General practice encounters for young patients with autism spectrum disorder in Australia

Autism ◽  
2017 ◽  
Vol 22 (7) ◽  
pp. 784-793 ◽  
Author(s):  
Kitty-Rose Foley ◽  
Allan J Pollack ◽  
Helena C Britt ◽  
Nicholas G Lennox ◽  
Julian N Trollor
Keyword(s):  
Autism Spectrum Disorder ◽  
General Practice ◽  
Confidence Interval ◽  
Young Patients ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Care Needs ◽  
Reason For Encounter ◽  
Australian General Practice ◽  
Reasons For Encounter

This study compared the patient demographics and reasons for encounter in general practice for patients <25 years with and without an autism spectrum disorder identified as a reason for encounter and/or problem managed. The Bettering the Evaluation and Care of Health programme collected information about clinical activities in Australian general practice. Each year, the programme recruited a random sample of 1000 general practitioners, each of whom collected data for 100 consecutive consultations (encounters). Encounters with patients <25 years, where at least one autism spectrum disorder was recorded as a reason for encounter and/or a problem managed (n = 579), were compared with all other encounters (n = 281,473) from April 2000 to March 2014 inclusive. Data were age–sex standardised. Patients at autism spectrum disorder encounters (compared to non-autism spectrum disorder encounters) were more likely to be younger and male. There was a dramatic rise in the number of general practitioner consultations at autism spectrum disorder encounters from 2000 to 2013. More reasons for encounter were recorded at autism spectrum disorder encounters than at non-autism spectrum disorder encounters (156.4 (95% confidence interval: 144.0–168.8) and 140.5 (95% confidence interval: 140.0–141.0), respectively). At autism spectrum disorder (vs non-autism spectrum disorder) encounters, there were more psychological, general and unspecified, and social reasons for encounter and fewer preventive and acute health reasons for encounter. People with an autism spectrum disorder have complex health care needs that require a skilled general practice workforce.

scholarly journals Possible tics diagnosed as stereotypies in patients with severe autism spectrum disorder: a video-based evaluation

2020 ◽  
Author(s):  
Cristiano Termine ◽  
Enzo Grossi ◽  
Valentina Anelli ◽  
Ledina Derhemi ◽  
Andrea E. Cavanna
Keyword(s):  
Autism Spectrum Disorder ◽  
Rating Scale ◽  
Young Patients ◽  
Autism Spectrum ◽  
Repetitive Behaviors ◽  
Spectrum Disorder ◽  
High Rate ◽  
Video Recordings ◽  
Significant Difference ◽  
Severe Autism

Abstract Background The association of stereotypies and tics is not rare in children with severe autism spectrum disorder (ASD). The differential diagnosis between stereotypies and tics in this patient population can be difficult; however, it could be clinically relevant because of treatment implications. Methods A total of 108 video recordings of repetitive behaviors in young patients with stereotypies in the context of ASD were reviewed by a movement disorders expert and a trainee, in order to assess the prevalence of possible co-morbid tics. The Modified Rush Videotape Rating Scale (MRVS) was used to rate tic frequency and severity. Results Out of 27 patients with stereotypies (24 males; mean age 14 years), 18 (67%) reported possible tics. The most frequently observed tics were eye blinking, shoulder shrugging, neck bending, staring, and throat clearing. The mean MRVS score was 5, indicating mild tic severity. The only significant difference between patients with tics and patients without tics was the total number of stereotypies, which was higher in the subgroup of patients without tics (p = 0.01). Conclusions Expert review of video-recordings of repetitive behaviors in young patients with ASD and stereotypies suggests the possibility of a relatively high rate of co-morbid tics. These findings need to be integrated with a comprehensive clinical assessment focusing on the diagnostic re-evaluation of heterogeneous motor manifestations.

Parent Experiences and Perceptions of Safety When Transporting Children With Autism Spectrum Disorder

2021 ◽  
Vol 75 (5) ◽  
Author(s):  
Teresa Plummer ◽  
Missy Bryan ◽  
Katherine Dullaghan ◽  
Abigail Harris ◽  
Michaela Isenberg ◽  
...  
Keyword(s):  
Autism Spectrum Disorder ◽  
Motor Vehicle ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Care Needs ◽  
Convenience Sample ◽  
Child Passenger Safety ◽  
Behavioral Safety ◽  
Children With Asd ◽  
Passenger Safety

