Characterizing Anxiety and Physiological Correlates in Preschool Children with Neurodevelopmental Disabilities

This dissertation is comprised of two original research manuscripts broadly examining anxiety and potential correlates in young children with neurodevelopmental disabilities. The first manuscript assessed cardiac regulation during an auditory startle paradigm in young children (3-6 years old) with autism spectrum disorder (ASD), fragile x syndrome (FXS), and neurotypical peers. The second manuscript utilized a new measure developed to capture anxiety in individuals with ASD in order to assess the rate of typical and atypical anxiety and potential risk factors (ASD severity, sex, cognitive ability) for anxiety in preschool children with ASD contrasted to neurotypical preschool children. Collectively, these two manuscripts address the limited understanding and many challenges of measuring anxiety disorders in young children with developmental disabilities and what individual characteristics may serve as risk or protective factors for these children. Additionally, the comparison of children with ASD to children with FXS in the first study can inform both shared risk and divergent features of each disorder. Overall, these studies provide insight into the complex presentation of anxiety in young children with comorbid developmental disorders. Further, this work can inform the early identification of risk factors to develop more targeted interventions in early life to improve long-term outcomes in children with neurodevelopmental disabilities

Impact of Adverse Childhood Events on the Psychosocial Functioning of Children Affected by Parental HIV in Rural China

Introduction: Children affected by parental HIV are more likely than unaffected peers to experience trauma and are at-risk for negative psychological and social outcomes. This study aimed to examine the relationship between adverse childhood events and psychosocial functioning among children affected by parental HIV. Methods: A total of 790 children ages 6–17 from Henan, China were enrolled in a longitudinal, randomized controlled trial of a resilience-based psychosocial intervention. At baseline, children reported on numerous psychosocial factors, including trauma exposure, symptoms of anxiety and depression, and peer social functioning. We used linear regression analysis to test the direct effect of trauma exposure on peer social functioning. We then tested whether depression and anxiety symptoms served as two potential parallel mediators in the association between trauma exposure and peer social functioning. Results: Trauma exposure was significantly associated with poor peer social functioning (β = −0.10, p = 0.005) when controlling for key covariates. When depression and anxiety symptoms were added to the model, the association between trauma exposure and peer social functioning became nonsignificant. Instead, there were significant indirect effects from trauma exposure to peer social functioning via depression (β = −0.06, 95%CI[−0.09, −0.03]) and anxiety (β = −0.02, 95%CI[−0.04, −0.00]). Conclusion: This study is among the first to link trauma exposure to peer social functioning deficits for children affected by parental HIV and demonstrates that symptoms of anxiety and depression mediate this relationship. Findings underscore the need for comprehensive psychosocial support for children affected by HIV, including screening for trauma exposure and mental health disorders

Integrating a Simple Traffic Incident Model for Rapid Evacuation Analysis

Road transportation networks are a segment of society\u27s critical infrastructure particularly susceptible to service disruptions. Traffic incidents disrupt road networks by producing blockages and increasing travel times, creating significant impacts during emergency events such as evacuations. For this reason, it is extremely important to incorporate traffic incidents in evacuation planning models. Emergency managers and decision makers need tools that enable rapid assessment of multiple, varied scenarios. Many evacuation simulations require high-fidelity data input making them impractical for rapid deployment by practitioners. Since there is such variation in evacuation types and the method of disruption, evacuation models do not require the high-fidelity data needed by other types of transportation models. This paper\u27s purpose is to show that decision makers can gain useful information from rapid evacuation modeling which includes a simple traffic incident model. To achieve this purpose, the research team integrated a generic incident model into the Real-time Evacuation Planning Model (RtePM), a tool commissioned by the U.S. Department of Homeland Security to help emergency planners determine regional evacuation clearance times in the United States. RtePM is a simple, web-based tool that enables emergency planners to consider multiple evacuation plans at no additional cost to the user. Using this tool, we analyzed a simple scenario of the United States\u27 National Capital Region (NCR) to determine the impact of traffic incidents when different destination routes are blocked. The results indicate significant variations in evacuation duration when blockages are considered

Prevalence And Predictors Of Anxiety Disorders In Adolescent And Adult Males With Autism Spectrum Disorder And Fragile X Syndrome

