Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 4 Years - Early Autism and Developmental Disabilities Monitoring Network, Seven Sites, United States, 2010, 2012, and 2014

Problem/Condition: Autism spectrum disorder (ASD) is estimated to affect up to 3% of children in the United States. Public health surveillance for ASD among children aged 4 years provides information about trends in prevalence, characteristics of children with ASD, and progress made toward decreasing the age of identification of ASD so that evidence-based interventions can begin as early as possible. Period Covered: 2010, 2012, and 2014. Description of System: The Early Autism and Developmental Disabilities Monitoring (Early ADDM) Network is an active surveillance system that provides biennial estimates of the prevalence and characteristics of ASD among children aged 4 years whose parents or guardians lived within designated sites. During surveillance years 2010, 2012, or 2014, data were collected in seven sites: Arizona, Colorado, Missouri, New Jersey, North Carolina, Utah, and Wisconsin. The Early ADDM Network is a subset of the broader ADDM Network (which included 13 total sites over the same period) that has been conducting ASD surveillance among children aged 8 years since 2000. Each Early ADDM site covers a smaller geographic area than the broader ADDM Network. Early ADDM ASD surveillance is conducted in two phases using the same methods and project staff members as the ADDM Network. The first phase consists of reviewing and abstracting data from children's records, including comprehensive evaluations performed by community professionals. Sources for these evaluations include general pediatric health clinics and specialized programs for children with developmental disabilities. In addition, special education records (for children aged >= 3 years) were reviewed for Arizona, Colorado, New Jersey, North Carolina, and Utah, and early intervention records (for children aged 0 to = 60% data on cognitive test scores (Arizona, New Jersey, North Carolina, and Utah), the frequency of co-occurring intellectual disabilities was significantly higher among children aged 4 years than among those aged 8 years for each site in each surveillance year except Arizona in 2010. The percentage of children with ASD who had a first evaluation by age 36 months ranged from 48.8% in Missouri in 2012 to 88.9% in Wisconsin in 2014. The percentage of children with a previous ASD diagnosis from a community provider varied by site, ranging from 43.0% for Arizona in 2012 to 86.5% for Missouri in 2012. The median age at earliest known ASD diagnosis varied from 28 months in North Carolina in 2014 to 39.0 months in Missouri and Wisconsin in 2012. In 2014, the ASD prevalence based on the DSM-IV-TR case definition was 20% higher than the prevalence based on the DSM-5 (17.0 versus 14.1 per 1,000, respectively). Trends in ASD prevalence and characteristics among children aged 4 years during the study period were assessed for the three sites with data for all 3 years and consistent data sources (Arizona, Missouri, and New Jersey) using the DSM-IV-TR case definition; prevalence was higher in 2014 than in 2010 among children aged 4 years in New Jersey and was stable in Arizona and Missouri. In Missouri, ASD prevalence was higher among children aged 8 years than among children aged 4 years. The percentage of children with ASD who had a comprehensive evaluation by age 36 months was stable in Arizona and Missouri and decreased in New Jersey. In the three sites, no change occurred in the age at earliest known ASD diagnosis during 2010-2014. Interpretation: The findings suggest that ASD prevalence among children aged 4 years was higher in 2014 than in 2010 in one site and remained stable in others. Among children with ASD, the frequency of cognitive impairment was higher among children aged 4 years than among those aged 8 years and suggests that surveillance at age 4 years might more often include children with more severe symptoms or those with co-occurring conditions such as intellectual disability. In the sites with data for all years and consistent data sources, no change in the age at earliest known ASD diagnosis was found, and children received their first developmental evaluation at the same or a later age in 2014 compared with 2010. Delays in the initiation of a first developmental evaluation might adversely affect children by delaying access to treatment and special services that can improve outcomes for children with ASD. Public Health Action: Efforts to increase awareness of ASD and improve the identification of ASD by community providers can facilitate early diagnosis of children with ASD. Heterogeneity of results across sites suggests that community-level differences in evaluation and diagnostic services as well as access to data sources might affect estimates of ASD prevalence and age of identification. Continuing improvements in providing developmental evaluations to children as soon as developmental concerns are identified might result in earlier ASD diagnoses and earlier receipt of services, which might improve developmental outcomes.This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Economic impacts of the COVID-19 pandemic on families of children with autism and other developmental disabilities

