Pubmed du 30/12/17

samedi 30 décembre 2017

1. Candon MK, Barry CL, Epstein AJ, Marcus SC, Kennedy-Hendricks A, Xie M, Mandell DS. The Differential Effects of Insurance Mandates on Health Care Spending for Children’s Autism Spectrum Disorder. Medical care. 2017.

OBJECTIVES : There is substantial variation in treatment intensity among children with autism spectrum disorder (ASD). This study asks whether policies that target health care utilization for ASD affect children differentially based on this variation. Specifically, we examine the impact of state-level insurance mandates that require commercial insurers to cover certain treatments for ASD for any fully-insured plan. METHODS : Using insurance claims between 2008 and 2012 from three national insurers, we used a difference-in-differences approach to compare children with ASD who were subject to mandates to children with ASD who were not. To allow for differential effects, we estimated quantile regressions that evaluate the impact of mandates across the spending distributions of three outcomes : (1) monthly spending on ASD-specific outpatient services, (2) monthly spending on ASD-specific inpatient services, and (3) quarterly spending on psychotropic medications. RESULTS : The change in spending on ASD-specific outpatient services attributable to mandates varied based on the child’s level of spending. For those children with ASD who were subject to the mandate, monthly spending for a child in the 95th percentile of the ASD-specific outpatient spending distribution increased by $1460 (P<0.001). In contrast, the effect was only $2 per month for a child in the fifth percentile (P<0.001). Mandates did not significantly affect spending on ASD-specific inpatient services or psychotropic medications. CONCLUSIONS : State-level insurance mandates have larger effects for those children with higher levels of spending. To the extent that spending approximates treatment intensity and the underlying severity of ASD, these results suggest that mandates target children with greater service needs.

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2. Eack SM, Hogarty SS, Greenwald DP, Litschge MY, Porton SA, Mazefsky CA, Minshew NJ. Cognitive enhancement therapy for adult autism spectrum disorder : Results of an 18-month randomized clinical trial. Autism Res. 2017.

Cognitive remediation is a promising approach to treating core cognitive deficits in adults with autism, but rigorously controlled trials of comprehensive interventions that target both social and non-social cognition over a sufficient period of time to impact functioning are lacking. This study examined the efficacy of cognitive enhancement therapy (CET) for improving core cognitive and employment outcomes in adult autism. Verbal adult outpatients with autism spectrum disorder (N = 54) were randomized to an 18-month, single-blind trial of CET, a cognitive remediation approach that integrates computer-based neurocognitive training with group-based training in social cognition, or an active enriched supportive therapy (EST) comparison focused on psychoeducation and condition management. Primary outcomes were composite indexes of neurocognitive and social-cognitive change. Competitive employment was a secondary outcome. Intent-to-treat analyses indicated that CET produced significant differential increases in neurocognitive function relative to EST (d = .46, P = .013). Both CET and EST were associated with large social-cognitive improvements, with CET demonstrating an advantage at 9 (d = .58, P = 0.020), but not 18 months (d = .27, P = 0.298). Effects on employment indicated that participants treated with CET were significantly more likely to gain competitive employment than those in EST, OR = 6.21, P = 0.023, which was mediated by cognitive improvement. CET is a feasible and potentially effective treatment for core cognitive deficits in adult autism spectrum disorder. The treatment of cognitive impairments in this population can contribute to meaningful improvements in adult outcomes. Autism Res 2017. (c) 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY : Cognitive enhancement therapy (CET), an 18-month cognitive remediation intervention designed to improve thinking and social understanding, was found to be more effective than supportive therapy at improving mental quickness, attention, and employment in adults living with autism. Social understanding was equally improved in CET and supportive therapy. Cognitive remediation interventions are feasible and may confer significant functional benefits to adults with autism.

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3. Nagar I, Gupta A. Examining Discrepancy between Performance on Traditional Measures and Parent Report Measure of Executive Functioning in Autism Spectrum Disorder. Indian journal of psychological medicine. 2017 ; 39(6) : 813-6.

There is a growing concern amongst the researchers regarding the ecological validity of the neuropsychological tests used to assess EF in ASD. Traditional EF tests have been criticized for not being unable to tap real-life scenarios that are relevant to and representative of everyday behavior. The present study aimed to examine any potential discrepancy between performance on traditional measures of executive function and behavioural expressions of EF in case of an individual with High Functioning Autism (HFA). The findings highlight the importance of use of ecologically valid measures to gain a more valid assessment of executive functions.

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4. Ryan S, Lai J, Weiss JA. Mental Health Service Use Among Youth with Autism Spectrum Disorder : A Comparison of Two Age Groups. J Dev Behav Pediatr. 2018 ; 39(1) : 20-7.

OBJECTIVE : Although youth with autism have elevated rates of mental health problems compared to typically developing youth, little is known about the mental health services that they receive. The current study examines predisposing, enabling, and clinical need factors as they relate to mental health service use in youth with autism. METHODS : The current study surveyed parents of 2337 children and adolescents with autism, compared their access to behavioral management and mental health treatment (MHT), and isolated the correlates of such receipt. RESULTS : Children used behavioral management more than adolescents, whereas the opposite was true for MHT. Mental health treatment receipt was associated with caregiver-related and mental health problems in both age groups, with routine health service use in children and with behavioral problems in adolescents. Behavioral management was correlated with caregiver-related services and behavioral problems in both age groups, and with sex and intellectual disability in adolescents. CONCLUSION : Clinical needs and caregiver service use are consistently associated with mental health care across ages, whereas the role of youth characteristics is particularly relevant when considering service use for adolescents.

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5. Shenoy MD, Indla V, Reddy H. Comprehensive Management of Autism : Current Evidence. Indian journal of psychological medicine. 2017 ; 39(6) : 727-31.

Autism is a neurodevelopmental disorder characterized by impaired social interaction, verbal and nonverbal communication, and restricted repetitive behavior. The goals of treatment are to target core behaviors, improve social interactions and communication, and reduce disruptive behavior. The present paper discusses the role of applied behavioral analysis and pharmacotherapy.

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