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Therapy and Psychotropic Medication Use in Young Children With Autism Spectrum Disorder

BACKGROUND AND OBJECTIVES:

Guidelines suggest young children with autism spectrum disorder (ASD) receive intensive nonpharmacologic interventions. Additionally, associated symptoms may be treated with psychotropic medications. Actual intervention use by young children has not been well characterized. Our aim in this study was to describe interventions received by young children (3–6 years old) with ASD. The association with sociodemographic factors was also explored.

METHODS:

Data were analyzed from the Autism Speaks Autism Treatment Network (AS-ATN), a research registry of children with ASD from 17 sites in the United States and Canada. AS-ATN participants receive a diagnostic evaluation and treatment recommendations. Parents report intervention use at follow-up visits. At follow-up, 805 participants had data available about therapies received, and 613 had data available about medications received.

RESULTS:

The median total hours per week of therapy was 5.5 hours (interquartile range 2.0–15.0), and only 33.4% of participants were reported to be getting behaviorally based therapies. A univariate analysis and a multiple regression model predicting total therapy time showed that a diagnosis of ASD before enrollment in the AS-ATN was a significant predictor. Additionally, 16.3% of participants were on ≥1 psychotropic medication. A univariate analysis and a multiple logistic model predicting psychotropic medication use showed site region as a significant predictor.

CONCLUSIONS:

Relatively few young children with ASD are receiving behavioral therapies or total therapy hours at the recommended intensity. There is regional variability in psychotropic medication use. Further research is needed to improve access to evidence-based treatments for young children with ASD.




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Patient- and Family-Centered Care in the Emergency Department for Children With Autism

BACKGROUND:

Emergency department (ED) care processes and environments impose unique challenges for children with autism spectrum disorder (ASD). The implementation of patient- and family-centered care (PFCC) emerges as a priority for optimizing ED care. In this article, as part of a larger study, we explore PFCC in the context of ASD. Our aims were to examine how elements of PFCC were experienced and applied relative to ED care for children with ASD.

METHODS:

Qualitative interviews were conducted with parents and ED service providers, drawing on a grounded theory approach. Interviews were audio recorded, transcribed verbatim, and analyzed by using established constant comparison methods. Data were reviewed to appraise the reported presence or absence of PFCC components.

RESULTS:

Fifty-three stakeholders (31 parents of children with ASD and 22 ED service providers) participated in interviews. Results revealed the value of PFCC in autism-based ED care. Helpful attributes of care were a person-centered approach, staff knowledge about ASD, consultation with parents, and a child-focused environment. Conversely, a lack of staff knowledge and/or experience in ASD, inattention to parent expertise, insufficient communication, insufficient family orientation to the ED, an inaccessible environment, insufficient support, a lack of resources, and system rigidities were identified to impede the experience of care.

CONCLUSIONS:

Findings amplify PFCC as integral to effectively serving children with ASD and their families in the ED. Resources that specifically nurture PFCC emerge as practice and program priorities.




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Family Engagement in the Autism Treatment and Learning Health Networks

Family involvement in the Autism Intervention Research Network on Physical Health, the Autism Treatment Network, and the Autism Learning Health Network, jointly the Autism Networks, has evolved and grown into a meaningful and robust collaboration between families, providers, and researchers. Family involvement at the center of the networks includes both local and national network-wide coproduction and contribution. Family involvement includes actively co-authoring research proposals for large grants, equal membership of network committees and workgroups, and formulating quality improvement pathways for local recruitment efforts and other network initiatives. Although families are involved in every aspect of network activity, families have been the driving force of specifically challenging the networks to concentrate research, education, and dissemination efforts around 3 pillar initiatives of addressing comorbidities of anxiety, attention-deficit/hyperactivity disorder, and irritability in autism during the networks’ upcoming funding cycle. The expansion of the networks’ Extension for Community Healthcare Outcomes program is an exciting network initiative that brings best practices in autism care to community providers. As equal hub members of each Extension for Community Healthcare Outcomes team, families ensure that participants are intimately cognizant of family perspectives and goals. Self-advocacy involvement in the networks is emerging, with plans for each site to have self-advocacy representation by the spring of 2020 and ultimately forming their own coproduction committee. The Autism Treatment Network, the Autism Intervention Research Network on Physical Health, and the Autism Learning Health Network continue to be trailblazing organizations in how families are involved in the growth of their networks, production of meaningful research, and dissemination of information to providers and families regarding emerging work in autism spectrum disorders.




