Sarah Carter Narendorf

Postsecondary Education and Employment Among Youth With an Autism Spectrum Disorder

OBJECTIVES: We examined the prevalence and correlates of postsecondary education and employment among youth with an autism spectrum disorder (ASD). METHODS: Data were from a nationally representative survey of parents, guardians, and young adults with an ASD. Participation in postsecondary employment, college, or vocational education and lack of participation in any of these activities were examined. Rates were compared with those of youth in 3 other eligibility categories: speech/language impairment, learning disability, and mental retardation. Logistic regression was used to examine correlates of each outcome. RESULTS: For youth with an ASD, 34.7% had attended college and 55.1% had held paid employment during the first 6 years after high school. More than 50% of youth who had left high school in the past 2 years had no participation in employment or education. Youth with an ASD had the lowest rates of participation in employment and the highest rates of no participation compared with youth in other disability categories. Higher income and higher functional ability were associated with higher adjusted odds of participation in postsecondary employment and education. CONCLUSIONS: Youth with an ASD have poor postsecondary employment and education outcomes, especially in the first 2 years after high school. Those from lower-income families and those with greater functional impairments are at heightened risk for poor outcomes. Further research is needed to understand how transition planning before high school exit can facilitate a better connection to productive postsecondary activities.

Bullying Involvement and Autism Spectrum Disorders: Prevalence and Correlates of Bullying Involvement Among Adolescents With an Autism Spectrum Disorder

OBJECTIVES To produce nationally representative estimates for rates of bullying involvement among adolescents with an autism spectrum disorder (ASD), to compare population estimates with adolescents who have other developmental disabilities, and to identify social ecological correlates of bullying involvement. DESIGN Nationally representative surveys from 2001. SETTING United States. PARTICIPANTS Parents of adolescents with an ASD, principals of the schools they attended, and staff members most familiar with their school programs. MAIN EXPOSURE Autism spectrum disorders. MAIN OUTCOME MEASURES Parent report of victimization, perpetration, and victimization/perpetration within the past school year. RESULTS The prevalence rates of bullying involvement for adolescents with an ASD were 46.3% for victimization, 14.8% for perpetration, and 8.9% for victimization/perpetration. Victimization was related to having a non-Hispanic ethnicity, attention-deficit/hyperactivity disorder, lower social skills, some form of conversational ability, and more classes in general education. Correlates of perpetration included being white, having attention-deficit/hyperactivity disorder, and getting together with friends at least once a week. Victimization/perpetration was associated with being white non-Hispanic, having attention-deficit/hyperactivity disorder, and getting together with friends at least once a week. CONCLUSIONS School-based bullying interventions need to target the core deficits of ASD (conversational ability and social skills) and comorbid conditions (eg, attention-deficit/hyperactivity disorder). Future bullying interventions also need to address the higher rates of victimization that occur in general education settings by increasing social integration into protective peer groups and increasing the empathy and social skills of typically developing students toward their peers with an ASD.

Prevalence and Correlates of Psychotropic Medication Use in Adolescents with an Autism Spectrum Disorder with and without Caregiver-Reported Attention-Deficit/Hyperactivity Disorder

BACKGROUND Many youths with an autism spectrum disorder (ASD) benefit from psychotropic medication treatment of co-morbid symptom patterns consistent with attention-deficit/hyperactivity disorder (ADHD). The lack of clear indications and algorithms to direct clinical practice has led to a very poor understanding of overall medication use for these youths. The present study examined the prevalence of psychotropic medication use compared across individuals with an ASD without a caregiver-reported ADHD diagnosis (ASD-only), ADHD without ASD (ADHD-only), and an ASD with co-morbid ADHD (ASD+ADHD). Correlates of medication use were also examined. METHODS Data on psychotropic medication from the first wave of the National Longitudinal Transition Study 2, a nationally representative study of adolescents ages 13-17 in special education, were used to compare the prevalence of medication use across the three groups, overall and by class. Separate logistic regression models were constructed for each group to examine the correlates of psychotropic medication use. Poisson regression models were used to examine correlates of the number of medications. RESULTS Youths with ASD+ADHD had the highest rates of use (58.2%), followed by youths with ADHD-only (49.0%) and youths with ASD-only (34.3%). Youths with an ASD, both ASD-only and ASD+ADHD, used medications across a variety of medication classes, whereas stimulants were dominant among youths with ADHD-only. African American youths with ASD-only and with ASD+ADHD were less likely to receive medication than white youths, whereas race was not associated with medication use in the ADHD-only group. CONCLUSIONS Clearer practice parameters for ADHD have likely contributed to more consistency in treatment, whereas treatment for ASD reflects a trial and error approach based on associated symptom patterns. Additional studies examining the treatment of core and associated ASD symptoms are needed to guide pharmacologic treatment of these youths. Interventions targeting African American youths with ASD and the physicians who serve them are also warranted.