Importance: Motor vehicle accidents are the leading cause of unintentional deaths of children ages 1 and older, particularly children with health care needs. Objective: To explore family caregivers’ experiences and current practices while transporting children diagnosed with autism spectrum disorder (ASD). Design: A concurrent nested mixed-methods approach was used to gain insight into caregiver experiences. Setting: Participants completed an online Qualtrics survey. Participants: A convenience sample of 54 caregivers of children with ASD from 17 U.S. states. Results: Themes that emerged include sensory behaviors of children, education related to child passenger safety, and participation in the community. Statistically significant findings suggest a correlation between caregivers (n = 39) being less likely to participate in activities away from home if the child had attempted to elope (p = .013), displayed aggressive behaviors (p = .005), or demonstrated self-injurious behaviors (p = .001). Conclusions and Relevance: The findings suggest a correlation between caregivers limiting the distance traveled during vehicular transportation and behavioral safety concerns. If caregivers must limit travel, they may refrain from accessing the community and engaging in leisure pursuits. What This Article Adds: The findings suggest that therapists who treat children with ASD should be familiar with child passenger safety restraints, particularly for elopement.

scholarly journals The bidirectional causal relationships of insomnia with five major psychiatric disorders: A Mendelian randomization study

2019 ◽  
Vol 60 ◽  
pp. 79-85 ◽  
Author(s):  
Xue Gao ◽  
Ling-Xian Meng ◽  
Kai-Li Ma ◽  
Jie Liang ◽  
Hui Wang ◽  
...  
Keyword(s):  
Autism Spectrum Disorder ◽  
Bipolar Disorder ◽  
Confidence Interval ◽  
Psychiatric Disorders ◽  
Mendelian Randomization ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Outcome Variable ◽  
Genome Wide Association Studies ◽  
Causal Relationships

AbstractBackground:Several observational studies have investigated the association of insomnia with psychiatric disorders. Such studies yielded mixed results, and whether these associations are causal remains unclear. Thus, we aimed to identify the causal relationships between insomnia and five major psychiatric disorders.Methods:The analysis was implemented with six genome-wide association studies; one for insomnia and five for psychiatric disorders (attention-deficit/hyperactivity disorder, autism spectrum disorder, major depressive disorder, schizophrenia, and bipolar disorder). A heterogeneity in dependent instrument (HEIDI) approach was used to remove the pleiotropic instruments, Mendelian randomization (MR)-Egger regression was adopted to test the validity of the screened instruments, and bidirectional generalized summary data-based MR was performed to estimate the causal relationships between insomnia and these major psychiatric disorders.Results:We observed significant causal effects of insomnia on the risk of autism spectrum disorder and bipolar disorder, with odds ratios of 1.739 (95% confidence interval: 1.217–2.486, p = 0.002) and 1.786 (95% confidence interval: 1.396–2.285, p = 4.02 × 10−6), respectively. There was no convincing evidence of reverse causality for insomnia with these two disorders (p = 0.945 and 0.546, respectively). When insomnia was considered as either the exposure or outcome variable, causal estimates for the remaining three psychiatric disorders were not significant.Conclusions:Our results suggest a causal role of insomnia in autism spectrum disorder and bipolar disorder. Future disease models should include insomnia as a factor for these two disorders to develop effective interventions. More detailed mechanism studies may also be inspired by this causal inference.

Gastrointestinal dysfunctions as a risk factor for sleep disorders in children with idiopathic autism spectrum disorder: A retrospective cohort study

Autism ◽  
2017 ◽  
Vol 21 (8) ◽  
pp. 1010-1020 ◽  
Author(s):  
Lena M McCue ◽  
Louise H Flick ◽  
Kimberly A Twyman ◽  
Hong Xian
Keyword(s):  
Quality Of Life ◽  
Autism Spectrum Disorder ◽  
Confidence Interval ◽  
Sleep Disorders ◽  
Sleep Disorder ◽  
Behavioral Problems ◽  
Sleep Problems ◽  
Autism Spectrum ◽  
Spectrum Disorder

Sleep disorders often co-occur with autism spectrum disorder. They further exacerbate autism spectrum disorder symptoms and interfere with children’s and parental quality of life. This study examines whether gastrointestinal dysfunctions increase the odds of having sleep disorders in 610 children with idiopathic autism spectrum disorder, aged 2–18 years, from the Autism Genetic Resource Exchange research program. The adjusted odds ratio for sleep disorder among those with gastrointestinal dysfunctions compared to those without was 1.74 (95% confidence interval: 1.22–2.48). In addition, the odds of having multiple sleep disorder symptoms among children with gastrointestinal dysfunctions, adjusted for age, gender, behavioral problems, bed wetting, current and past supplements, and current and past medications for autism spectrum disorder symptoms were 1.75 (95% confidence interval: 1.10–2.79) compared to children without gastrointestinal dysfunctions. Early detection and treatment of gastrointestinal dysfunctions in autism spectrum disorder may be means to reduce prevalence and severity of sleep problems and improve quality of life and developmental outcomes in this population.

