Guillermo Montes

Psychological Functioning and Coping Among Mothers of Children With Autism: A Population-Based Study

OBJECTIVES. Studies suggest that having a child with autism has a negative impact on maternal psychological functioning, but no large-scale, population-based studies are available. The objectives of this study were to (1) describe the psychological functioning, physical and mental health, family communication, and parenting support of mothers of a child with autism compared with other mothers on a population basis and (2) assess the independent relationship between having a child with autism and these outcomes, controlling for the childs social skills and demographic background. METHODS. Mothers of 61772 children who were 4 to 17 years of age were surveyed by the National Survey of Childrens Health, 2003. Autism was measured from an affirmative maternal response to the question, “Has a doctor or health professional ever told you your child has autism?” There were 364 children with autism in the sample. RESULTS. Mothers of a child with autism were highly stressed and more likely to report poor or fair mental health than mothers in the general population, even after adjustment for the childs social skills and demographic background. However, mothers of a child with autism were more likely to report a close relationship and better coping with parenting tasks and less likely to report being angry with their child after adjustment for the childs social skills and demographic background. Having a child with autism was not associated with lower social support for parenting, an altered manner in which serious disagreements were discussed in the household, or increased violence in the household. CONCLUSION. Mothers of children with autism showed remarkable strengths in the parent–child relationship, social support, and stability of the household in the context of high stress and poorer mental health.

Association of Childhood Autism Spectrum Disorders and Loss of Family Income

BACKGROUND. Parents of children with autism have significant out-of-pocket expenditures related to their childs care. The impact of having a child with autism on household income is not known. OBJECTIVE. The purpose of this work was to estimate the loss of household income associated with childhood autism using a nationally representative sample. METHODS. Parents of 11684 children enrolled in kindergarten to eighth grade were surveyed by the National Household Education Survey-After School Programs and Activities in 2005. An autism spectrum disorder was defined as an affirmative response to the questions, “has a health professional told you that [child] has any of the following disabilities? 1) autism? 2) pervasive developmental disorder or PDD?” There were 131 children with autism spectrum disorder in the sample and 2775 children with other disabilities. We used ordinal logistic regression analyses to estimate the expected income of families of children with autism given their education level and demographic characteristics and compared the expected income with their reported income. RESULTS. Both having a child with autism spectrum disorder and having a child with other disabilities were associated with decreased odds of living in a higher income household after controlling for parental education, type of family, parental age, location of the household, and minority ethnicity. The average loss of annual income associated with having a child with autism spectrum disorder was

Access to and Satisfaction With School and Community Health Services for US Children With ASD

6200 or 14% of their reported income. CONCLUSION. Childhood autism is associated with a substantial loss of annual household income. This likely places a significant burden on families in the face of additional out-of-pocket expenditures.

Child Care Problems and Employment Among Families With Preschool-Aged Children With Autism in the United States

OBJECTIVE: Our objective was to compare access to and satisfaction with school and community health resources among families with a child with an autism spectrum disorder (ASD) and families of other children with special health care needs (CSHCN). METHODS: Parents of 40256 children aged 0 to 17 were surveyed by the 2005–2006 National Survey of Children With Special Health Care Needs. Autism was defined by the question, “To the best of your knowledge, does (child) currently have autism or autism spectrum disorder, that is, ASD?” We used χ2 and multivariate regression analyses to compare access to and satisfaction with services for parents of children with ASDs and parents of other CSHCN. RESULTS: Children with ASDs (n = 2123) comprise 5.4% of the CSHCN. More parents of children with ASDs reported difficulty using school and community services (27.6% vs 9.7%) and dissatisfaction (19.8% vs 7.9%) than parents of other CSHCN. Multivariate models determined that parents of children with ASDs were 3.39 times more likely to experience difficulty in obtaining services and 2.65 times more likely to be dissatisfied with services received than parents of other CSHCN, after controlling for household demographics and insurance status. Parents of children with ASDs reported a lack of available services and skilled providers. CONCLUSIONS: Parents of children with ASDs reported less access to and more dissatisfaction with school and community health services than parents of other CSHCN. An increased supply of appropriate services with qualified providers for children with ASDs is needed in the United States.