Mental health service use among adolescents with an autism spectrum disorder.

OBJECTIVE This study examined prevalence and correlates of mental health service use among adolescents with an autism spectrum disorder. METHODS Data from the National Longitudinal Transition Study-2 were used to examine mental health service use among 920 youths with this disorder. Estimates are nationally representative of students enrolled in the special education autism category. Regression models examined the association of predisposing, enabling, and need factors with service use overall and with a focus on receiving these services at school. RESULTS Overall, 46% (weighted) of the youths had used a mental health service in the past year. Of those who had, 49% (weighted) had received it at school. Need variables were the strongest correlates of service use. African-American youths and youths from lower-income families were more likely to receive school-based services. CONCLUSIONS Schools played a key role in providing services, especially for vulnerable populations. Focused attention on youths with an autism spectrum disorder is needed to ensure continuity of care as youths leave high school.

Synthesizing Gender Based HIV Interventions in Sub-Sahara Africa: A Systematic Review of the Evidence

Gender is a critical component of HIV and sexual risk interventions. Examining the range, effectiveness and methodological rigor of studies that include a gender based component can inform current interventions and future directions for intervention research. This review investigated gender informed intervention studies conducted in sub-Saharan Africa that measured an outcome related to HIV. We reviewed 311 articles, 41 of which met our inclusion criteria, resulting in 11 articles that described eight different studies used in the analyses. The findings demonstrated wide variations in the types of interventions from low intensity educational content to multi-component interventions. Study outcomes were categorized into biological outcomes, HIV risk, behavioral, violence and risk reduction. Most interventions showed positive effects, and although research methodologies varied considerably, longer interventions appeared to be more effective. More research, however, is needed to build the evidence base for effectiveness of gender-based programs in reducing HIV infections in sub-Saharan Africa.ResumenEl género es un componente crítico del VIH y las intervenciones de riesgo sexual. Examinando el rango, la eficacia y el rigor metodológico de los estudios que incluyen un componente basado de género puede informar a las intervenciones actuales y a las futuras direcciones para la intervención investigativa.Esta revisóin investigó los estudios de intervención fundamentadas en género llevadas a cabo en África subsahariana, que medía un resultado relacionado con el VIH. Se revisaron 311 artículos, 41 de los cuales cumplieron con los criterios de inclusión, lo que resulta en 11 artículos que describían 8 diferentes estudios utilizados en los análisis. Los resultados demostraron amplias variaciones en los tipos de intervenciones desde baja intensidad en el contenido educativo a intervenciones de múltiples componentes. Los resultados del estudio se clasificaron en los resultados biológicos, riesgos del VIH, del comportamiento, la violencia y la reducción de riesgos. La mayoría de las intervenciones mostraron efectos positivos, y a pesar de las metodologías de investigación varían considerablemente, las intervenciones más largas parecían para ser más eficaces. Sin embargo, más investigación es necesaria para construir la base de pruebas para eficacia de los programas relacionados con el género en la reducción de infecciones por VIH en África subsahariana.

Relations between mental health diagnoses, mental health treatment, and substance use in homeless youth

