Pubmed du 09/06/19

dimanche 9 juin 2019

1. Ibanez LV, Stoep AV, Myers K, Zhou C, Dorsey S, Steinman KJ, Stone WL. Promoting early autism detection and intervention in underserved communities : study protocol for a pragmatic trial using a stepped-wedge design. BMC Psychiatry ;2019 (Jun 7) ;19(1):169.

BACKGROUND : Despite the known benefits of early, specialized intervention for toddlers with Autism Spectrum Disorder (ASD), access to such intervention remains limited. This pragmatic trial examines a novel healthcare delivery model (Screen-Refer-Treat [SRT]), which capitalizes upon existing health care and early intervention (EI) infrastructure to increase community capacity for ASD detection and treatment before age 3, when it is likely to have the greatest impact. This model comprises three components : (1) universal use of Stage 1 ASD screening by primary care providers (PCPs) at 18-month well-child visits (i.e., Screen) ; (2) immediate referral of positive screens to a community-based EI program (i.e., Refer) ; and (3) provision of an inexpensive, evidence-based ASD-specialized treatment by EI providers, after verifying ASD risk with a Stage 2 screen (i.e., Treat). This paper describes our research design and the initial successes, challenges, and adaptations made during the early implementation phase. METHOD/DESIGN : A stepped-wedge cluster RCT was used to implement the SRT model sequentially in four diverse Washington State counties ("clusters"). Counties are randomly assigned to the time of receipt of the SRT intervention, which comprises training workshops and technical assistance focused on the use of evidence-based ASD screening and intervention tools. Separate cohorts of families with toddlers (16-35 months old) with and without ASD concerns are recruited before and after the SRT intervention from participating PCP practices and EI programs. PCPs and EI providers complete measures on their screening, referral, and intervention practices before and after the SRT intervention. Each family cohort completes surveys about their well-being, parenting efficacy, health care satisfaction, and toddler’s social-communicative behaviors. CONCLUSION : This trial is the first of its kind to work simultaneously with two service delivery systems with the goal of improving early detection and treatment for ASD. Our approach was successful in attaining buy-in from PCPs and EI providers, building and maintaining partnerships with providers, and achieving high levels of retention and survey completion. Fostering provider engagement and problem-solving issues together as partners were integral to overcoming the main challenges. Numerous lessons have been learned thus far, which have applicability for implementation researchers in ASD and those in other fields. TRIAL REGISTRATION : The registration number for this trial is NCT02409303 and it was posted on ClinicalTrials.gov on April 6, 2015.

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2. Kurt O, Kutlu M. Effectiveness of Social Stories in Teaching Abduction-Prevention Skills to Children with Autism. J Autism Dev Disord ;2019 (Jun 7)

The purpose of the present study was to examine the effectiveness of social stories in teaching abduction-prevention skills to children with autism spectrum disorder (ASD). Three male participants with ASD, aged 4-12 years, participated in the study, which was conducted using a multiple-probe-across-participants design. Thirty-nine voluntary adults participated in the study as strangers who presented lures to the participants. The findings of the study showed that social stories were effective on promoting acquisition for all students with ASD. All the participants were able to learn the target skill and maintain their learning. Social validity data were also collected from participants and their parents. Social validity findings revealed that the opinions of the participants and their parents were positive overall.

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3. Lukasik J, Patro-Golab B, Horvath A, Baron R, Szajewska H. Early Life Exposure to Antibiotics and Autism Spectrum Disorders : A Systematic Review. J Autism Dev Disord ;2019 (Jun 8)

We systematically reviewed evidence from observational studies on the associations between autism spectrum disorders (ASD) and early-life antibiotic exposure. Eleven articles were included in the review. Prenatal antibiotic exposure was associated with a slightly increased risk of ASD in two cohort studies on overlapping populations and in one case-control study ; in three other case-control studies, no significant association was found. One cohort study found a slightly reduced risk of ASD after postnatal antibiotic exposure, while two other cohort studies on overlapping populations and three case-control studies reported an increased risk. Meta-analysis of the eligible studies showed no significant associations. Current data are conflicting and do not conclusively support the hypothesis that early-life antibiotic exposure is associated with subsequent ASD development.

