Building executive functioning to facilitate IADL skills for emerging adults with autism spectrum disorder: the EFFECT program

Autism Spectrum Disorder (ASD) is a complex neurologically based developmental disorder that can affect an individual’s thinking, feeling, language development and social interactions. The prevalence of ASD in the United States continues to rise and today is identified in approximately 1 in 68 children. The symptoms of ASD interfere with and limit everyday functioning (Centers for Disease Control, 2015), which results in the majority of individuals with ASD remaining dependent on caregivers in the areas of education, habitation, and recreation (Billstedt, Gillberg, and Gillberg, 2005 & 2011). There is growing evidence that executive dysfunction may contribute to the social, cognitive and functional deficits observed in individuals with ASD; however, there is a significant lack of evidence based interventions that address executive functioning skills for emerging adults with ASD. The EFFECT program was developed to address this identified need. It is an 8-week comprehensive program based on research, that facilitates activities of daily living and instrumental activities of daily living by addressing underlying executive functioning skills. A thorough literature review, methods for program implementation, funding, dissemination and program evaluation are described.2018-03-03T00:00:00

Transitioning from Individualized Pediatric Dental Care of Children with Autism Spectrum Disorder at the Mailman Segal Dental Clinic to Traditional Dental Settings

Background: Children with special healthcare needs (SHCN) such as Autism Spectrum Disorder (ASD) usually develop strong bonds with their pediatric dental care provider. However, as they mature, transitioning to other services or providers is necessary. Low rates of successful transition of children with SHCN have gained national attention especially since their lifelong conditions require continuous care. It is important to facilitate a smooth transition among providers; dental care providers specifically. These transitions are imperative to prevent these children from losing access to dental care as they mature. This pilot study seeks to describe the proportion of children with ASD seen at the Mailman Segal Center for Human Development Dental Clinic (MSD) that were required to transition to other dental providers and determine characteristics that influenced the decision to remain at Nova Southeastern University (NSU) dental clinics. Objective: Although children with Autism Spectrum Disorder (ASD) develop strong bonds with their pediatric dental provider, as they age, a transition to other providers is necessary. Low rates of successful transition, coupled with the need for long-term care, highlight the importance of understanding the transition process. The objective of this study is to examine characteristics associated with the retention of patients at NSU dental clinics. Methods: A retrospective chart review of patients with an ASD diagnosis was conducted. Data such as demographics, insurance status, and household income were collected. A logistic regression analysis was conducted to examine patient factors associated with the transition to an NSU clinic. Results: Data were collected for 101 children (89.1% male & 10.9% female) required to transition between 2015-2019; Medicaid was the most frequently reported insurance type (68%). In terms of transitions, 42% of patients transitioned to an NSU clinic, 5.9% sought care privately, 19% are still active patients, and the remaining 33% were lost to follow up. Regression analysis indicated that insurance type was significantly associated with transition to NSU. Children with Medicaid were seven times more likely to transition to an NSU clinic than to seek private care (OR= 7.156; [CI: 2.931, 17.472]; p=0.000). Conclusion: Results demonstrate that insurance may play a major role in a family’s decision to seek care at a facility. Since many studies have shown that Medicaid acceptance is low among private dental care providers, these findings suggest that this may be a major barrier to finding facilities to transition children with ASD

Autism genetic database (AGD): a comprehensive database including autism susceptibility gene-CNVs integrated with known noncoding RNAs and fragile sites