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Improving Behavior Challenges and Quality of Life in the Autism Learning Health Network

OBJECTIVES:

To summarize baseline data and lessons learned from the Autism Learning Health Network, designed to improve care and outcomes for children with autism spectrum disorder (ASD). We describe challenging behaviors, co-occurring medical conditions, quality of life (QoL), receipt of recommended health services, and next steps.

METHODS:

A cross-sectional study of children 3 to 12 years old with ASD receiving care at 13 sites. Parent-reported characteristics of children with ASD were collected as outcome measures aligned with our network’s aims of reducing rates of challenging behaviors, improving QoL, and ensuring receipt of recommended health services. Parents completed a survey about behavioral challenges, co-occurring conditions, health services, and the Patient-Reported Outcomes Measurement Information System Global Health Measure and the Aberrant Behavior Checklist to assess QoL and behavior symptoms, respectively.

RESULTS:

Analysis included 530 children. Challenging behaviors were reported by the majority of parents (93%), frequently noting attention-deficit/hyperactivity disorder symptoms, irritability, and anxiety. Mean (SD) scores on the Aberrant Behavior Checklist hyperactivity and irritability subscales were 17.9 (10.5) and 13.5 (9.2), respectively. The Patient-Reported Outcomes Measurement Information System Global Health Measure total score of 23.6 (3.7) was lower than scores reported in a general pediatric population. Most children had received recommended well-child (94%) and dental (85%) care in the past 12 months.

CONCLUSIONS:

This baseline data (1) affirmed the focus on addressing challenging behaviors; (2) prioritized 3 behavior domains, that of attention-deficit/hyperactivity disorder, irritability, and anxiety; and (3) identified targets for reducing severity of behaviors and strategies to improve data collection.




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Maternal and Child Health Bureaus Autism Research Program

OBJECTIVES:

To provide an overview and quantitatively demonstrate the reach of the Health Resources and Services Administration’s Maternal and Child Health Bureau autism research program.

METHODS:

We reviewed program reports and internal data from 59 autism research grantees. The US federal Interagency Autism Coordinating Committee’s strategic plan questions were used as a framework to highlight the contributions of the autism research program in advancing the field.

RESULTS:

The autism research program grantees advance research in several ways. Grantees have strengthened the evidence for autism interventions by conducting 89 studies at 79 distinct research sites. A total of 212 708 participants have enrolled in autism research program studies and 361 researchers have contributed to furthering autism research. The program addresses topics that align with the majority of the Interagency Autism Coordinating Committee’s priority topic areas, including advancements in treatments and interventions, services and supports, and identifying risk factors. Grantee products include 387 peer-reviewed publications, 19 tools, and 13 practice guidelines for improving care and intervention practices.

CONCLUSIONS:

The autism research program has contributed to medical advances in research, leveraged innovative training platforms to provide specialized training, and provided access to health services through research-based screening and diagnostic procedures. Autism research program studies have contributed to the development of evidence-based practice guidelines, informed policy guidelines, and quality improvement efforts to bolster advancements in the field. Although disparities still exist, the Health Resources and Services Administration’s Maternal and Child Health Bureau can reduce gaps in screening and diagnosis by targeting interventions to underserved populations including minority and rural communities.




