Identifying Predictors of Diagnostic Instability of Autism Spectrum Disorder and Global Developmental Delay In Toddlers

Although Autism Spectrum Disorder (ASD) is considered to be a lifelong condition, some toddlers experience diagnostic instability over time. In particular, some toddlers’ diagnosis changes between ASD and Global Developmental Delay (GDD). However, little is known about the subset of children who change diagnosis. In a total of 424 toddlers who either maintained or changed diagnosis, the current study identified predictors of change in diagnosis and severity in those who change from ASD to non-ASD (ASD-NON), ASD to GDD (ASD-GDD), non-ASD to ASD (NON-ASD), and GDD to ASD (GDD-ASD) between two years old and four years old. Initial ASD symptom severity and participation in intervention services were predictive of all transitions. Additionally, receptive language predicted ASD-NON transition and socioeconomic status predicted ASD-GDD transition. Implications for informing prognosis of children, identifying targets of intervention, refining of screening and diagnostic measures, and measuring change in severity regardless of categorical change are discussed

Interrogating Systems That Cause Disparities: Testing the Social-Ecological Model in Low- Versus High-Density African American Communities

This study utilized the four-level social-ecological model to provide a better understanding of the disparities in health-related outcomes in high- and low-density African American (AA) communities. The current research sought to understand the relationships between mental and physical health, social-economic factors, and physical environment within this community. The goal of this study was to understand the relationship between these indicators of health, to better inform health-care strategies. The results highlight the significant difference between high- and low-density AA communities and socio-economic factors, physical environment, poor physical days, and poor mental health days. Implications for behavioral health providers are explored

Antiracism Internship: Applying the Ecological Social Justice School Counseling Theory

This manuscript describes an empirically designed internship course that utilized the Ecological Social Justice School Counseling theory to teach internship students how to engage in antiracist practice to address social determinants of health in schools. The research reports on the eight school counseling internship students\u27 experiences, through five themes and 12 subthemes, highlighting the ways they increased awareness of SDOH, antiracist practice, and related constructs at their schools and with students including their action toward addressing SDOH, advocacy, barriers, and growth. Implications for counselor educators and site supervisors conclude

Effectiveness of Early Antiretroviral Therapy Initiation to Improve Survival among HIV-Infected Adults with Tuberculosis: A Retrospective Cohort Study

Molly Franke, Megan Murray, and colleagues report that early cART reduces mortality among HIV-infected adults with tuberculosis and improves retention in care, regardless of CD4 count

Self-renewing resident arterial macrophages arise from embryonic CX3CR1+ precursors and circulating monocytes immediately after birth

Resident macrophages densely populate the normal arterial wall, yet their origins and the mechanisms that sustain them are poorly understood. Here we use gene-expression profiling to show that arterial macrophages constitute a distinct population among macrophages. Using multiple fate-mapping approaches, we show that arterial macrophages arise embryonically from CX3CR1+ precursors and postnatally from bone marrow–derived monocytes that colonize the tissue immediately after birth. In adulthood, proliferation (rather than monocyte recruitment) sustains arterial macrophages in the steady state and after severe depletion following sepsis. After infection, arterial macrophages return rapidly to functional homeostasis. Finally, survival of resident arterial macrophages depends on a CX3CR1-CX3CL1 axis within the vascular niche

Counselor Educators Experiences and Techniques Teaching about Social-Health Inequities

Social Determinants of Health (SDOH) are social-health inequities which cause wellness disparities amongst the population. This phenomenological investigation explored counselor educators’ (N=12) methods for teaching about SDOH. Two structural themes (pedagogic strategies and instructor context) and seven textural themes were identified, displaying the comprehensive coverage of SDOH in counseling courses. Implications for refinement of SDOH coverage are included

The first five minutes: Initial impressions during autism spectrum disorder diagnostic evaluations in young children.

Diagnosticians report that autism spectrum disorder (ASD) is immediately apparent in some, but not all, children ultimately diagnosed. Clinicians' initial diagnostic impressions have implications for ASD early detection, yet the literature raises questions about their accuracy. This study explores diagnostic impressions of ASD specialists made within the first 5 minutes of meeting a young child and investigates factors associated with the match between initial impressions and final diagnoses. Participants were children (n = 294, aged 12-53 months) referred for an ASD evaluation as part of multi-site ASD screening studies. After 5 minutes observing each child, clinicians with expertise diagnosing ASD recorded if they thought the child would meet criteria for ASD following a complete evaluation, and recorded their confidence in this impression. Clinicians' initial impressions matched the final diagnosis in 81% of cases. Ninety-two percent of cases initially thought to have ASD met criteria following a full evaluation; however, 24% of cases initially thought not to have ASD also met criteria, suggesting a high miss rate. Clinicians were generally confident in their initial impressions, reporting highest confidence for children initially thought correctly not to have ASD. ASD behavioral presentation, but not demographic characteristics or developmental level, were associated with matching initial impression and final diagnosis, and confidence. Brief observations indicating ASD should trigger referral to intervention services, but are likely to under-detect positive cases and should not be used to rule out ASD, highlighting the need to incorporate information beyond initial clinical impression. LAY SUMMARY: When children come in for an autism evaluation, clinicians often form early impressions-before doing any formal testing-about whether the child has autism. We studied how often these early impressions match the final diagnosis, and found that clinicians could not easily rule out autism (many children who initially appeared not to have autism were ultimately diagnosed), but were generally accurate ruling in autism (when a child appeared to have autism within 5 minutes, they were almost always so diagnosed)