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1.
Res Dev Disabil ; 109: 103851, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33465589

RESUMO

PURPOSE: In the wake of the COVID-19 outbreak, already limited services and resources for families of children with autism spectrum disorder (ASD) in China became even more scarce. This qualitative case study highlights one online parent education and training (PET) program developed during the pandemic to offer home-intervention strategies to parents of children with ASD in mainland China. This exploratory study sought to examine the emic perspectives of the trainers and parents who participated in the 12-week intensive training program while considering the cultural context in China and the transnational, remote nature of the program. METHODS: The primary data focused on the experiences of the trainers and parents within PET program's structure and strategies, which were adapted from the Training of Trainers model, and were collected from semi-structured, in-depth individual and focus group interviews conducted virtually with trainers (n = 4). Supplemental data sources included training session materials and feedback forms collected from parents (n = 294) at the midpoint and end of the program. After the collected data were sorted and condensed, a thematic analysis was performed using the data analysis spiral to further organize and code the data, and the codes were finally collapsed into themes. FINDINGS: Three overarching themes were identified: (1) training as modeling with resources, (2) dilemmas in cultural contexts and expectations, and (3) cultivating parent support networks. CONCLUSION: The online PET program became a hub of support networks and learning spaces for parents of children with ASD in different regions in China during the pandemic. Through the interactive virtual training sessions, parents were supported by continuous feedback on their home intervention and coached to cultivate support networks among themselves despite tensions arising from cultural differences and to implement effective intervention strategies that were individualized and authenticated to their specific familial needs.


Assuntos
Transtorno do Espectro Autista , Educação a Distância/métodos , Educação não Profissionalizante , Educação/métodos , Pais/psicologia , Sistemas de Apoio Psicossocial , Adulto , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/psicologia , /prevenção & controle , Criança , China/epidemiologia , Educação não Profissionalizante/métodos , Educação não Profissionalizante/tendências , Feminino , Humanos , Masculino , Modelos Educacionais , Relações Pais-Filho , Poder Familiar/psicologia
2.
Ideggyogy Sz ; 74(1-2): 67-72, 2021 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-33497052

RESUMO

Background and purpose: Autism spectrum disorder is a neurodevelopmental disorder with a heterogeneous presentation, the etiology of which is not clearly elucidated. In recent years, comorbidity has become more evident with the increase in the frequency of autism and diagnostic possibilities of inborn errors of metabolism. Methods: One hundred and seventy-nine patients with diagnosis of autism spectrum disorder who presented to the Pediatric Metabolism outpatient clinic between 01/September/2018-29/February/2020 constituted the study population. The personal information, routine and specific metabolic tests of the patients were analyzed retrospectively. Results: Out of the 3261 patients who presented to our outpatient clinic, 179 (5.48%) were diagnosed with autism spectrum disorder and were included in the study. As a result of specific metabolic examinations performed, 6 (3.3%) patients were diagnosed with inborn errors of metabolism. Two of our patients were diagnosed with classical phenylketonuria, two with classical homocystinuria, one with mucopolysaccharidosis type 3D (Sanfilippo syndrome) and one with 3-methylchrotonyl Co-A carboxylase deficiency. Conclusion: Inborn errors of metabolism may rarely present with autism spectrum disorder symptoms. Careful evaluation of the history, physical examination and additional findings in patients diagnosed with autism spectrum disorder will guide the clinician in the decision-making process and chose the appropriate specific metabolic investigation. An underlying inborn errors of metabolism may be a treatable cause of autism.


Assuntos
Transtorno do Espectro Autista , Erros Inatos do Metabolismo , Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Criança , Comorbidade , Humanos , Erros Inatos do Metabolismo/complicações , Erros Inatos do Metabolismo/diagnóstico , Erros Inatos do Metabolismo/epidemiologia , Estudos Retrospectivos
3.
Gen Dent ; 69(1): 62-68, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33350958

RESUMO

Autism spectrum disorder is a neurodevelopmental disorder affecting communication, behavior, and socialization in a large number of children and adults. In addition to the classically considered features of autism, individuals with this disorder also often present with multiple significant medical comorbidities that affect dental treatment. This article discusses the most common of these neurologic, psychiatric, and gastrointestinal issues and explores their relevance to dental care. It is incumbent on dentists and members of the dental team to be familiar with the features and comorbidities of autism spectrum disorder and effectively use this knowledge to provide care for patients with autism.


