Issues related to the diagnosis and treatment of autism spectrum disorder

Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin 53705, USA.
Mental Retardation and Developmental Disabilities Research Reviews (Impact Factor: 3.8). 01/2007; 13(2):129-35. DOI: 10.1002/mrdd.20143
Source: PubMed


This paper explores issues and implications for diagnosis and treatment, stemming from the growing number of children identified with autism spectrum disorders (ASDs). Recent developments and innovations in special education and Medicaid programs are emphasized. Eligibility determination policies, innovations in diagnostic practices, the cost and financing of assessment, variability among programs in diagnostic criteria, and racial/ethnic disparities in the timing of diagnosis all influence the capacity of service systems to provide diagnoses in a timely, coordinated, accurate, economical, and equitable manner. There are several barriers to the more widespread provision of intensive intervention for children with ASDs, including lack of strong evidence of effectiveness in scaled-up public programs, uncertainty about the extent of obligations to provide services under the Individuals with Disabilities Education Act, high cost of intervention, and variability among states in their willingness to fund intensive intervention via Medicaid. Innovative policy experiments with respect to financing intensive intervention through schools and Medicaid are being conducted in a number of states.

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    • "Although these studies may not estimate the actual prevalence of the disorder among Latinos (Mandell et al.), they do provide evidence of differences in rates of diagnosis of ASD between Latinos and other groups. Multiple factors may contribute to the differential rates of ASD diagnosis between Latinos and other groups including a lack of information about developmental disabilities and autism in Latino communities (Mercadante et al. 2009) and financial barriers in accessing diagnostic services (e.g., no insurance or funds; Shattuck and Grosse 2007). Further, diagnostic clinics are often unable to serve children of Spanish speaking parents because they do not employ bilingual professionals and because diagnostic instruments have not been culturally adapted for the Latino population, raising questions regarding validity (Williams et al. 2009). "
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    ABSTRACT: Abstract There is greater identification of children with autism spectrum disorders (ASD) and, as a result, more attention to specialty services to address the challenges children with ASD face. Along with the growth in identification of ASD is a growth in the population of Latino children, yet there is some evidence that disparities exist in diagnosis and services between Latino and non-Latino White children. This study further documents these disparities and investigates the mechanisms that may contribute to them. Diagnosis and specialty services were compared between 48 Latino and 56 non-Latino White children diagnosed with ASD, and factors that contribute to differences are explored. Results show that Latino children were diagnosed almost one year later than White children, received fewer specialty services, and had higher unmet service needs. Factors that accounted for differences in the number of services received were maternal level of education and the number of sources of knowledge about autism. Findings suggest that service providers need to work to provide greater awareness and knowledge about autism, and make services more accessible to Latino families.
    Intellectual and Developmental Disabilities 06/2013; 51(3):141-53. DOI:10.1352/1934-9556-51.3.141 · 1.13 Impact Factor
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    • "The combination of increasing numbers of children identified with autism and increased advocacy for interventions that community practitioners often are ill-equipped to provide has created a crisis (Shattuck and Grosse 2007). Researchers often assume that this crisis can be resolved through the development of interventions, which will be disseminated automatically once efficacy is ascertained; however, efficacious treatments are rarely adopted or successfully implemented in community settings (Proctor et al. 2009), leading researchers to conclude that the " pipeline " model assumes an unrealistic progression from efficacy to uptake (Proctor et al. 2009; Schoenwald and Hoagwood 2001; Weisz et al. 2004). "
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    ABSTRACT: There is growing evidence that efficacious interventions for autism are rarely adopted or successfully implemented in public mental health and education systems. We propose applying diffusion of innovation theory to further our understanding of why this is the case. We pose a practical set of questions that administrators face as they decide about the use of interventions. Using literature from autism intervention and dissemination science, we describe reasons why efficacious interventions for autism are rarely adopted, implemented, and maintained in community settings, all revolving around the perceived fit between the intervention and the needs and capacities of the setting. Finally, we suggest strategies for intervention development that may increase the probability that these interventions will be used in real-world settings.
    Journal of Autism and Developmental Disorders 05/2011; 41(5):597-609. DOI:10.1007/s10803-010-1081-0 · 3.06 Impact Factor
    • "Social support can enhance views of family members concerning their family structure and optimistic viewpoints are important in the development of helpful coping strategies for eventual family adaptation (Folkman & Moskowitz, 2000). Parents of children with autism often find that community support is not equally accessible by every family that needs help (Shattuck & Grosse, 2007). If parents of children with autism find themselves living in an area where community support programs are unavailable, or if parents find themselves unable to attend meetings, parents will depend upon family members and community members to strengthen them as they learn to parent, cope, and adapt (Bailey, Nelson, Hebbeler, & Spiker, 2007). "
    Journal of Pediatric Nursing 04/2010; 25(2):e17. DOI:10.1016/j.pedn.2009.12.052 · 1.01 Impact Factor
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