocentrism.

Autism spectrum disorders and developmental disabilities in children from immigrant families in the United States

OBJECTIVES

Recent census data show that nearly one-quarter of US children have at least 1 immigrant parent; moreover, there has been a dramatic increase in children diagnosed with autism spectrum disorders (ASDs) and select developmental disabilities (DDs). However, little is known about access to medical home and adequacy of insurance coverage for children with ASDs and select DDs from immigrant families.

METHODS

By using the 2007 National Survey of Children's Health, we compared children with ASDs and select DDs from immigrant (n = 413, foreign born or reside with at least 1 immigrant parent) and nonimmigrant (n = 5411) families on various measures of medical home and insurance coverage. We used weighted logistic regression to examine the association between immigrant family and selected outcome measures while controlling for confounding factors.

RESULTS

Compared with nonimmigrant families, children with ASD and select DD from immigrant families were more than twice as likely to lack usual source of care and report physicians not spending enough time with family. Furthermore, multivariable analyses indicate that insurance coverage is an important factor in mitigating health care barriers for immigrant families.

CONCLUSIONS

The study demonstrates important areas of deficits in the health care experiences of children with ASD and select DD from immigrant households. Public policy implications include increasing access to existing insurance programs, augmenting public awareness resources for ASD and select DD, and offering assistance to immigrant families that are struggling with the medical needs of their children.

Socialization goals among first- and second-generation migrant Turkish and German mothers

The current study examines generational differences in Turkish mothers' socialization goals following migration to Germany. A total of 78 working-class mothers from three different groups (Turkish first- and second-generation, and German non-migrant) participated. Each mother had a child between 18 and 36 months of age. Mothers were interviewed using the Socialization Goals Interview. The results indicate that compared to both groups of Turkish mothers, German mothers placed more emphasis on self-control as a socialization goal, and compared with the first-generation mothers only, were more concerned that their child develop characteristics associated with psychological independence and self-confidence. Among the Turkish mothers, more highly educated mothers placed less emphasis on the importance of respect towards others than did less educated mothers.

Culture and class influences on Anglo and Puerto Rican mothers' beliefs regarding long-term socialization goals and child behavior

These 2 studies examine culture and socioeconomic status as simultaneous possible sources for group differences in mothers' beliefs regarding desirable and undesirable long-term socialization goals and child behavior. In Study 1, 100 mothers of young toddlers aged 12-24 months from 5 sociocultural groups participated: middle- and lower-class Anglo, middle- and lower-class island Puerto Rican, and lower-class migrant Puerto Rican. Results indicate that culture and socioeconomic status contribute independently to group differences, but that cultural effects appear to be stronger. Study 2 examined cultural differences in perceptions of behaviors using middle-class Anglo and Puerto Rican mothers only. The findings support those of Study 1, suggesting that Anglo and Puerto Rican mothers place differential value on the constructs of Self-Maximization and Proper Demeanor, even when socioeconomic status is controlled for. The findings of these studies have important implications for the culturally sensitive study of the relation between parental beliefs and behaviors.

Culture and child behavior and psychosocial development

This paper provides an overview of the relationship between cultural beliefs, values, practices, behavior, and psychosocial development. A framework for analyzing this relationship is presented, illustrated with studies from the cross-cultural literature. We then present a review of the literature concerning the cultural influences on one specific behavioral issue, temperament. We conclude with a critical discussion of the unique methodological issues encountered in the study of child behavior and psychosocial development in a cross-cultural and/or culturally diverse perspective.

The influence of culturally derived values on Anglo and Puerto Rican mothers' perceptions of attachment behavior

This 2-part investigation examined indigenous concepts of desirable and undesirable attachment behavior among middle- and lower-class Anglo and lower-class Puerto Rican mothers in order to formulate culturally sensitive criteria of normative attachment behavior. Study 1 elicited indigenous concepts of desirable and undesirable attachment behavior using open-ended probes. On the basis of mothers' responses in Study 1, culturally sensitive vignettes of desirable and undesirable attachment behavior were constructed, and culturally relevant descriptors of toddler characteristics were selected. In Study 2, mothers' perceptions of the hypothetical toddlers were compared using the selected descriptors. The findings indicate that, whereas the Anglo mothers focus more on characteristics associated with the presence or absence of individual autonomy, the Puerto Rican mothers place more emphasis on the child's ability to maintain proper demeanor in a public context. These findings were coherent across mothers': (a) open-ended conceptualizations, (b) desirability ratings, and (c) descriptor ratings of the toddlers.

Promoting competent young people in competence-enhancing environments: a systems-based perspective on primary prevention

Recent studies indicate that 15-22% of American children and adolescents suffer from diagnosable mental disorders. Researchers estimate that 25-50% engage in risk behaviors for negative health and behavior outcomes, such as drug abuse, unwanted pregnancy, AIDS, delinquency, and school dropout. The prevalence of problem behaviors, as well as current social trends, demands that effective primary prevention programs be developed and disseminated. This article reviews successful family-, school-, and community-based prevention efforts aimed at reducing the incidence and severity of children's psychosocial problems. High-quality, comprehensive, competence-promotion programs that focus on both children and their socializing environments represent the state of the art in prevention. Establishing enduring, effective preventive interventions requires increased attention to program design, implementation, and institutionalization.

Promoting competent young people in competence-enhancing environments: A systems-based perspective on primary prevention

Recent studies indicate that 15-22% of American children and adolescents suffer from diagnosable mental disorders. Researchers estimate that 25-50% engage in risk behaviors for negative health and behavior outcomes, such as drug abuse, unwanted pregnancy, AIDS, delinquency, and school dropout. The prevalence of problem behaviors, as well as current social trends, demands that effective primary prevention programs be developed and disseminated. This article reviews successful family-, school-, and community-based prevention efforts aimed at reducing the incidence and severity of children's psychosocial problems. High-quality, comprehensive, competence-promotion programs that focus on both children and their socializing environments represent the state of the art in prevention. Establishing enduring, effective preventive interventions requires increased attention to program design, implementation, and institutionalization.

Perceptions of social responsibilities in India and in the United States: moral imperatives or personal decisions?

Indian and American adults' and children's (N = 400) moral reasoning about hypothetical situations in which an agent failed to help someone experiencing either life-threatening, moderately serious, or minor need was compared. For 1/3 of Ss, the agent's relationship to the needy other was portrayed as that of parent; for another 1/3, as that of best friend; for the rest, as that of stranger. Indians tended to regard the failure to aid another in moral terms in all conditions. In contrast, Americans tended to view it in moral terms only in life-threatening cases or in cases of parents responding to the moderately serious needs of their children. The results imply that Indian culture forwards a broader and more stringent view of social responsibilities than does American culture. Discussion centers on theoretical implications of the various cultural, need, role, and developmental effects observed.

Perceptions of social responsibilities in India and in the United States: Moral imperatives or personal decisions?

Indian and American adults' and children's (N = 400) moral reasoning about hypothetical situations in which an agent failed to help someone experiencing either life-threatening, moderately serious, or minor need was compared. For 1/3 of Ss, the agent's relationship to the needy other was portrayed as that of parent; for another 1/3, as that of best friend; for the rest, as that of stranger. Indians tended to regard the failure to aid another in moral terms in all conditions. In contrast, Americans tended to view it in moral terms only in life-threatening cases or in cases of parents responding to the moderately serious needs of their children. The results imply that Indian culture forwards a broader and more stringent view of social responsibilities than does American culture. Discussion centers on theoretical implications of the various cultural, need, role, and developmental effects observed.