Assuntos
Transtorno do Espectro Autista , Adulto , Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/epidemiologia , Criança , Comunicação , Comorbidade , Assistência Odontológica , Trato Gastrointestinal , Humanos
4.
Artigo em Inglês | MEDLINE | ID: mdl-33333991

RESUMO

Social campaigns are carried out to promote autism spectrum disorder (ASD) awareness, normalization, and visibility. The internet helps to shape perceptions of Asperger syndrome and autism. In fact, these campaigns often coincide with the increase in searches for both diagnoses on Google. We have two study objectives: to use Google Trends to identify the annual time points from 2015 to 2019 with the highest Google search traffic in Spain for the terms "autism" and "Asperger", and to identify news and trending topics related to ASD that took place during the weeks with the highest number of Google searches for these terms. Google Trend, MyNews and Trendinalia were used to analyze the volume of searches and trending topics related to ASD. As a result, social marketing campaigns, social networks and the publication of news items act as powerful voices that can provide a realistic or sensationalist picture of the disorder. For this reason, we concluded that campaigns play an important role in the normalization of ASD, and that it is important for organizations concerned with the visibility and social inclusion of people with ASD to check the way ASD is portrayed through the internet, media, and social networks.


Assuntos
Síndrome de Asperger , Transtorno do Espectro Autista , Transtorno Autístico , Síndrome de Asperger/epidemiologia , Transtorno do Espectro Autista/epidemiologia , Humanos , Internet , Espanha/epidemiologia
5.
Artigo em Inglês | MEDLINE | ID: mdl-33375475

RESUMO

Children with autism spectrum disorders (ASD) are at risk for oral health disparities. With the dramatic rise in ASD prevalence to 1 in 54 children, it is likely that an increasing number of dental practitioners will encounter or be asked to treat children with ASD. This paper reviews explanations related to the increasing prevalence of ASD, provides reasons why children with ASD are at increased risk for poor oral health, and discusses unique interprofessional collaborations between dental practitioners and occupational therapists. Occupational therapists and dentists can work together to plan modifications to the dental environment or adapt dental protocols to reduce some of the barriers encountered by those with ASD, provide desensitization strategies before the clinic visit, or help a child with emotional regulation during clinical treatments.


Assuntos
Transtorno do Espectro Autista , Odontologia , Terapia Ocupacional , Saúde Bucal , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/terapia , Criança , Odontólogos , Humanos , Comunicação Interdisciplinar , Papel Profissional
6.
Artigo em Russo | MEDLINE | ID: mdl-33340302

RESUMO

OBJECTIVE: Screening of children 18-48 months of age at risk of mental and developmental disorders in the general population. MATERIAL AND METHODS: The survey was conducted by a continuous epidemiological method in primary health care institutions in the nine largest regions of Russia. For the period 2017-2019, 595 691 parents of children, aged 18-48 months, were surveyed. RESULTS AND CONCLUSION: The prevalence risk rate for mental and developmental disorders was determined as 1.307:10 000. The prevalence rate for mental and behavioural disorders (ICD-10) was 151:10 000. The analysis of the structure of mental and behavioural disorders was carried out. An increase in cases of pervasive developmental disorders (item F84) was detected - autism spectrum disorders (ASD) with an increase in the age of children. The prevalence of ASD under the age of 48 months was found to be 18:10 000, compared with 2015-2016 - 5:10 000 under the age of 24 months.