BackgroundTo control the spread of the coronavirus disease (COVID-19), many jurisdictions throughout the world enacted public health measures that had vast socio-economic implications. In emergency situations, families of children with developmental disabilities (DDs), including autism, may experience increased difficulty accessing therapies, economic hardship, and caregiver stress, with the potential to exacerbate autism symptoms. Yet, limited research exists on the economic impacts of the COVID-19 pandemic on families of children with autism or another DD compared to families of children from the general population.ObjectivesTo assess impact of the COVID-19 pandemic related to parental employment and economic difficulties in families of children with autism, another DD, and in the general population, considering potential modification by socioeconomic disadvantage before the pandemic and levels of child behavioral and emotional problems.MethodsThe Study to Explore Early Development (SEED) is a multi-site, multi-phase, case-control study of young children with autism or another DD as compared to a population comparison group (POP). During January-July 2021, a COVID-19 Impact Assessment Questionnaire was sent to eligible participants (n=1,789) who had enrolled in SEED Phase 3 from September 2017-March 2020. Parents completed a questionnaire on impacts of the pandemic in 2020 and completed the Child Behavior Checklist (CBCL) to measure behavioral and emotional health of their child during this time. Multiple logistic regression models were built for employment reduction, increased remote work, difficulty paying bills, or fear of losing their home. Covariates include group status (autism, DD, POP), household income at enrollment, child’s race and ethnicity, and binary CBCL Total Problems T-score (<60 vs. ≥60). Unadjusted and adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated.ResultsThe study included 274 children with autism, 368 children with another DD, and 385 POP children. The mean age of 6.1 years (standard deviation, 0.8) at the COVID-19 Impact Assessment did not differ between study groups. Parents of children with autism were less likely to transition to remote work (aOR [95% CI] = 0.6 [0.4, 1.0]) and more likely to report difficulty paying bills during the pandemic (1.8 [1.2, 2.9]) relative to parents of POP children. Lower income was associated with greater employment reduction, difficulty paying bills, and fear of losing their home, but inversely associated with transitioning to remote work. Parents of non-Hispanic (NH) Black children experienced greater employment reduction compared to parents of NH White children (1.9 [1.1, 3.0]). Parents from racial and ethnic minority groups were more likely to experience difficulty paying bills and fear losing their home, relative to NH White parents. Caregivers of children with CBCL scores in the clinical range were more likely to fear losing their home (2.1 [1.3, 3.4]).ConclusionThese findings suggest that families of children with autism, families of lower socio-economic status, and families of racial and ethnic minority groups experienced fewer work flexibilities and greater financial distress during the pandemic. Future research can be used to assess if these impacts are sustained over time

Parental investment in the Eastern Bluebird, Sialia sialis.

http://deepblue.lib.umich.edu/bitstream/2027.42/54122/1/2557.pdfDescription of 2557.pdf : Access restricted to on-site users at the U-M Biological Station

Social, ecological, and endocrine influences on female relationships in blue monkeys (Cercopithecus mitis stuhlmanni)

In this dissertation I provide some of the most detailed data available for any species of African forest guenon, the blue monkey (Cercopithecus mitis stuhlmanni). Focal observations were conducted on 32 adult females from two social groups in the Kakamega Forest, western Kenya. Fecal samples were also obtained to provide a non-invasive measure of reproductive physiology through an evaluation of their ovarian hormone content. Intragroup contest competition was found to play a remarkably small role in structuring female relationships. Agonism rates were extremely low, and although it was possible to detect near-linear dominance hierarchies, rank had little influence on resource acquisition. Data from this study tentatively suggest that blue monkeys avoid contest competition by using alternative mechanisms to partition limiting resources. Female were also found to spend an extremely small proportion of their time with the resident male of their group. This pattern sharply contrasts that which has been documented for baboons and macaques in which females form strong heterosexual relationships. In the absence of clear interspecific differences in the ecological costs and benefits of associating with males, it is suggested that the one-male structure of blue monkey groups precludes the possibility for males to provide females with protection from harassment and infanticide committed by non-affiliated males. Fecal samples reliably indicated when females were cycling and could be used to narrow the window of potential conception dates. The hormone profiles obtained tentatively suggest that females most often conceive on their first ovulation following periods of amenorrhea, although a rise in estrogen prior to this time appears to promote an early onset of sexual behavior. Consistent with the paternity confusion hypothesis, females often mated when conception was unlikely or impossible. However, this tendency was not necessarily strengthened by the presence of unfamiliar males. Potentially, females have evolved hormonal mechanisms to promote non-conceptive sexual behavior which cannot be facultatively expressed. Alternative hypotheses are also discussed to explain the consistency of female mating patterns in the presence and absence of unfamiliar males