Prospective cohort study of vitamin D and autism spectrum disorder diagnoses in early childhood

Autism ◽  
2018 ◽  
Vol 23 (3) ◽  
pp. 584-593 ◽  
Author(s):  
Yamna Ali ◽  
Laura N Anderson ◽  
Sharon Smile ◽  
Yang Chen ◽  
Cornelia M Borkhoff ◽  
...  
Keyword(s):  
Autism Spectrum Disorder ◽  
Vitamin D ◽  
Early Childhood ◽  
Relative Risk ◽  
Confidence Interval ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Adjusted Relative Risk ◽  
Hydroxyvitamin D ◽  
25 Hydroxyvitamin D

Several studies have suggested an association between vitamin D in childhood and autism spectrum disorder. No prospective studies have evaluated whether lower vitamin D levels precede ASD diagnoses – a necessary condition for causality. The objective of this study was to prospectively evaluate whether vitamin D serum levels in early childhood was associated with incident physician diagnosed ASD. A prospective cohort study was conducted using data from preschool-aged children in the TARGet Kids! practice-based research network in Toronto, Canada, from June 2008 to July 2015. 25-hydroxyvitamin D concentration was measured through blood samples and vitamin D supplementation from parent report. Autism spectrum disorder diagnosis was determined from medical records at follow-up visits. Covariates included age, sex, family history of autism spectrum disorder, maternal ethnicity, and neighborhood household income. Unadjusted and adjusted relative risks and 95% confidence intervals were estimated using Poisson regression with a robust error variance. In this study, 3852 children were included. Autism spectrum disorder diagnosis was identified in 41 children (incidence = 1.1%) over the observation period (average follow-up time = 2.5 years). An association between 25-hydroxyvitamin D concentration and autism spectrum disorder was not identified in the unadjusted (relative risk = 1.04, 95% confidence interval: 0.97, 1.11 per 10 nmol/L increase in 25-hydroxyvitamin D concentration) or adjusted models (adjusted relative risk = 1.06; 95% confidence interval: 0.95, 1.18). An association between vitamin D supplementation in early childhood and autism spectrum disorder was also not identified (adjusted relative risk = 0.86, 95% confidence interval: 0.46, 1.62). Vitamin D in early childhood may not be associated with incident physician diagnoses of autism spectrum disorder.

scholarly journals Early life influences on child weight outcomes in the Study to Explore Early Development

Autism ◽  
2018 ◽  
Vol 23 (4) ◽  
pp. 954-962
Author(s):  
Tanja VE Kral ◽  
Jesse Chittams ◽  
Chyrise B Bradley ◽  
Julie L Daniels ◽  
Carolyn G DiGuiseppi ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Autism Spectrum Disorder ◽  
Weight Gain ◽  
Confidence Interval ◽  
Gestational Weight Gain ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Rapid Weight Gain ◽  
Gestational Weight

We examined associations between child body mass index at 2–5 years and maternal pre-pregnancy body mass index, gestational weight gain, and rapid weight gain during infancy in children with autism spectrum disorder, developmental delays, or population controls. The Study to Explore Early Development is a multi-site case–control study of children, aged 2–5 years, classified as autism spectrum disorder ( n = 668), developmental delays ( n = 914), or population controls ( n = 884). Maternal gestational weight gain was compared to the Institute of Medicine recommendations. Rapid weight gain was a change in weight-for-age z-scores from birth to 6 months > 0.67 standard deviations. After adjusting for case status, mothers with pre-pregnancy overweight/obesity were 2.38 times (95% confidence interval: 1.96–2.90) more likely, and mothers who exceeded gestational weight gain recommendations were 1.48 times (95% confidence interval: 1.17–1.87) more likely, to have an overweight/obese child than other mothers ( P < 0.001). Children with autism spectrum disorder showed the highest frequency of rapid weight gain (44%) and were 3.47 times (95% confidence interval: 1.85–6.51) more likely to be overweight/obese as children with autism spectrum disorder without rapid weight gain ( P < 0.001). Helping mothers achieve a healthy pre-pregnancy body mass index and gestational weight gain represent important targets for all children. Healthy infant growth patterns carry special importance for children at increased risk for an autism spectrum disorder diagnosis.