BACKGROUND Youth experiencing homelessness have elevated rates of mental illness and substance use compared to the general population. However, the extent to which underlying mental health issues may contribute to substance use as a way to manage symptoms and whether mental health treatment may reduce risk for substance use is unclear. This paper investigated these relations in a community sample of homeless youth. METHODS Youth ages 13-24 (N=416) were interviewed as part of a community count and survey of homeless youth in Houston, Texas. A path analysis examined relations among lifetime diagnoses of ADHD, bipolar disorder, and depression; past-month marijuana, alcohol, and synthetic marijuana use, and hypothesized mediators of past-year mental health treatment and perceived unmet need for treatment. RESULTS Rates of prior mental disorder diagnoses were high, with extensive comorbidity across the three diagnoses (n=114, 27.3% had all three diagnoses). Relations varied by diagnoses and substances. ADHD was positively related to current marijuana use (β=0.55 (0.16), p<0.001), a relation that mental health treatment did not mediate. Depression was positively related to synthetic marijuana use through unmet need (β=0.25 (0.09), p=0.004) and to alcohol use through unmet need (β=0.20 (0.10), p=0.04) CONCLUSIONS: This study provides new information about relations between prior mental health diagnoses and substance use in homeless youth. Findings support the need to consider prior mental disorder diagnoses in relation to current substance use and to assess for whether youth perceive they have unmet needs for mental health treatment.

Perception of Need and Receipt of Mental Health Treatment: A Three-Group Comparison of Young Adults With Psychological Distress

OBJECTIVE This study examined mental health service use among three groups of young adults with assessed psychological distress: no perceived need for treatment, reported unmet need, and received treatment. METHODS Data came from participants ages 18 to 25 in the National Survey on Drug Use and Health (2008-2013) who met criteria for psychological distress (N=19,775). Demographic, access-, and need-related predictors of perceived need and treatment group were examined by using multinomial logistic regression. RESULTS Half the sample did not perceive a need for treatment (51.0%), and only one-third had received treatment (33.7%). White youths were more likely than those from other racial-ethnic groups to perceive a need and to receive treatment. Men were less likely than women to perceive need but equally likely to receive treatment. Higher education and having insurance also predicted treatment receipt. CONCLUSIONS Efforts to increase service utilization among young adults should increase awareness of mental health problems and facilitate access, particularly for racial-ethnic minority groups.

Pioneering the Psychiatric Nurse Role in Foster Care

Older youth served in the foster care system have elevated rates of mental health disorders and are high users of mental health services, yet concerns have been raised about the quality of this care. This paper describes the details of a psychiatric nurses work within a multidisciplinary team to address gaps in care for older youth with psychiatric disorders. We describe the process, outcomes, and lessons learned in developing and piloting a psychiatric nurse intervention for older youth in the foster care system as part of a multidimensional treatment foster care program. Our experiences support further work to develop a role for nursing to improve the quality of mental health treatment in foster care.

Parenting and Homeless: Profiles of Young Adult Mothers and Fathers in Unstable Housing Situations

Young adults who are pregnant or parents are a vulnerable subgroup of the homeless population, yet there is limited research about their specific service needs. To fill this gap, we used data from a survey of homeless and unstably housed young adults, ages 18–24, collected over 4 weeks in Houston, Texas, to examine the characteristics, risk factors, and protective factors of homeless parents (n = 109) compared to other homeless young adults (n = 243), then differences between mothers (n = 61) and fathers (n = 48). Unique risk and protective profiles for homeless parents were identified, as well as differences between mothers and fathers. Implications for service delivery targeted to the unique needs of young adult homeless mothers and fathers are discussed.

Perspectives on Psychotropic Medication Treatment Among Young Adults Formerly Served in Public Systems of Care: A Thematic and Narrative Analysis

This study examines the perspectives of psychotropic medications held by young adults with mood disorder diagnoses. This article presents an analysis of qualitative interviews with 52 young adults who had been involved with public systems of care during adolescence and had used psychiatric medications. A concatenated analytic approach was used. First, we used a thematic analysis across cases, then a narrative analysis within selected cases. Two main themes emerged from the thematic analysis that captured aspects of the experience of taking medication. First, young adults described the effects of the medications and how they thought the medications were working. They described the impact on their moods, thinking, bodies, and functioning, and the ways in which these effects related to their lives. Second, the process of taking medications emerged as an important aspect of the medication treatment experience, including the trial-and-error nature of treatment and interactions with psychiatrists. The narrative analysis within cases identified that some youth created a medication narrative composed of three elements: why medications were needed, what medications do, and participants’ outlook on future medication use. These narratives are helpful in understanding prior patterns of service use and are instructive in framing young people’s future intentions to use medications. Findings support the importance of eliciting the perspectives of young adults about their treatment and ensuring that services are designed and delivered in developmentally appropriate ways tailored to this group.