Assuntos
Transtorno do Espectro Autista , Transtornos Globais do Desenvolvimento Infantil , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Criança , Pré-Escolar , Humanos , Lactente , Programas de Rastreamento , Prevalência , Federação Russa/epidemiologia
7.
Pap. psicol ; 41(3): 228-235, sept.-dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-197411

RESUMO

Para poder realizar el diagnóstico del trastorno del espectro autista (TEA) se requiere de la evaluación por parte de diferentes informantes. Sin embargo, en ocasiones, se producen ciertas discrepancias entre evaluadores. Con el objetivo de aportar luz a las posibles discrepancias entre informantes, este trabajo incluye una revisión actualizada de la literatura para examinar el grado de acuerdo entre diferentes informantes en lo que respecta a la sintomatología característica del TEA en niños y adolescentes (hasta los 17 años de edad). Se analizaron un total de 20 estudios, en los que los niveles de correlación entre las evaluaciones realizadas por diferentes informantes fueron moderados o bajos. Gran parte de los estudios incluidos en la presente revisión obtuvieron que un mayor grado de acuerdo entre informantes fue asociado con menor sintomatología, mayor CI y mejores resultados en habilidades cognitivas y adaptativas. Considerando estos resultados, es necesario continuar investigando en aspectos contextuales que pueden estar condicionando los resultados de las evaluaciones multi-informantes


In order to establish a diagnosis of autism spectrum disorder (ASD), assessment by different informants is required. Sometimes, however, there are certain discrepancies between evaluators. With the aim of shedding light on possible discrepancies between informants, this work includes an updated review of the literature to examine the degree of agreement between different informants regarding the characteristic symptomatology of ASD in children and adolescents (up to 17 years of age). A total of 20 studies were analyzed, in which the levels of correlation between the evaluations carried out by different informants were moderate or low. A large part of the studies included in this review obtained that a greater degree of agreement among informants was associated with lower symptoms, a higher IQ, and better results in cognitive and adaptive skills. Considering these results, it is necessary to continue investigating contextual aspects that may be conditioning the results of multi-informant evaluations


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/psicologia , Teoria Psicológica , Transtornos do Comportamento Infantil/diagnóstico , Transtornos do Comportamento Infantil/psicologia
8.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32900877

RESUMO

BACKGROUND: Children born preterm are at high risk for autism spectrum disorder (ASD). However, there is still a lack of appropriate developmental markers. In this study, we aim to examine whether early mental performance trajectory is related to ASD outcome in the preterm population. METHODS: The population-based cohort included 414 very preterm survivors born between 2008 and 2014. After excluding children with severe neurosensory impairment, 319 children with available records of developmental quotients before age 2 years were enrolled. The trajectory of mental performance evaluated by using the Bayley Scales of Infant Development across 6, 12, and 24 months of age was analyzed with group-based trajectory modeling. At 5 years of age, the ASD diagnosis was established by using the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview-Revised. RESULTS: There were 29 children with ASD and 290 children without ASD. The mental performances from age 6 to 24 months could be classified into 3 trajectory patterns: low declining, high declining, and high stable, which corresponded to ASD prevalence at age 5 years of 35%, 9%, and 3%, respectively. ASD odds was 15 times higher in the low-declining group than in the high-stable group (odds ratio 15; 95% confidence interval 3.8-59; P < .001). Through the analysis of multinomial logistic regression, we found that male infants with longer exposure to oxygen therapy whose mothers had lower maternal education levels tended to follow the low-declining trajectory. CONCLUSIONS: The early-life mental trajectory patterns, by using the Bayley Scales of Infant Development, may lead to identification of vulnerable children born preterm for early ASD diagnosis and targeted intervention.


Assuntos
Transtorno do Espectro Autista , Desenvolvimento Infantil , Lactente Extremamente Prematuro , Fatores Etários , Transtorno do Espectro Autista/classificação , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/fisiopatologia , Pré-Escolar , Intervalos de Confiança , Diagnóstico Precoce , Escolaridade , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Razão de Chances , Oxigênio/uso terapêutico , Prevalência , Fatores Sexuais
9.
Yonsei Med J ; 61(10): 880-890, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32975063