scholarly journals Changes in spending and service use after a state autism insurance mandate

Autism ◽  
2017 ◽  
Vol 23 (1) ◽  
pp. 167-174 ◽  
Author(s):  
Brendan Saloner ◽  
Colleen L Barry
Keyword(s):  
Autism Spectrum Disorder ◽  
Confidence Interval ◽  
Health Plan ◽  
Service Use ◽  
Autism Spectrum ◽  
Employee Health ◽  
The State ◽  
Spectrum Disorder ◽  
Disorder Treatment ◽  
State Employee

Almost all states have insurance coverage mandates for childhood autism spectrum disorder treatment, yet little is known about how mandates affect spending and service use. We evaluated a 2011 Kansas law mandating comprehensive coverage of autism spectrum disorder treatments in the State Employee Health Plan. Data were extracted from the Kansas All-Payer Claims Database from 2009 to 2013 for enrollees of State Employee Health Plan and private health plans. The sample included children aged 0–18 years with >2 claims with an autism spectrum disorder diagnosis insured through State Employee Health Plan or a comparison group enrolled through private health plans. We estimated differences-in-differences regression models to compare trends among State Employee Health Plan to privately insured children. Average annual total spending on autism spectrum disorder services increased by US$912 (95% confidence interval: US$331–US$1492) and average annual out-of-pocket spending on autism spectrum disorder services increased by US$138 (95% confidence interval: US$53–US$223) among diagnosed children in the State Employee Health Plan relative to the comparison group following the mandate, representing 92% and 75% increases over baseline total and out-of-pocket autism spectrum disorder spending, respectively. Average annual quantity of outpatient autism spectrum disorder services increased by 15.0 services (95% confidence interval: 8.4–21.6) among children in the State Employee Health Plan, more than doubling the baseline average. Implementation of a comprehensive autism spectrum disorder mandate in the Kansas State Employee Health Plan was associated with substantial increases in service use and spending for autism spectrum disorder treatment among autism spectrum disorder–diagnosed children.

Individuals with Developmental Disabilities

2017 ◽  
Author(s):  
Katharine Stratigos ◽  
Nina Tioleco ◽  
Anna Silberman ◽  
Agnes Whitaker
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Autism Spectrum Disorder ◽  
Mental Illness ◽  
Developmental Disabilities ◽  
Social Services ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Federal State ◽  
Care Needs

Persons with developmental disabilities (DD), such as autism spectrum disorder and intellectual disability, are at substantially greater risk of having comorbid mental illness compared to the general population. Their mental health care needs, however, are vastly undertreated. Contributors to this situation include the challenges of evaluating mental illness in individuals with DD; stigma associated with and systematic barriers against people with DD; communication barriers; inadequate training of health care workers; insufficient availability of community mental health services; and the complexity of the available social services and legal systems at the federal, state, and community levels. This chapter uses a case to review the different factors that contribute to irritability and problem behavior in a person who has autism spectrum disorder with intellectual and language impairment. Also reviewed is the complicated system of services and statutes that may be of assistance when working with this population.

scholarly journals Mobile Aid to Assist with Care Decisions in Children with Autism Spectrum Disorder (ASD)

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Arshia Khan ◽  
Kun Li ◽  
Janna Madden
Keyword(s):  
Autism Spectrum Disorder ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Human Communication ◽  
Care Needs ◽  
Negative Behaviors ◽  
Personalized Care ◽  
Children With Asd ◽  
Communicating With Children ◽  
Communication Methods

MyHeifer is an autism spectrum disorder (ASD) intervention application aimed at better understanding patients’ behavioral patterns and informing healthcare decisions, easing caregiver burden, and providing an emotional outlet for patients. Children with ASD often struggle with the complexity of human communication because of the array of verbal and nonverbal communication methods at play. Because of this, technological interventions can be a valuable tool for communicating with children with ASD because of their simplicity. Hence the MyHeifer application seeks to provide an uncomplicated environment for children with ASD to express and explore their emotions. Children perform “actions” or “interactions” which are classified as either positive or negative behaviors. Through these interactions, children learn various ways to react to situations. The choices children make are collected and serve as a basis for future healthcare decisions. Because communication is often difficult for children with ASD, utilizing data from past actions or interactions helps caregivers anticipate and understand the challenges to make better emotional and behavioral connections in individual patients in order to address personalized care needs.

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