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.

The Impact of Developmental Behavioral Pediatrics in a Population of Children with Down Syndrome.

PURPOSE: Children with Down syndrome (DS) have a unique developmental profile with an increased risk for co-morbid neurodevelopmental diagnoses, including autism spectrum disorder (ASD), anxiety, and attention deficit/hyperactivity disorder (ADHD), among others. A delay in a diagnosis of these conditions can impact the health and psychosocial wellbeing of the child and family. The purpose of this study was to assess identification of secondary co-morbid neurodevelopmental diagnoses within an academic DS specialty Clinic. DESIGN AND METHODS: A retrospective chart review of secondary co-morbid neurodevelopmental diagnoses including children with DS ages 2 to 17 years old, with a visit encounter in a pediatric DS specialty clinic between January 2018 to August 2019 was conducted. Comparisons included diagnoses identified before (T1) and after (T2) inclusion of developmental behavioral specialists as pediatric DS providers. Two sample t-tests, Chi-square test and Fisher's exact t-test were utilized to compare categorical and non-categorical variables. RESULTS: 145 children were identified in T1 of which 51.7% were male. 225 children were seen in T2, 56.0% were male. Increased detection of several co-morbid conditions occurred between T1 and T2 including language disorder (p < 0.0001), intellectual disability (p < 0.0001), and non-specific developmental/behavioral diagnoses (p < 0.0001). CONCLUSION: Developmental/behavioral assessment is integral for detection of co-morbid conditions among a pediatric DS population and prevention of diagnostic overshadowing. PRACTICE IMPLICATIONS: Interprofessional teams, including pediatric nurse practitioners, play a key role in providing health supervision and assessment for a pediatric DS population.