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Editors Note and Prologue




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Understanding Gaps in Developmental Screening and Referral




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The Costs and Benefits of Regionalized Care for Children




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Red Cell Transfusion and Thrombotic Risk in Children




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Eosinophilic Pneumonia and Lymphadenopathy Associated With Vaping and Tetrahydrocannabinol Use

Idiopathic acute eosinophilic pneumonia is a rare and potentially life-threatening condition that is defined by bilateral pulmonary infiltrates and fever in the presence of pulmonary eosinophilia. It often presents acutely in previously healthy individuals and can be difficult to distinguish from infectious pneumonia. Although the exact etiology of idiopathic acute eosinophilic pneumonia remains unknown, an acute hypersensitivity reaction to an inhaled antigen is suggested, which is further supported by recent public health risks of vaping (electronic cigarette) use and the development of lung disease. In this case, a patient with a year-long history of vaping in conjunction with tetrahydrocannabinol cartridge use who was diagnosed with idiopathic acute eosinophilic pneumonia with associated bilateral hilar lymphadenopathy is described.




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Weakness, Anemia, and Neutropenia in a 9-Year-Old Girl With Influenza

A previously healthy 9-year-old immigrant girl from Mexico was evaluated in the emergency department (ED) with one week of fatigue, fevers, rhinorrhea, and cough. She initially presented to her primary pediatrician, where a complete blood count revealed neutropenia, prompting referral to the ED. In the ED, she was found to be influenza A–positive. Because of dehydration, she received intravenous fluids and was admitted to the pediatric hospital medicine service. After 2 days, influenza symptoms improved, and oral intake increased. However, she was noted to have decreased bilateral lower-extremity strength, absent Achilles reflexes, decreased lower-extremity sensation and proprioception, a positive result on the Romberg sign, and abnormal heel-to-shin testing results. These findings prompted an urgent neurology consultation. After extensive imaging, laboratory evaluation, and further consultations, a diagnosis was established.




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Diagnosis and Management of Polycystic Ovary Syndrome in Adolescents

Polycystic ovary syndrome (PCOS) is a common female reproductive disorder that often manifests during adolescence and is associated with disruptions in health-related quality of life. Prompt evaluation and clinical support after diagnosis may prevent associated complications and optimize overall health management. This article incorporates the most recent evidence and consensus guidelines to provide an updated review of the pathogenesis, clinical presentation, diagnostic evaluation, and management strategies for adolescents with this complex condition. We will review the recent international guidelines on PCOS; because the diagnosis of PCOS remains controversial, management of this condition is inconsistent. In 2019, PCOS remains a common, yet neglected, condition, in part, because of the lack of agreement around both diagnosis and management.




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Primary and Secondary Prevention of Youth Suicide

Youth suicide is a national and global public health crisis. Pediatricians can use primary and secondary prevention strategies to intervene with youth before or after the onset of suicidal behaviors. Universal suicide risk screening programs can be used to identify youth in medical settings who may otherwise pass through the health care setting with undetected suicide risk. Pediatricians are uniquely positioned to help foster resilience in their young patients and equip families of at-risk youth with safety plans and lethal means safety counseling. Pediatricians on the frontlines of this critical public health crisis require education and training in detecting suicide risk, managing those who screen positive, and connecting their patients to much needed mental health interventions and treatments. Evidence-based suicide risk screening and assessment tools, paired with interventions, are feasible and potentially life-saving in the medical setting.




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Technology Use for Adolescent Health and Wellness

As avid users of technology, adolescents are a key demographic to engage when designing and developing technology applications for health. There are multiple opportunities for improving adolescent health, from promoting preventive behaviors to providing guidance for adolescents with chronic illness in supporting treatment adherence and transition to adult health care systems. This article will provide a brief overview of current technologies and then highlight new technologies being used specifically for adolescent health, such as artificial intelligence, virtual and augmented reality, and machine learning. Because there is paucity of evidence in this field, we will make recommendations for future research.