Social, ecological, and endocrine influences on female relationships in blue monkeys (Cercopithecus mitis stuhlmanni)

In this dissertation I provide some of the most detailed data available for any species of African forest guenon, the blue monkey (Cercopithecus mitis stuhlmanni). Focal observations were conducted on 32 adult females from two social groups in the Kakamega Forest, western Kenya. Fecal samples were also obtained to provide a non-invasive measure of reproductive physiology through an evaluation of their ovarian hormone content. Intragroup contest competition was found to play a remarkably small role in structuring female relationships. Agonism rates were extremely low, and although it was possible to detect near-linear dominance hierarchies, rank had little influence on resource acquisition. Data from this study tentatively suggest that blue monkeys avoid contest competition by using alternative mechanisms to partition limiting resources. Female were also found to spend an extremely small proportion of their time with the resident male of their group. This pattern sharply contrasts that which has been documented for baboons and macaques in which females form strong heterosexual relationships. In the absence of clear interspecific differences in the ecological costs and benefits of associating with males, it is suggested that the one-male structure of blue monkey groups precludes the possibility for males to provide females with protection from harassment and infanticide committed by non-affiliated males. Fecal samples reliably indicated when females were cycling and could be used to narrow the window of potential conception dates. The hormone profiles obtained tentatively suggest that females most often conceive on their first ovulation following periods of amenorrhea, although a rise in estrogen prior to this time appears to promote an early onset of sexual behavior. Consistent with the paternity confusion hypothesis, females often mated when conception was unlikely or impossible. However, this tendency was not necessarily strengthened by the presence of unfamiliar males. Potentially, females have evolved hormonal mechanisms to promote non-conceptive sexual behavior which cannot be facultatively expressed. Alternative hypotheses are also discussed to explain the consistency of female mating patterns in the presence and absence of unfamiliar males

Update: Providing Quality Family Planning Services - Recommendations From CDC and the U.S. Office of Population Affairs, 2017

In April 2014, CDC published Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs (QFP), which describes the scope of services that should be offered in a family planning visit and how to provide those services (e.g., periodicity of screening, which persons are in need of services, etc.) (1). The sections in QFP include the following: Determining the Client\u27s Need for Services; Contraceptive Services; Pregnancy Testing and Counseling; Clients Who Want to Become Pregnant; Basic Infertility Services; Preconception Health Services; Sexually Transmitted Disease Services; and Related Preventive Health Services. In addition, the QFP includes an appendix entitled Screening Services for Which Evidence Does Not Support Screening

Impact of Contraceptive Education on Knowledge and Decision Making: An Updated Systematic Review.

CONTEXT: Educational interventions can help individuals increase their knowledge of available contraceptive methods, enabling them to make informed decisions and use contraception correctly. This review updates a previous review of contraceptive education. EVIDENCE ACQUISITION: Multiple databases were searched for articles published March 2011-November 2016. Primary outcomes were knowledge, participation in and satisfaction/comfort with decision making, attitudes toward contraception, and selection of more effective methods. Secondary outcomes included contraceptive behaviors and pregnancy. Excluded articles described interventions that had no comparison group, could not be conducted feasibly in a clinic setting, or were conducted outside the U.S. or similar country. EVIDENCE SYNTHESIS: A total of 24,953 articles were identified. Combined with the original review, 37 articles met inclusion criteria and described 31 studies implementing a range of educational approaches (interactive tools, written materials, audio/videotapes, and text messages), with and without healthcare provider feedback, for a total of 36 independent interventions. Of the 31 interventions for which knowledge was assessed, 28 had a positive effect. Fewer were assessed for their effect on attitudes toward contraception, selection of more effective methods, contraceptive behaviors, or pregnancy-although increased knowledge was found to mediate additional outcomes (positive attitudes toward contraception and contraceptive continuation). CONCLUSIONS: This systematic review is consistent with evidence from the broader healthcare field in suggesting that a range of interventions can increase knowledge. Future studies should assess what aspects are most effective, the benefits of including provider feedback, and the extent to which educational interventions can facilitate behavior change and attainment of reproductive health goals. THEME INFORMATION: This article is part of a theme issue entitled Updating the Systematic Reviews Used to Develop the U.S. Recommendations for Providing Quality Family Planning Services, which is sponsored by the Office of Population Affairs, U.S. Department of Health and Human Services