<p>Abstract</p> <p>Background</p> <p>Autism is a highly heritable complex neurodevelopmental disorder, therefore identifying its genetic basis has been challenging. To date, numerous susceptibility genes and chromosomal abnormalities have been reported in association with autism, but most discoveries either fail to be replicated or account for a small effect. Thus, in most cases the underlying causative genetic mechanisms are not fully understood. In the present work, the Autism Genetic Database (AGD) was developed as a literature-driven, web-based, and easy to access database designed with the aim of creating a comprehensive repository for all the currently reported genes and genomic copy number variations (CNVs) associated with autism in order to further facilitate the assessment of these autism susceptibility genetic factors.</p> <p>Description</p> <p>AGD is a relational database that organizes data resulting from exhaustive literature searches for reported susceptibility genes and CNVs associated with autism. Furthermore, genomic information about human fragile sites and noncoding RNAs was also downloaded and parsed from miRBase, snoRNA-LBME-db, piRNABank, and the MIT/ICBP siRNA database. A web client genome browser enables viewing of the features while a web client query tool provides access to more specific information for the features. When applicable, links to external databases including GenBank, PubMed, miRBase, snoRNA-LBME-db, piRNABank, and the MIT siRNA database are provided.</p> <p>Conclusion</p> <p>AGD comprises a comprehensive list of susceptibility genes and copy number variations reported to-date in association with autism, as well as all known human noncoding RNA genes and fragile sites. Such a unique and inclusive autism genetic database will facilitate the evaluation of autism susceptibility factors in relation to known human noncoding RNAs and fragile sites, impacting on human diseases. As a result, this new autism database offers a valuable tool for the research community to evaluate genetic findings for this complex multifactorial disorder in an integrated format. AGD provides a genome browser and a web based query client for conveniently selecting features of interest. Access to AGD is freely available at <url>http://wren.bcf.ku.edu/</url>.</p

AsdKB: A Chinese Knowledge Base for the Early Screening and Diagnosis of Autism Spectrum Disorder

To easily obtain the knowledge about autism spectrum disorder and help its early screening and diagnosis, we create AsdKB, a Chinese knowledge base on autism spectrum disorder. The knowledge base is built on top of various sources, including 1) the disease knowledge from SNOMED CT and ICD-10 clinical descriptions on mental and behavioural disorders, 2) the diagnostic knowledge from DSM-5 and different screening tools recommended by social organizations and medical institutes, and 3) the expert knowledge on professional physicians and hospitals from the Web. AsdKB contains both ontological and factual knowledge, and is accessible as Linked Data at https://w3id.org/asdkb/. The potential applications of AsdKB are question answering, auxiliary diagnosis, and expert recommendation, and we illustrate them with a prototype which can be accessed at http://asdkb.org.cn/.Comment: 17 pages, Accepted by the Resource Track of ISWC 202

Computer decision support changes physician practice but not knowledge regarding autism spectrum disorders

Objective: To examine whether adding an autism module promoting adherence to clinical guidelines to an existing computer decision support system (CDSS) changed physician knowledge and self-reported clinical practice. Methods: The CHICA (Child Health Improvement through Computer Automation) system, a CDSS, was enhanced with a module to improve management of autism in 2 of the 4 community pediatric clinics using the system. We examined the knowledge and beliefs of pediatric users using cross-sectional surveys administered at 3 time points (baseline, 12 months and 24 months post-implementation) between November 2010 and January 2013. Surveys measured knowledge, beliefs and self-reported practice patterns related to autism. Results: A total of 45, 39, and 42 pediatricians responded at each time point, respectively, a 95-100% response rate. Respondents’ knowledge of autism and perception of role for diagnosis did not vary between control and intervention groups either at baseline or any of the two post-intervention time points. At baseline, there was no difference between these groups in rates in the routine use of parent-rated screening instruments for autism. However, by 12 and 24 months post-implementation there was a significant difference between intervention and control clinics in terms of the intervention clinics consistently screening eligible patients with a validated autism tool. Physicians at all clinics reported ongoing challenges to community resources for further work-up and treatment related to autism. Conclusions: A CDSS module to improve primary care management of ASD in pediatric practice led to significant improvements in physician-reported use of validated screening tools to screen for ASDs. However it did not lead to corresponding changes in physician knowledge or attitudes

Characteristics Associated with Successful Dental Treatment in Children with Autism Spectrum Disorder