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Marijuana Legalization and Youth

Various states have legalized marijuana for medical purposes and/or decriminalized recreational marijuana use. These changes coincide with a decrease in perceived harmfulness of the drug and an increase in its use among youth. This change is of critical concern because of the potential harmful impact of marijuana exposure on adolescents. Marijuana use has been associated with several adverse mental health outcomes, including increased incidence of addiction and comorbid substance use, suicidality, and new-onset psychosis. Negative impacts on cognition and academic performance have also been observed. As the trend toward legalization continues, the pediatric community will be called on to navigate the subsequent challenges that arise with changing policies. Pediatricians are uniquely positioned to provide innovative care and educate youth and families on the ever-evolving issues pertaining to the impact of marijuana legalization on communities. In this article, we present and analyze the most up-to-date data on the effects of legalization on adolescent marijuana use, the effects of adolescent use on mental health and cognitive outcomes, and the current interventions being recommended for use in pediatric office settings.




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Management of Opioid Misuse and Opioid Use Disorders Among Youth

In response to the growing impact of the current opioid public health crisis in the United States on adolescents and young adults, pediatricians have an expanding role in identifying opioid use early, preventing escalation of risky use, reducing opioid-related harms, and delivering effective therapies. Research and expert consensus suggest the use of brief interventions focused on reducing risks associated with ongoing opioid use and using motivational interviewing strategies to engage youth in treatment. Because fatal opioid overdose remains a major cause of opioid-related mortality among youth, delivering overdose education as part of any visit in which a youth endorses opioid use is one evidence-based strategy to decrease the burden of opioid-related mortality. For youth that are injecting opioids, safe injection practices and linkage to needle or syringe exchanges should be considered to reduce complications from injection drug use. It is crucial that youth be offered treatment at the time of diagnosis of an opioid use disorder (OUD), including medications, behavioral interventions, and/or referral to mutual support groups. The 2 medications commonly used for office-based OUD treatment in adolescents are extended-release naltrexone (opioid antagonist) and buprenorphine (partial opioid agonist), although there is a significant treatment gap in prescribing these medications to youth, especially adolescents <18 years of age. Addiction is a pediatric disease that pediatricians and adolescent medicine physicians are uniquely poised to manage, given their expertise in longitudinal, preventive, and family- and patient-centered care. Growing evidence supports the need for integration of OUD treatment into primary care.




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Meet Anna with OM Ireland

Canadian by birth, but Papua New Guinean at heart, Anna Stanton shares how God led her to serve with OM Ireland.




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Golf and the gospel

OM Ireland and FCA Golf hold a four-day golf camp in Co. Westmeath, Ireland, to promote golf and the gospel.




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Impacting Ireland

Participants from all over the world joined together in Ireland for two weeks of training and outreach in partnership with local churches.




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Camel and donkey preach the gospel to thousands

OM Ireland's two multi-media puppet shows perform over 75 times in schools around Ireland. The gospel message is expected to be heard by thousands.




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OM Sweden and OM Ireland team up over Easter

OM Sweden joined OM Ireland for outreach over the Easter holiday in Carlow town.




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Trained and equipped in Ireland

Through training at OM, Rebecca became more confident sharing Jesus in her home country.




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The truth and rain

The Africa Trek team reaches out to the Damara people in Namibia.




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Standing on the Father's Rock

Young men from African nations find their identity and destiny through hiking in Namibia with the Wilderness Therapy Programme.




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Life and light on the Kuiseb

Two native Namibians stand as the only Christians in their community




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Time of growth and change at TeenStreet

God changes teens' lives during TeenStreet Queensland in Australia at the beginning of July.




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Prayer and the Word of God changes lives

OM worker is amazed to see God change lives, as he peers over his book table on a busy Muslim street in Australia.




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More than coffee and sweets

MAP Australia hosts Bound for Paradise, a week-long outreach to Muslims from the Persian Gulf in Queensland, Australia, from 25-29 August.