disorders are the most prevalent disorders in children and adolescents, affecting approximately 15-20% of individuals under the age of 18 (Salum et al, 2013). Clinical subgroups, like autism spectrum disorder (ASD) and fragile X syndrome (FXS), have an elevated risk of a co-occurring anxiety disorder. Despite the elevated risk of anxiety in these groups, few research studies have investigated the rates and predictors of anxiety disorders in adolescents with these ASD and FXS. In the current study, participants included males with FXS (n=31) or ASD (n=20) aged 16 to 24. Measures included the Children’s Interview for Psychiatric Symptoms-Parent Version (P-ChIPS), the Autism Diagnostic Observation Schedule-2 (ADOS-2), and the Leiter International Performance Scale-Revised (Leiter-R). Descriptive statistics indicated that 48% of the FXS adolescents met criteria for an anxiety disorder compared with 50% in ASD. Additionally, 13% of the FXS and 30% of the ASD sample met for multiple anxiety disorders. Across the FXS and ASD groups 35% versus 15% met for Specific Phobia, 12% versus 30% met for Social Phobia and 33% versus 40% met for GAD, respectively. T-tests showed no significant differences within and across groups for those meeting criteria for an anxiety disorder verses those not meeting criteria for age, NVIQ growth scores, and ASD severity. Results of the binary logistic regression did not show age, NVIQ growth scores, or ASD severity as significant predictors of any anxiety disorder across FXS and ASD. Lastly, approximately 40% of participants with FXS who met criteria for an anxiety disorder were prescribed medications for anxiety, as compared iv to 20% of the participants with ASD who met criteria for an anxiety disorder. Logistic regression results showed that taking anxiety medications were not significantly predictive of meeting criteria for an anxiety diagnosis however anxiety medication use was predictive of group diagnosis. Our primary finding is that approximately half of the FXS and ASD sample met for an anxiety disorder based on DSM-V criteria. Further, This study is the first that directly compares rates of anxiety disorders across adolescents and adults with FXS and idiopathic ASD within a small range of ages, intellectual ability, and autism severity. Reduced rates of anxiety disorders may be indicative of adolescent or young adult males with lower intellectual functioning who have FXS or ASD

Prevalence and Predictors of Anxiety Disorders in Adolescent and Adult Males with Autism Spectrum Disorder and Fragile X Syndrome

Anxiety disorders affect ~ 15-20% of youths without neurodevelopmental disorders, with persons having autism spectrum disorder (ASD) and fragile X syndrome (FXS) at elevated risk for anxiety disorders. Few studies have compared rates and predictors of anxiety disorders in adolescents with FXS or ASD. This study directly compares rates, predictors, and medication of anxiety disorders between age-matched, male adolescents with FXS (n = 31) or ASD (n = 20). Results indicate that 51.6% of FXS and 50.0% of ASD adolescents met criteria for an anxiety disorder. Cognitive scores and ASD severity did not predict anxiety. Of those with anxiety, ~ 40% of the FXS and 20% of the ASD participants were prescribed medications for anxiety

Biobehavioral composite of social aspects of anxiety in young adults with fragile X syndrome contrasted to autism spectrum disorder.

Social anxiety is a common disorder that has negative impacts across multiple domains of function. Several clinical groups are at elevated risk for social anxiety, including those with fragile X syndrome and those with autism spectrum disorder. Measuring social anxiety in these clinical subgroups is fraught with challenge, however, given the complexity of social anxiety and measurement limitations that are particularly acute in persons with neurodevelopmental disorders. The over-arching aim of this study was to contribute to our understanding of the nature of social anxiety in fragile X syndrome and its association with autism spectrum disorder. To address this aim, we created a multi-faceted composite representing behavioral and biological aspects of social anxiety and examined differences in two adolescent and young adult-aged groups: 59 males with fragile X syndrome and 18 males with autism spectrum disorder. Results indicated a lower score on the multivariate composite for the males with fragile X syndrome relative to autism spectrum disorder but with evidence that traits of autism and social anxiety overlap. We conclude that measuring anxiety and autism traits in fragile X syndrome and autism spectrum disorder is complex with features that overlap and interact in a dynamic manner

Bones

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Toward a Theory of the Underpinnings and Vulnerabilities of Structural Racism: Looking Upstream from Disease Inequities among People Who Use Drugs

Structural racism is increasingly recognized as a key driver of health inequities and other adverse outcomes. This paper focuses on structural racism as an “upstream” institutionalized process, how it creates health inequities and how structural racism persists in spite of generations of efforts to end it. So far, “downstream” efforts to reduce these health inequities have had little success in eliminating them. Here, we attempt to increase public health awareness of structural racism and its institutionalization and sociopolitical supports so that research and action can address them. This paper presents both a theoretic and an analytic approach to how structural racism contributes to disproportionate rates of HIV/AIDS and related diseases among oppressed populations. We first discuss differences in disease and health outcomes among people who use drugs (PWUD) and other groups at risk for HIV from different racial and ethnic populations. The paper then briefly analyzes the history of racism; how racial oppression, class, gender and other intersectional divisions interact to create health inequities; and how structural racism is institutionalized in ways that contribute to disease disparities among people who use drugs and other people. It examines the processes, institutions and other structures that reinforce structural racism, and how these, combined with processes that normalize racism, serve as barriers to efforts to counter and dismantle the structural racism that Black, indigenous and Latinx people have confronted for centuries. Finally, we discuss the implications of this analysis for public health research and action to undo racism and to enhance the health of populations who have suffered lifetimes of racial/ethnic oppression, with a focus on HIV/AIDS outcomes