The Impact of Health Insurance Gaps on Access to Care Among Children with Asthma in the United States

BACKGROUND. The impact of childhood autism on parental employment is largely unknown. OBJECTIVE. The purpose of this work was to describe the child care arrangements of children with autism and to determine whether families of preschool-aged children with autism are more likely to report that child care arrangements affected employment compared with typically developing children and children at high risk for developmental problems. METHODS. Parents of 16282 preschool-aged children were surveyed by the National Survey of Childrens Health. An autism spectrum disorder was defined as an affirmative response to the question, “Has a doctor or health professional ever told you that [child] has any of the following conditions? Autism?” There were 82 children with autism spectrum disorder in the sample, and 1955 children at high risk on the basis of the Parents Evaluation of Developmental Status. We used χ2 and multivariate logistic regression analyses. RESULTS. Ninety-seven percent of preschool-aged children diagnosed with autism spectrum disorder were cared for in community settings, particularly preschool and Head Start, with only 3% in exclusive parental care. Thirty-nine percent of the parents of children with autism spectrum disorder reported that child care problems had greatly affected their employment decisions, compared with 16% of the children at high risk and 9% of those who were typically developing. In multivariate analyses, families with a child with autism spectrum disorder were 7 times more likely to state that child care problems affected employment than other families, after controlling for household and child covariates. This effect was 3 times larger than the effect of poverty. CONCLUSIONS. Developmental problems and autism spectrum disorder are associated with higher use of child care services and higher probability that child care problems will greatly affect employment. These findings warrant evaluation of the community resources available to families with children with special needs.

School Readiness Among Urban Children With Asthma

BACKGROUND Health insurance coverage is important to help assure children appropriate access to medical care and preventive services. Insurance gaps could be particularly problematic for children with asthma, since appropriate preventive care for these children depends on frequent, consistent contacts with health care providers. OBJECTIVE The aim of this study was to determine the association between insurance gaps and access to care among a nationally representative sample of children with asthma. METHODS The National Survey of Childrens Health provided parent-report data for 8097 children with asthma. We identified children with continuous public or continuous private insurance and defined 3 groups with gaps in insurance coverage: those currently insured who had a lapse in coverage during the prior 12 months (gained insurance), those currently uninsured who had been insured at some time during the prior 12 months (lost insurance), and those with no health insurance at all during the prior 12 months (full-year uninsured). RESULTS Thirteen percent of children had coverage gaps (7% gained insurance, 4% lost insurance, and 2% were full-year uninsured). Many children with gaps in coverage had unmet needs for care (7.4%, 12.8%, and 15.1% among the gained insurance, lost insurance, and full-year uninsured groups, respectively). In multivariate models, we found significant associations between insurance gaps and every indicator of poor access to care among this population. CONCLUSIONS Many children with asthma have unmet health care needs and poor access to consistent primary care, and lack of continuous health insurance coverage may play an important role. Efforts are needed to ensure uninterrupted coverage for these children.

Characteristics of school-age children with autism

BACKGROUND Children with chronic illnesses, including asthma, are at risk for school problems. Developmental problems, however, may begin before school entry, and the developmental status of preschool children with asthma has not been evaluated. OBJECTIVE To test the hypothesis that urban preschool children with asthma have lower parent-reported developmental scores compared with children without asthma. METHODS A comprehensive survey of children beginning kindergarten in 1998 in the urban school system in Rochester, NY, collected parent reports of demographic, medical, and developmental data. We compared children with asthma with and without limitation of activity to children without asthma for motor, language, socioemotional, and school readiness skills and the need for extra help with learning. Linear and logistic regression were used to determine associations between asthma and developmental outcomes. RESULTS Among the 1058 children in this sample, 9% had asthma, including 5% with asthma with limitation of activity. After adjustment for multiple potential confounding variables, the children with asthma with limitation had lower scores on school readiness skills compared with children without asthma (2.0 vs 2.5, P <.001). Further, the parents of children with asthma with limitation were substantially more likely (P <.05) to describe them as needing extra help with learning (74% vs 56%; odds ratio, 3.2; 95% confidence interval, 1.5--7.8). CONCLUSIONS Urban preschool children with significant asthma had poorer parent-reported school readiness skills and a greater need for extra help with learning compared with children without asthma. This finding suggests that developmental problems for children with asthma may begin before school entry.