RESUMO

PURPOSE: The aim of this study was to investigate differences in language ability and emotional-behavioral problems according to the severity of social communication impairments (SCI) and restricted and repetitive behaviors (RRB) in children with autism spectrum disorders (ASD). MATERIALS AND METHODS: We grouped 113 children with ASD aged 3-12 years according to the severity of SCI and RRB, and investigated language differences and emotional-behavioral problems among the severity groups. If differences in language abilities between the groups were observed, they were further subdivided to examine possible predictors of both receptive and expressive language abilities. RESULTS: In cluster analyses using subdomains of the Autism Diagnostic Interview-revised, severe SCI individuals showed lower language ability than their milder counterparts, while RRB showed no differences. Receptive and expressive language in the severe SCI group was negatively predicted by social communication and social motivation, respectively. The severe RRB group showed significantly higher levels of anxiety/distress, somatic complaints, thought problems, attention problems, and aggressive behavior, while the severe SCI group was reported to be more withdrawn. CONCLUSION: The results of this study suggest that the severity of SCI greatly affects language ability. In children with severe SCI, social communication and social motivation negatively predicted receptive language and expressive language, respectively. Children with severe RRB may have more emotional-behavioral problems that require active intervention.


Assuntos
Sintomas Afetivos/diagnóstico , Sintomas Afetivos/psicologia , Transtorno do Espectro Autista/psicologia , Transtornos do Comportamento Infantil/diagnóstico , Transtornos do Comportamento Infantil/psicologia , Transtornos do Desenvolvimento da Linguagem/diagnóstico , Transtornos do Desenvolvimento da Linguagem/psicologia , Desenvolvimento da Linguagem , Sintomas Afetivos/epidemiologia , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Criança , Transtornos do Comportamento Infantil/epidemiologia , Pré-Escolar , Emoções , Feminino , Humanos , Idioma , Transtornos do Desenvolvimento da Linguagem/epidemiologia , Masculino , Comportamento Problema , Índice de Gravidade de Doença
10.
Am J Nurs ; 120(10): 30-37, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32976150

RESUMO

Autism spectrum disorder (ASD) is a condition characterized by impaired social communication as well as restricted and repetitive behaviors. It is considered a neurodevelopmental disorder because it is associated with neurologic changes that may begin in prenatal or early postnatal life, alters the typical pattern of child development, and produces chronic signs and symptoms that usually manifest in early childhood and have potential long-term consequences. In past decades, autism was conceptualized as a strictly defined set of behaviors, usually accompanied by intellectual impairment. Today, it is recognized as a spectrum, ranging from mild to severe, in which behaviors vary substantially and the majority of children who fall on the spectrum have average to above average intellectual ability. Here, the authors discuss the risk factors for ASD, its epidemiology, common concurrent conditions, evaluation, diagnosis, treatments, and outcomes.


Assuntos
Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/terapia , Adolescente , Adulto , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/etiologia , Centers for Disease Control and Prevention, U.S. , Criança , Pré-Escolar , Comorbidade , Feminino , Humanos , Lactente , Masculino , Programas de Rastreamento , Papel do Profissional de Enfermagem , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
11.
Tijdschr Gerontol Geriatr ; 51(2)2020 Jun 04.
Artigo em Holandês | MEDLINE | ID: mdl-32951379

RESUMO

Scientific knowledge of autism spectrum disorders (ASD) in older adults is still scarce. Differential diagnosis of ASD and personality disorders is complicated, especially in later life. There is overlap between ASD and personality disorders, both conceptually and descriptively. The manifestation of both disorders is heterogeneous, influenced by age specific factors and characterised by similar behavioural symptoms and the lack of a sound developmental history. In both disorders, age specific changes can exceed adaptive abilities of patients, so ASD and personality disorders may become manifest for the first time in old age. More research is needed to fully understand the relationship between ASD and personality development across the life span. Also, there is a need for assessment instruments for both adults and older people with comorbid mental disorders and personality disorders in particular. As comorbidity of ASD and personality disorders appears to be common, more research should be done into treatment of comorbid personality disorders, also in later life.


Assuntos
Transtorno do Espectro Autista , Transtornos da Personalidade/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Comorbidade , Diagnóstico Diferencial , Humanos , Transtornos da Personalidade/epidemiologia
12.
PLoS One ; 15(9): e0238652, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881960