Background. ASD is a neurodevelopmental disability, responsible for social, communicative and behavioral deficits. The prevalence of children diagnosed with ASD in the United States has more than doubled in the past two decades, from 1 in 150 to 1 in 68. Children diagnosed with ASD have a very high occurrence of certain comorbidities, such as developmental delay, intellectual disability and speech delay. Unmet dental needs remain high among children with special health care needs (SHCN), with 78% reporting the need for dental care within the last 12 months. Recent studies have focused on barriers to care for these patients; the child’s behavior has been identified as a major barrier to dental care. Objective. This study was conducted to examine and provide an overview of characteristics of children with Autism Spectrum Disorder (ASD) undergoing dental care, specifically, an exploration of associations between patient demographic and health characteristics on the outcome of completing a cleaning. Methods. A retrospective chart review explored ASD patient demographics (including, but not limited to, ASD diagnosis, a variety of active therapies, comorbidities listed above, behavior and level of communication) and related them to successful dental treatments. Comparisons were made using t-test, bivariate and multivariate analyses. Results. Patients reporting non-verbal communication took more visits to complete the tasks (3.26 versus 2.64, P=0.028). Hispanic ethnicity [OR 0.073; (95% CI 0.017, 0.315); P=0.000] and parental lack of knowledge related to patient cooperation [OR 0.078; (95% CI 0.018, 0.344); P=0.001] were significantly associated with lower odds of completing the tasks. Conclusion. Educating dentists about key patient characteristics, including verbal/non-verbal communicative abilities, ongoing patient therapies, and cultural upbringings can potentially improve access to oral health care for children with ASD

Pearl Harvesting Autism

This thesis addresses the difficulties of on-line information searching as it relates to the topic of autism. A review of existing search strategies is presented and their limitations are discussed. A new method for deriving a set of search-terms for comprehensive searching, Pearl Harvesting, was tested here to determine the necessary search terms (i.e., synonym ring) for ERIC and PsycINFO databases. Once discovered and validated, a synonym ring can be copied and pasted directly into the search box of the database, providing a simple, thorough and time saving way of conducting on-line research in the field. This easily used method is applicable for use by professionals across disciplines. Specific characteristics of the ERIC and PsycINFO databases are discussed and conclusions are presented in relation to Pearl Harvesting

Lag Time between Parental First Concerns about Development and Entry into Early Intervention: Impact of Child/Family Factors, First Concerns, and Symptom Presentation

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that impacts an individual’s ability to relate to and communicate with others. Although children often do not receive a diagnosis until age 4-5 years (Centers for Disease Control and Prevention, 2014), parents typically recognize developmental problems by age 2 years (Chawarska et al., 2007), and often in the first year of life (Kishore & Basu, 2011). However, these early concerns do not always translate into appropriate or timely steps to access care. Few studies have examined factors relating to the time lag that exists between early concerns and action. Because early intervention for ASD is critical for best outcomes, it is important to understand factors that can delay access to treatment. The current study included 4,215 toddlers between the ages of 16-37 months who were evaluated for an IDEA, Part C early intervention program in Louisiana. It closely examined child and family factors (i.e., the age of the child when parents first note concerns, gender, ethnicity, birth order, presence of a family member with ASD), the nature of early parental concerns, and symptom presentation to determine how these factors impact the time lag between parental first concern and entry into an early intervention program. Ethnicity was found to be a significant predictor of lag time such that minority families experienced a longer lag. The disparity was present across all functioning levels, although the difference was most pronounced for toddlers with functional impairments. Longer lags when parents reported general rather than specific concerns about their child’s development were also noted. Additional findings, their implications, and future directions for research relating to lag time were discussed

Peer Inclusion in Interventions for Children with ADHD: A Systematic Review and Meta-Analysis

Objective. To assess the effectiveness of peer inclusion in interventions to improve the social functioning of children with ADHD. Methods. We searched four electronic databases for randomized controlled trials and controlled quasi-experimental studies that investigated peer inclusion interventions alone or combined with pharmacological treatment. Data were collected from the included studies and methodologically assessed. Meta-analyses were conducted using a random-effects model. Results. Seventeen studies met eligibility criteria. Studies investigated interventions consisting of peer involvement and peer proximity; no study included peer mediation. Most included studies had an unclear or high risk of bias regarding inadequate reporting of randomization, blinding, and control for confounders. Meta-analyses indicated improvements in pre-post measures of social functioning for participants in peer-inclusive treatment groups. Peer inclusion was advantageous compared to treatment as usual. The benefits of peer inclusion over other therapies or medication only could not be determined. Using parents as raters for outcome measurement significantly mediated the intervention effect. Conclusions. The evidence to support or contest the efficacy of peer inclusion interventions for children with ADHD is lacking. Future studies need to reduce risks of bias, use appropriate sample sizes, and provide detailed results to investigate the efficacy of peer inclusion interventions for children with ADHD