Irina Zamora

Autism assessment in children with optic nerve hypoplasia and other vision impairments

This study examined the utility of standard autism diagnostic measures in nine children (aged 5–9y) with severe vision impairment and a range of social and language functioning.

How Sex of Children with Autism Spectrum Disorders and Access to Treatment Services Relates to Parental Stress

Parents of children with autism spectrum disorders (ASD) experience higher levels of stress in comparison to parents of neurotypical children and consequently are more susceptible to negative health and social outcomes (Dunn et al., 2001). However, less is known about how individual child characteristics impact stress levels in parents of children with ASD. In this study, we examined the relationship between individual characteristics (i.e., sex) of children with ASD and parental stress. Access to comprehensive treatment services was also examined as a contributing factor to parental stress. Parenting stress was higher for parents of girls than for parents of boys, and for parents of girls (but not boys) fewer services predicted higher parental distress. Findings highlight the importance of providing parents of girls with ASD with more tailored support.

Phenotype of 7q11.23 duplication: A family clinical series.

Duplication 7q11.23 syndrome is the reciprocal of Williams–Beuren deletion syndrome. Studies have reported a recognizable phenotype, including autism, intellectual disability, speech, and language delay, social anxiety, and behavioral difficulties in these individuals. Previous studies revealed a variety of craniofacial abnormalities, brain malformations, and cardiac abnormalities, including aortic dilation. This patient series evaluates five family members aged 2 months to 35 years, all with confirmed 7q11.23 duplication syndrome. All had characteristic craniofacial findings and joint hyperextensibility, and three experienced broken bones/fractures with minimal trauma. Other features included frequent headaches, sleep problems, hydrocephalus, and in two of the children, mildly dilated aortic root, and ascending aorta. Psychological test results reveal borderline to low average nonverbal cognitive abilities and speech and language delays. All five family members with 7q11.23 syndrome meet criteria for autism spectrum disorder. Adaptive functioning is impaired for all four children, but higher for the childrens father. The infant shows developmental delays in language and motor skills, but some improvements in reciprocal social behaviors over time. Two children exhibit hyperactivity and inattention, and the father and second youngest child exhibit anxiety. This family clinical series contributes to the growing literature on the phenotype of 7q11.23 microduplication syndrome across the age range. Physicians are encouraged to urge focused medical surveillance and intensive early intervention targeting speech‐language and social reciprocity.

Clinical considerations in the psychological assessment of bilingual young children.

As the United States population continues to grow in cultural and linguistic diversity, many psychologists are left with important questions related to accurate and valid assessment practices. Although many of these questions are beginning to be addressed through the publication of newly normed measures and best-practice guidelines, few of these publications have focused on assessment with very young children. Accurate assessment in early childhood is vital to the identification of early intervention and mental health needs. Given the scarcity of appropriately normed psychological and developmental measures, along with limited published guidelines available for making adaptations to existing resources, young children being raised in non-English-speaking homes are at risk for misdiagnosis. The authors addressed this concern by providing clinical considerations for assessment with young children (ages 0–5) and families who speak languages other than English. These considerations have been informed by an interdisciplinary infant mental health perspective, drawing largely from the fields of psychology and speech–language pathology. The authors illustrated each key point throughout the various phases of assessment with a clinical case vignette, including diagnostic classification and cultural formulation using the newly revised Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (ZERO TO THREE, 2017a).

Broad Developmental Screening Misses Young Children With Social-Emotional Needs:

Many pediatricians use a broad developmental screening test as part of well-child care, but do not specifically screen for behavioral and emotional disorders. Parents at 2 urban community agencies completed both the Ages and Stages Questionnaire (ASQ-3) and the Ages and Stages Questionnaire: Social Emotional (ASQ:SE) for 608 children, ages 2 to 60 months; 51.8% in Spanish. Less than half of the children with a positive screen on the ASQ:SE would have been identified as needing additional assessment or intervention if only the ASQ-3 had been administered. Younger children with positive ASQ:SE screens were significantly less likely to be referred for mental health services compared with older children. Physicians should consider screening all young children for social-emotional and behavioral needs, and referring those identified for infant and early childhood mental health services.

Parent-Reported Strengths in Children with Autism Spectrum Disorders at the Time of an Interdisciplinary Diagnostic Evaluation

Objective: Parents of children with autism spectrum disorders (ASD) often focus on concerns in discussions with health care providers. However, studying child strengths and positive parental attributions is an emerging area of focus and not often highlighted in many studies with children with ASD. The objective of this study was to identify parent-reported strengths in a sample of children with ASD. Methods: This was a qualitative study of parent report of strengths in clinical notes with children between the ages 3 and 8 presenting for a team diagnostic evaluation and meeting the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV-Text Revision (TR) or DSM-V diagnostic criteria for ASD. The reported childs strengths were qualitatively analyzed, coded, and clustered into themes. Results: Ninety-eight charts were reviewed. Five meta-themes of strengths were identified: Personality Characteristics, Social Personality, Cognitive Functioning, Behavioral Characteristics/Coping Mechanisms, and Skills. On average, parents reported more strengths in the Cognitive Functioning and Personality Characteristics meta-themes. Conclusion: Pediatricians have a unique opportunity to discuss parental positive perceptions of children with ASD and to learn about their strengths.

Developmental Screening and Referrals: Assessing the Influence of Provider Specialty, Training, and Interagency Communication:

Previous studies have shown that different provider approaches, amount of familiarity with the referral and screening process, and level of interagency communication can increase or decrease the likelihood of caregivers completing a recommended referral to early intervention (EI). We surveyed 60 family practitioners and pediatricians at 2 primary care clinics to assess these factors. Pediatricians were more likely than family practitioners to report using, evaluating, and discussing the results of developmental screens. Providers with more experience and recent training expressed more confidence in their ability to describe the EI system to families. Most providers expressed a lack of confidence in their own agency to complete referrals or EI to provide follow-up. The knowledge gaps and communication problems identified in this study could serve as a basis for future interventional work.