RESUMO

BACKGROUND: Almost all children with autism spectrum disorder (ASD) have experienced challenging behavior, including disruptive and aggressive behavior symptoms to both themselves and others. In conjunction with appropriate strategic parenting, challenging behavior can be prevented by empowering children's sociality and optimizing their environment. However, a means of measuring such parenting has yet to appear. This study developed the Parental Self-Efficacy Scale for Preventing Challenging Behaviors in Children with Autism Spectrum Disorder (PASEC) and evaluated its reliability and validity. METHOD: Self-administered questionnaires were distributed to 1,344 parents of children with ASD at all 521 child development support centers in Japan. Confirmed construct validity of the PASEC was determined using confirmatory factor analysis. Internal consistency of the PASEC was calculated using Cronbach's alpha. The self-efficacy subscale of the Parenting Sense of Competence (PSOC) was administered to assess criterion-related validity of the PASEC. RESULTS: In total, 260 parents provided valid responses. Exploratory and confirmatory factor analyses identified six items from two factors: empowerment of children's sociality and optimization of children's environment. The final model showed goodness-of-fit index, 0.981; adjusted goodness-of-fit index, 0.944; comparative fit index, 0.999; and root mean square error of approximation, 0.019. Cronbach's alpha for the entire PASEC was 0.82; that for each factor was above 0.70. The correlation coefficient between the self-efficacy subscale of the PSOC and the entire PASEC was r = 0.52 (P <0.001). CONCLUSIONS: The PASEC demonstrated adequate reliability and validity to assess parents' self-efficacy for preventing challenging behavior for children with ASD. That scale can help prevent challenging behavior; it can contribute to improving the mental health of parents and children with ASD as well as to primary prevention of child maltreatment and abuse.


Assuntos
Transtorno do Espectro Autista/epidemiologia , Comportamento Infantil , Pais , Autoeficácia , Adulto , Criança , Pré-Escolar , Análise Fatorial , Feminino , Humanos , Masculino
13.
PLoS One ; 15(8): e0236994, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32854110

RESUMO

INTRODUCTION: Prematurity has been identified as a risk factor for Autism Spectrum Disorder (ASD). The link between Autism Spectrum Disorder (ASD) and birth-week has not been strongly evidenced. We evaluated the correlation between the degree of prematurity and the incidence of autism in a cohort of 871 children born prematurely and followed from birth. The cohort was reduced to 416 premature infants born between 2011-2017 who were followed for 2-14 years, and analyzed according to birth week (degree of prematurity), and according to gender. RESULTS: 43 children (10.3%) received a definite diagnosis of ASD. There was a significant correlation between birth week and the risk of ASD, with 22.6% of children diagnosed with ASD when born at 25 weeks, versus 6% of ASD diagnoses at 31 weeks of prematurity. For children born after 32 weeks, the incidence decreased to 8-12.5%. A strong link was found between earlier birth week and increased autism risk; the risk remained elevated during near-term prematurity in boys. A correlation between early birth week and an elevated risk for ASD was seen in all children, but accentuated in females, gradually decreasing as birth week progresses; in males the risk for ASD remains elevated for any birth week. CONCLUSION: A statistically significant increase in rates of autism was found with each additional week of prematurity. Females drove this direct risk related to degree of prematurity, while males had an elevated risk throughout prematurity weeks, even at near-term. We recommend including ASD screening in follow up of infants born prematurely, at all levels of prematurity.


Assuntos
Transtorno Autístico/etiologia , Recém-Nascido Prematuro , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/etiologia , Transtorno Autístico/epidemiologia , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Humanos , Incidência , Recém-Nascido , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido Prematuro/psicologia , Israel/epidemiologia , Masculino , Gravidez , Nascimento Prematuro , Prevalência , Fatores de Risco , Caracteres Sexuais
15.
Ann Epidemiol ; 48: 1-8, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32778226

RESUMO

PURPOSE: Studies indicate an apparent sharp increasing trend in autism spectrum disorder (ASD) incidence and prevalence worldwide. This nationwide study aims at depicting ASD prevalence distribution in Israel in both space and time. METHODS: Based on data from Israel National Insurance Institute, the study population included all children born in Israel 2000-2011 (n = 1,786,194), of whom 11,699 (0.655%) were subsequently diagnosed with ASD (until December 31, 2016). Prevalence was calculated and mapped by dividing the number of ASD cases within each year of birth by the number of births during that year, for each spatial unit, and similarly for several spatiotemporal levels of aggregation. RESULTS: ASD prevalence varies substantially across different geographic areas in Israel, with considerably higher prevalence concentrated in central Israel. Strong associations were found between locality-level socioeconomic index, ethnicity, and peripherality and ASD prevalence, and even after adjustment for them, excess prevalence for ASD still persisted in certain localities. No spatial dependence of prevalence, with and without adjustment for the locality-level variables, was found (Moran's I = -0.000546, -0.00335, respectively). CONCLUSIONS: Our findings provide important insights regarding health disparities affecting ASD diagnosis, directing further health policy intervention and further research.