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Lost and found

God restores a lost bag to the OM team during a short-term outreach to school children in northern Russia.




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Teaching spiritual and physical fitness

An OM Ukraine sports team member helps young Ukrainian women gain a healthier understanding and appreciation of the bodies God gave them.




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War, winter and witnesses in the Ukraine

Ministering in a country at war is not fun – but a privilege. Ukraine is going through intense emotions and people are open to Kingdom conversations.




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OM lending a hand to start the healing

OM supported the Ukrainian Military Ministry in order to print trauma counselling books




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New Soccer and sports ministry in Odessa, Ukraine

Through the "Lighthouse" soccer team, Maksim Shlikov is reaching out to young orphanage graduates looking for meaning and hope.




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Failing business man finds hope and purpose

A welder's life is renewed in Kaharlyk, Ukraine through a new business opportunity with OM.




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Bus4Life brings literature and life to Europe

Bus4Life is OM’s mobile missions centre to the unreached people of Central and Eastern Europe, bringing books and also participating in summer programmes, as it did in summer 2017.




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Over 60 villages and only four churches

OM Ukraine team gets excited about church planting in a northern Odessa province after participating in a Bus4Life outreach in the area.




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Others need to know and get involved

After a trip to repair war damaged churches in the east, construction workers share their experience in order to inspire others to go.




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Burkas and saris in western Panama

A former student of OM Panama brings the world to her small church in western Panama.




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Protection and forgiveness

A man goes from being sought by gangsters to being sought by God.




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Loved and not forgotten

Workers of OM Panama remind young boys with a troubled past that God has a purpose for their lives.




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Young, achingly hip and social media savvy: welcome to the world of Scotland's fashion influencers

Founded by Wendy H Gilmour in 2011, Thankfifi began as a fashion blog and has since grown to cover lifestyle, travel and interiors.




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Fin24.com | MONEY CLINIC: I've been forced into early retirement and can't afford to repay my debt, what can I do?

A Fin24 user who was forced into early retirement is struggling to pay credit card debt amounting to over R109 000. An expert responds.




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Fin24.com | MONEY CLINIC: Can we invest our retirement annuity without a broker, and negotiate fees charged?

A Fin24 reader looking to invest in a living annuity, was shocked to find that she would have to pay fees of up to R110 000 per annum. She wants to know if there are other options. An investment expert responds.




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The 10 best places to get a burger in Scotland

ONCE a staple of drive-thrus and fast food restaurants, burgers have had something of an image overhaul in recent years.




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Days Out: Scotland’s top 10 winter walks for foodies

Quiet, crisp and clear winter days are perfect for exploring Scotland’s most spectacular coast and countryside scenery – especially with the promise of a wholesome, heart-warming meal and a cosy room after a day exploring. While Munro-bagging at this time of year might be a little too ambitious, Scotland has no shortage of shorter and more gentle winter walks, all within a stone’s throw of some of Scotland’s best foodie destinations. Here is a selection of Scotland’s top 10 winter walk




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Let's have lifetime bans for gobby cinema and theatre goers

"I'M hungry."




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'A mesmerising voice that commands your undivided attention': A Thousand Moons by Sebastian Barry

A Thousand Moons




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Scottish independence: Coronavirus is a blow to Indyref2 and changes the Scottish political landscape

IT is a truth universally acknowledged – at least by its advocates – that all things inexorably advance the cause of independence.




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How to Use Microsoft Cortana on iOS and Android

Need a virtual assistant that can work between your PC and mobile device? Cortana can handle your questions and requests on iOS, Android, and Windows 10.




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How to Subscribe to Podcasts on iOS, Mac, and iTunes

Apple's Podcasts app is available on mobile and the desktop, but in macOS Catalina, a new standalone Podcasts app replaces iTunes. Here's how to subscribe, listen, and adjust settings on iOS, iPadOS, iTunes, and Mac.