Clinical utility of the ECLECTIC framework in providing culturally-informed autism spectrum disorder evaluations: A pediatric case-based approach.

Objective: Social cognition does not exist within a vacuum. One's culture and surrounding social environment influence 1) development of social skills and behaviors, and 2) society's expectations regarding "normal" behavior versus behaviors consistent with the diagnosis of Autism Spectrum Disorder (ASD). Use of a comprehensive cultural framework such as Fujii's ECLECTIC model undergirds valid ASD testing by enhancing clinician awareness of potential biases during clinical decision-making and by supporting culturally relevant recommendations. Method: Four diverse pediatric patients presenting for concerns of ASD are described. Neuropsychological test data and salient cultural considerations are presented within the ECLECTIC framework. Results: The cases illustrate relevant cultural factors critical to the ASD assessment for youth with wide diversity (Southeast Asian, Deaf, Black, Hispanic/Latinx, and Chinese cultures) and varied contextual factors (adoption, underlying Down syndrome). The ECLETIC model better allows integration of salient factors such as cognition, family dynamics, behaviors, educational services, and language dominance. Conclusions: Unrecognized ethnocentric biases may shadow the complexities and nuances involved in ASD assessment across cultures. Such errors are minimized using a comprehensive cultural framework to guide equitable neuropsychological services. The ECLECTIC model's emphasis on cultural and contextual factors results in more accurate findings and more individualized planning for the patient. Recommendations for clinical application are provided.

Latex allergy guidelines for people with spina bifida.

An estimated 85% of individuals with spina bifida (SB) survive into adulthood, warranting SB-specific transition to adult healthcare guidelines to address the diverse and complex medical, adaptive, and social needs particular to this condition. Latex allergy constitutes one important health concern for this population that requires ongoing and life-long evidence-based management. This article discusses management of latex allergy according to the SB Latex Allergy Healthcare Guidelines from the 2018 Spina Bifida Association's Fourth Edition of the Guidelines for the Care of People with Spina Bifida, reviews current care models in which such latex allergy guidelines can be implemented, and explores further relevant research topics in SB care relative to latex allergy.

A trauma-informed approach supports health and development in children and youth with spina bifida.

Children with developmental disabilities may be at greater risk for experiencing maltreatment and traumatic events, threats to their physical and psychological safety and well-being. Young children and youth with spina bifida benefit from being considered in light of this risk, and may be especially vulnerable given the complexity of their neurodevelopmental condition. A trauma-informed approach brings together evidence from the neurosciences, epidemiology and psychology to promote improved developmental, behavioral, physical and mental health status. Incorporating a trauma-informed approach strengthens a longitudinal, interdisciplinary and developmentally-oriented care model for children and youth with spina bifida. A case example further illustrates how using a trauma-informed approach and evidence-based interventions can foster the development and well-being of youth with spina bifida who have been impacted by a traumatic event.

Supporting a Youth with Cerebellar Ataxia into Adolescence.

CASE: Zoe, a 13-year-old white girl, presents as a new patient to your pediatric clinic with complaints of frequent emesis, anxiety, and learning problems, and previous diagnosis of cerebellar ataxia. Parents accompany Zoe and state, "it is really hard for her to go out, she gets sick and falls easily." She was born full term by vaginal delivery without complications. Given globally delayed milestones, she received early intervention services. Feeding problems began at infancy, including gastroesophageal reflux and aspiration pneumonia.At age 2, Zoe saw a neurologist and brain MRI revealed cerebellar atrophy. She recently saw a geneticist and genetic studies are pending. Parents report receiving "little" information regarding prognosis; through their own research, they read about individuals having similar symptoms in adulthood, with a degenerative pattern. They worry that Zoe is "still very young and we do not know what her future will be like."Despite ongoing speech and feeding challenges, the parents report difficulty finding a speech and language therapist in their area. Zoe does see an otolaryngologist for frequent otitis media and hearing loss and an ophthalmologist for vision problems. Still, she continues to fall further behind in school. Furthermore, she is intensely afraid of falling at school and has few friends, resulting in the family being at a loss regarding "what to do about school."She lives with both parents and 2 healthy older sisters. Her mother has Crohn's disease and has been unable to work. Her maternal aunt is close to Zoe and has hypothyroidism. Her father works as an insurance agent and resources have been "tight." Zoe's mother describes "making" Zoe go out to the movies, "otherwise she just stays home." Zoe usually needs assistance to walk in public, to keep from stumbling. Parents share that simply being in a public place or meeting a new physician may trigger emesis. Zoe does enjoy interacting with neighborhood children and says she wants to be "normal," wear nail polish, and date. She seeks independence, often refusing to use her wheelchair. Parents feel she requires more intensive occupational and physical therapy.On examination, she is very slender with hypertelorism and nystagmus. Holding an emesis bag, she gags intermittently, producing clear secretions. She has a notable tremor and walks slightly stooped with wide-based gait. Her few words demonstrate articulation differences and cognitive expression characteristic of a younger child. She wears light make-up and age-appropriate clothes. She asks, "When can I go home?"At the end of the visit, parents share their worry that Zoe is "so young and we do not know anything, what to expect, or what to tell her." As the family's new medical home, they ask you to weigh in on what to do next to best support her? Where do you begin?