Assuntos
Transtorno do Espectro Autista/epidemiologia , Grupos Étnicos/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Vigilância da População/métodos , Características de Residência , Adolescente , Transtorno do Espectro Autista/etnologia , Criança , Estudos de Coortes , Feminino , Sistemas de Informação Geográfica , Humanos , Incidência , Israel/epidemiologia , Masculino , Análise Espaço-Temporal
16.
Chronobiol Int ; 37(8): 1207-1213, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32746638

RESUMO

This study aimed to investigate the relationship between chronotype preference/sleep problems and symptom severity of children with Autism spectrum disorder (ASD) during the confinement and social isolation of the COVID-19 outbreak. This study included 46 drug-naive children aged 4-17 y diagnosed with ASD. The Autism Behavior Checklist (AuBC), Children's Sleep Habits Questionnaire (CSHQ), and Children's chronotype questionnaire (CCQ) were filled out before and at the end of the COVID-19 mandated home confinement by the children's parents. Children with ASD during the home confinement reported higher chronotype scores, i.e., eveningness chronotype, sleep problems, and autism symptom scores compared to the normal non-hone confinement state. The chronotype score and sleep problems of children with ASD during the home confinement period varied according to the AuBC score. The sleep problems of the children with ASD during the home confinement period mediated the relationship between chronotype score and severity of autism symptoms. It is essential to validate the role of the mediator effect of sleep problems and chronotype in larger samples of children with ASD with restricted to home confinement during the pandemic period. If sleep problems can be controlled with parental education, pharmacotherapy, and psychotherapeutic interventions, the impact on children with ASD of home confinement can be reduced.


Assuntos
Transtorno do Espectro Autista/epidemiologia , Betacoronavirus , Ritmo Circadiano/fisiologia , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Sono/fisiologia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/fisiopatologia , Feminino , Humanos , Masculino , Pandemias , Pneumonia Viral/fisiopatologia , Índice de Gravidade de Doença , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/fisiopatologia
17.
PLoS One ; 15(7): e0236329, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32716951

RESUMO

BACKGROUND: Research suggests that families' knowledge and cultural perceptions of autism spectrum disorder (ASD), and beliefs about its etiology and prognosis, can affect parents' recognition of the first signs of autism in their children and influence help seeking and treatment decisions. OBJECTIVE: This study investigated explanatory models of autism among parents of young children with ASD in the multicultural context of Sweden. METHOD: Seventeen parents from diverse cultural, ethnic and linguistic backgrounds participated in semi-structured interviews. A deductive approach to qualitative content analysis was used to analyze data. Five domains of the Explanatory Model supplementary module of the Cultural Formulation Interview (CFI) were used as coding categories, operationalized as 'Parents' understanding of autism'; 'Autism prototypes'; 'Causal explanations'; 'Course of autism', and 'Help seeking and treatment expectations'. RESULTS: The results showed that parents' prior knowledge of autism and experience of young children's typical developmental trajectories, as well as the opinions of children's grandparents and preschool teachers, affected symptom recognition and help seeking. There were differences in parents' explanatory models before and after ASD diagnosis. Initial interpretations of the disorder included medical conditions and reaction to environmental influences, while genetic, supernatural/religious factors, and vaccinations were mentioned as definite causes after obtaining a clinical diagnosis. Parents also held multiple explanatory models, influenced by the views of family members and information obtained from media or from health care professionals. Parents' treatment decisions included use of available state-funded support services, and complementary and alternative treatments. CONCLUSION: The results demonstrate the utility of the CFI's Explanatory Model supplementary module in autism research. Implications for clinical practice are discussed.