Screening for Environmental Tobacco Smoke Exposure among Inner City Children with Asthma

ABSTRACT The objectives of this study were to provide a national profile of children with autism, to describe the impact of autism on school functioning, and to describe the utilization of services among children with autism. We performed a cross-sectional descriptive analysis of 9583 children (grades K-8) from the 2001 National Household Education Survey Before and After School Survey. We used parent-reported information to determine the prevalence of autism, and children with autism were compared to children without autism on sociodemographic measures and several measures of school functioning and utilization of services. The prevalence of autism in this sample was 66 per 10,000. Children with autism were proportionately represented in all communities and all regions of the country. While children with autism were equally likely to attend public schools compared to children without autism, they were significantly more likely to have learning difficulties and to carry multiple diagnoses, including attention deficit disorder and learning disability. Most of these children received services for their disability through the school district. In conclusion, data from this survey yielded a prevalence estimate of autism similar to other recent studies. Children with autism have performance and behavior problems that persist despite the availability of services to the majority of children. The important needs of these children warrant further attention.

Generalization of the Child Observation Record: A Validity Study for Diverse Samples of Urban, Low-Income Preschool Children.

OBJECTIVES. The goals were (1) to develop an index measure of environmental tobacco smoke based on parent self-report of smoking behaviors and (2) to determine whether the index score was associated with childrens present and future cotinine levels. METHODS. Data were drawn from a community intervention for inner-city children with persistent asthma (N = 226; response rate: 72%). Measures of child salivary cotinine levels and parent self-reported environmental tobacco smoke-related behaviors were obtained at baseline and 7 to 9 months later. To develop the index score, we used a 15-fold cross-validation method, with 70% of our data, that considered combinations of smoke exposure variables and controlled for demographic features. We chose the most parsimonious model that minimized the mean square predictive error. The resulting index score included primary caregiver smoking and home smoking ban status. We validated our model with the remaining 30% of the data. Analysis of variance and multivariate analyses were used to determine the association of the index score with childrens cotinine levels. RESULTS. Fifty-four percent of children with asthma lived with ≥1 smoker, and 51% of caregivers reported a complete home smoking ban. The childrens mean baseline cotinine level was 1.55 ng/mL (range: 0.0–21.3 ng/mL). Childrens baseline and follow-up cotinine levels increased as scores on the index measure increased. In a linear regression, the index score was significantly positively associated with childrens cotinine measurements at baseline and 7 to 9 months later. CONCLUSION. An index measure with combined information regarding primary caregiver smoking and household smoking restrictions helped to identify children with asthma with the greatest exposure to environmental tobacco smoke and could predict which children would have elevated cotinine levels 7 to 9 months later.

School readiness among children with behavior problems at entrance into kindergarten: results from a US national study.

The present investigation addressed the construct validity of the Child Observation Record (COR) with low-income urban preschool children. From two separate samples representing low-income preschool children, COR ratings were analyzed using multivariate techniques. Independent analyses from these two urban sites yielded a three-dimensional structure: Cognitive Skills, Social Engagement, and Coordinated Movement. Further analyses cross-validated this structure for males and females and across ethnic groups. Concurrent assessments provided convergent and discriminant validity for the Social Engagement dimension and convergent validity for Cognitive Skills dimension. Analyses of item distributions of the 5-point developmental sequences represented by the 30 COR items were used to examine the assumption that all the distributions were continuous unimodal distributions. Findings did not universally support this assumption revealing some irregular distributions with troughs in the mid-range of continua. Implications of the findings for early childhood assessment of vulnerable children and future research were discussed.