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4. Mosner MG, Kinard JL, Shah JS, McWeeny S, Greene RK, Lowery SC, Mazefsky CA, Dichter GS. Rates of Co-occurring Psychiatric Disorders in Autism Spectrum Disorder Using the Mini International Neuropsychiatric Interview. J Autism Dev Disord ;2019 (Jun 7)

Individuals with autism spectrum disorder (ASD) often meet criteria for at least one additional psychiatric disorder. The present study evaluated the utility of the Mini International Neuropsychiatric Interview (MINI) in assessing co-occurring psychiatric disorders in children, adolescents, and young adults with ASD. Ninety-one percent of children/adolescents and thirty-one percent of young adults were diagnosed with one or more co-occurring diagnoses using the MINI. MINI diagnostic rates were comparable to those found in the literature on children/adolescents with ASD ; however, in young adults, MINI diagnostic rates were lower relative to rates found in the literature on young adults with ASD. Implications for treatment, transitioning to adulthood, and the need for instruments developed specifically to diagnose co-occurring disorders in ASD are discussed.

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5. Printz JN, Mirkin KA, Hollenbeak CS, Carr MM. Morbidity after tonsillectomy in children with autism spectrum disorders. Am J Otolaryngol ;2019 (May 30)

OBJECTIVES : As the incidence of autism spectrum disorder (ASD) increases, otolaryngologists are more likely to encounter patients from this population during tonsillectomy. The purpose of this study was to examine whether outcomes differ between pediatric patients with and without ASD in a national cohort of children undergoing tonsillectomy. Understanding these differences may be used to inform future approaches to improve clinical outcomes and healthcare costs. METHODS : Data for this study were obtained from the Kids Inpatient Database (KID) of the Healthcare Cost Utilization Project. We studied pediatric patients who underwent tonsillectomy during 2003, 2006, 2009, and 2012. Tonsillectomy was identified using ICD-9-CM diagnosis codes 28.2 (tonsillectomy without adenoidectomy) and 28.3 (tonsillectomy with adenoidectomy). ASD was identified using ICD-9-CM diagnosis code 299 (autism). Outcomes including complications, length of hospital stay, and total hospitalization costs. Analyses were performed using multivariable models. Propensity score matching was used to control for covariate imbalance between patients with and without ASD. RESULTS : In our sample of 27,040 patients, 322 (1.2%) had a diagnosis of ASD. After controlling for potential confounders, multivariable modeling suggested patients with ASD had a shorter LOS of 0.50days (p<0.0001), were less likely to experience complications (odds ratio 0.57, p=0.001), and had lower associated costs of $1308 less (p<0.0001). Propensity score matching confirmed the findings of the multivariable modeling. CONCLUSION : Although ASD alone does not appear to confer additional costs or morbidity, differences between children with and without ASD suggest the need for providers to address patients with ASD uniquely.

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6. Thom RP, McDougle CJ, Hazen EP. Challenges in the Medical Care of Patients With Autism Spectrum Disorder : The Role of the Consultation-Liaison Psychiatrist. Psychosomatics ;2019 (Apr 28)

BACKGROUND : Autism spectrum disorder (ASD) is a common neurodevelopmental disorder that affects one in 40 children. Individuals with ASD have high rates of medical comorbidity, excess mortality, high health care expenditures, and difficulty accessing coordinated medical care. As the prevalence of ASD rises, consultation-liaison (C-L) psychiatrists will be increasingly called upon to assist patients with ASD both in inpatient and outpatient medical settings. METHODS : In this article, we review the patient, provider, and systems factors that converge to create challenges for delivering high-quality, patient-centered medical care for patients with ASD. CONCLUSION : Strategies to optimize the care of patients with ASD in medical settings, include previsit planning, anticipating and reducing sources of distress, facilitating a patient- and family-centered multidisciplinary approach, employing environmental interventions, and using psychopharmacologic treatments.

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7. Xiang AH, Chow T, Martinez MP, Getahun D, Page KA, Buchanan TA, Feldman RK. Hemoglobin A1c Levels During Pregnancy and Risk of Autism Spectrum Disorders in Offspring. Jama ;2019 (Jun 9)

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