Assuntos
Transtorno do Espectro Autista/epidemiologia , Diversidade Cultural , Modelos Teóricos , Pais , Adulto , Transtorno do Espectro Autista/terapia , Criança , Pré-Escolar , Terapias Complementares , Família , Humanos , Lactente , Aprendizagem , Fatores Socioeconômicos , Suécia
19.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32632023

RESUMO

Although autism spectrum disorder (ASD) can be reliably detected in the second year of life, the average age of diagnosis is 4 to 5 years. Limitations in access to timely ASD diagnostic evaluations delay enrollment in interventions known to improve developmental outcomes. As such, developing and testing streamlined methods for ASD diagnosis is a public health and research priority. In this report, we describe the Early Autism Evaluation (EAE) Hub system, a statewide initiative for ASD screening and diagnosis in the primary care setting. Development of the EAE Hub system involved geographically targeted provision of developmental screening technical assistance to primary care, community outreach, and training primary care clinicians in ASD evaluation. At the EAE Hubs, a standard clinical pathway was implemented for evaluation of children, ages 18 to 48 months, at risk for ASD. From 2012 to 2018, 2076 children were evaluated (mean age: 30 months; median evaluation wait time: 62 days), and 33% of children received a diagnosis of ASD. Our findings suggest that developing a tiered system of developmental screening and early ASD evaluation is feasible in a geographic region facing health care access problems. Through targeted delivery of education, outreach, and intensive practice-based training, large numbers of young children at risk for ASD can be identified, referred, and evaluated in the local primary care setting. The EAE Hub model has potential for dissemination to other states facing similar neurodevelopmental health care system burdens. Implementation lessons learned and key system successes, challenges, and future directions are reviewed.


Assuntos
Transtorno do Espectro Autista/diagnóstico , Programas de Rastreamento , Transtorno do Espectro Autista/epidemiologia , Pré-Escolar , Procedimentos Clínicos , Diagnóstico Precoce , Humanos , Indiana/epidemiologia , Lactente , Capacitação em Serviço , Profissionais de Enfermagem Pediátrica/educação , Pediatras/educação , Atenção Primária à Saúde , Vigilância em Saúde Pública
20.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32632024

RESUMO

OBJECTIVES: To describe the proportion of children screened by the Modified Checklist for Autism in Toddlers (M-CHAT), identify characteristics associated with screen completion, and examine associations between autism spectrum disorder (ASD) screening and later ASD diagnosis. METHODS: We examined data from children attending 18- and 24-month visits between 2013 and 2016 from 20 clinics within a health care system for evidence of screening with the M-CHAT and subsequent coding of ASD diagnosis at age >4.75 years. We interviewed providers for information about usual methods of M-CHAT scoring and ASD referral. RESULTS: Of 36 233 toddlers, 73% were screened and 1.4% were later diagnosed with ASD. Hispanic children were less likely to be screened (adjusted prevalence ratio [APR]: 0.95, 95% confidence interval [CI]: 0.92-0.98), and family physicians were less likely to screen (APR: 0.12, 95% CI: 0.09-0.15). Compared with unscreened children, screen-positive children were more likely to be diagnosed with ASD (APR: 10.3, 95% CI: 7.6-14.1) and were diagnosed younger (38.5 vs 48.5 months, P < .001). The M-CHAT's sensitivity for ASD diagnosis was 33.1%, and the positive predictive value was 17.8%. Providers routinely omitted the M-CHAT follow-up interview and had uneven referral patterns. CONCLUSIONS: A majority of children were screened for ASD, but disparities exist among those screened. Benefits for screen-positive children are improved detection and younger age of diagnosis. Performance of the M-CHAT can be improved in real-world health care settings by administering screens with fidelity and facilitating timely ASD evaluations for screen-positive children. Providers should continue to monitor for signs of ASD in screen-negative children.


Assuntos
Transtorno do Espectro Autista/diagnóstico , Testes Neuropsicológicos , Atenção Primária à Saúde/métodos , Transtorno do Espectro Autista/epidemiologia , Lista de Checagem , Pré-Escolar , Diagnóstico Tardio , Diagnóstico Precoce , Feminino , Seguimentos , Disparidades em Assistência à Saúde , Hispano-Americanos , Humanos , Lactente , Masculino , Programas de Rastreamento/métodos , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Utah/epidemiologia
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