"Footprints in the Bathroom": The Role of Spirituality in Patient Diagnosis.

CASE: Lucy is a 12-year-old Latina whose mother brought her to the pediatric clinic for help with her anxiety symptoms, "hearing voices," and episodes of "spacing out." Lucy did not cry at birth secondary to vocal cord paralysis and still has the tracheostomy performed at a few days of life. In addition to her neonatal intensive care unit stay, she has been hospitalized for pneumonia. Her mother says she is "sickly" and has a weak immune system due to her asthma symptoms. Lucy also experiences somatic complaints related to gastroesophageal reflux and constipation.Lucy is described as being "in another world" and must be called several times before she responds. Lucy states she is nervous "all the time" and often experiences a fast heartbeat, chest pain, and headache. Her attention and internalizing problems began at age 4 years and have worsened since she entered adolescence. When she is alone in the dark, she sees an unknown person and becomes frightened. She hears the voice of her paternal uncle telling her something will harm her mother and runs crying to "check" on her. Lucy also says she hears voices of paternal family members fighting. She has dreamed that her paternal uncle stabbed her in an alley. Lucy reports experiencing sadness and feelings of wanting to die. She has not tried to harm herself and has no plan to do this. She states that she does not know when she is awake or asleep and "hate people talking in my head." She does not report drug use.Lucy's family is bilingual, English and Spanish. Her mother works part-time as a nutritionist, and her father is a machinist. Her father receives counseling for anger management, and there have been previous unsub- stantiated child abuse reports involving Lucy and her younger brother. The maternal uncle has been involved in a gang and attempts to phone Lucy's mother, who does not wish to have contact with him. Lucy's mother expresses strong Christian religious and spiritual beliefs, including demons and spirits that may enter her home and can be cast off with prayer. Recently, the family purchased a "cuadro" (picture) at a yard sale, and Lucy's mother said this resulted in footprints in the bathroom that are disappearing with prayer, guidance from the church minister, and discarding of the "cuadro."The primary pediatrician ordered a home school program, given Lucy's frequent illnesses. She is progressing well with a special education teacher. Her recent psychological evaluation at school showed a below average nonverbal intelligence quotient, with strengths in the areas of perceptual, logical, and abstract relationships. Lucy's mother in the past has been hesitant to follow through with psychiatric evaluation because "it is up to God."In the clinic, she is pale and slender with an ethereal look. She is awake and alert with appropriate affect and mentation. Her tracheostomy is intact without any respiratory distress noted. There are no signs of drug use or active hallucinations. You are left wondering whether these voices need psychiatric management.

A novel methodology for determining low-cost fine particulate matter street sweeping routes.

This paper addresses the problem of low-cost PM10 (particulate matter with aerodynamic diameter < 10 microm) street sweeping route. In order to do so, only a subset of the streets of the urban area to be swept is selected for sweeping, based on their PM10 emission factor values. Subsequently, a low-cost route that visits each street in the set is computed. Unlike related problems of waste collection where streets must be visited once (Chinese or Rural Postman Problem, respectively), in this case, the sweeping vehicle route must visit each selected street exactly as many times as its number of street sides, since the vehicle can sweep only one street side at a time. Additionally, the route must comply with traffic flow and turn constraints. A novel transformation of the original arc routing problem into a node routing problem is proposed in this paper. This is accomplished by building a graph that represents the area to sweep in such a way that the problem can be solved by applying any known solution to the Traveling Salesman Problem (TSP). As a way of illustration, the proposed method was applied to the northeast area of the Municipality of Santiago (Chile). Results show that the proposed methodology achieved up to 37% savings in kilometers traveled by the sweeping vehicle when compared to the solution obtained by solving the TSP problem with Geographic Information Systems (GIS)--aware tools.