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Find video protocols related to scientific articles indexed in Pubmed.
Services for children with autism spectrum disorder in three, large urban school districts: Perspectives of parents and educators.
Autism
PUBLISHED: 09-05-2014
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This study used qualitative methods to evaluate the perceptions of parents, educators, and school administrators in three large, urban school districts (Los Angeles, Philadelphia, and Rochester) regarding services for children with autism spectrum disorder within the context of limited district resources. Facilitators followed a standard discussion guide that contained open-ended questions regarding participants' views on strengths and limitations of existing services and contextual factors that would facilitate or inhibit the process of introducing new interventions. Three primary themes were identified: (1) tension between participant groups (teachers and paraprofessionals, staff and administration, teachers and parents, special education and general education teachers), (2) necessity of autism spectrum disorder-specific and behavioral training for school personnel, and (3) desire for a school culture of accepting difference. These themes highlight the importance of developing trainings that are feasible to deliver on a large scale, that focus on practical interventions, and that enhance communication and relationships of school personnel with one another and with families.
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Home- and community-based waivers for children with autism: effects on service use and costs.
Intellect Dev Disabil
PUBLISHED: 07-26-2014
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We examined (a) the associations between Medicaid home and community-based waiver participation and service use and expenditures among children with ASD; and (b) how states' waiver spending moderates these effects. We used 2005 Medicaid claims to identify a sample of children with autism spectrum disorder (ASD). We selected two comparison groups who had no waiver participation: (a) children who were eligible for Medicaid through disability (disability group), and (b) children who had at least one inpatient/long-term care (IP/LT) episode (IP/LT group). Waiver participants were less likely to use IP/LT services and had lower associated expenditures than the disability group. As states' waiver spending increased, waiver participants became increasingly less likely to use IP/LT services. Waiver participants had more outpatient visits and associated expenditures; this difference increased as state waiver spending increased. Compared with the IP/LT group, waiver participants had lower IP/LT expenditures, more outpatient visits, and associated expenditures. Higher state waiver generosity increased this effect on outpatient visits and expenditures.
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Costs of autism spectrum disorders in the United Kingdom and the United States.
JAMA Pediatr
PUBLISHED: 06-10-2014
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The economic effect of autism spectrum disorders (ASDs) on individuals with the disorder, their families, and society as a whole is poorly understood and has not been updated in light of recent findings.
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Pediatric Sialendoscopy: Initial experience in a pediatric otolaryngology group practice.
Laryngoscope
PUBLISHED: 04-27-2014
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To describe the initial results of sialendoscopy as a diagnostic and therapeutic tool in pediatric inflammatory salivary gland disease.
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Sex differences in the timing of identification among children and adults with autism spectrum disorders.
J Autism Dev Disord
PUBLISHED: 10-22-2013
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To examine differences by sex in the timing of identification of individuals with autism spectrum disorders (ASD), survey data were collected in the Netherlands from 2,275 males and females with autistic disorder, Aspergers syndrome and PDD-NOS. Among participants < 18 years of age, females with Aspergers syndrome were identified later than males. Among participants ? 18 years of age, females with autistic disorder were identified later than males. In more recent years, girls with Aspergers syndrome are diagnosed later than boys, confirming earlier findings. In adults, the delayed timing of diagnosis in females with autistic disorder may be related to changing practices in diagnosis over time. Strategies for changing clinician behaviour to improve recognition of ASD in females are needed.
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Healthcare service use and costs for autism spectrum disorder: a comparison between medicaid and private insurance.
J Autism Dev Disord
PUBLISHED: 10-22-2013
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Healthcare costs and service use for autism spectrum disorder (ASD) were compared between Medicaid and private insurance, using 2003 insurance claims data in 24 states. In terms of costs and service use per child with ASD, Medicaid had higher total healthcare costs ($22,653 vs. $5,254), higher ASD-specific costs ($7,438 vs. $928), higher psychotropic medication costs($1,468 vs. $875), more speech therapy visits (13.0 vs. 3.6 visits), more occupational/physical therapy visits (6.4 vs. 0.9 visits), and more behavior modification/social skills visits (3.8 vs. 1.1 visits) than private insurance (all p < 0.0001). In multivariate analysis, being enrolled in Medicaid had the largest effect on costs, after controlling for other variables. The findings emphasize the need for continued efforts to improve private insurance coverage of autism.
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Age-related variation in health service use and associated expenditures among children with autism.
J Autism Dev Disord
PUBLISHED: 10-18-2013
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This study examined differences by age in service use and associated expenditures during 2005 for Medicaid-enrolled children with autism spectrum disorders. Aging was associated with significantly higher use and costs for restrictive, institution-based care and lower use and costs for community-based therapeutic services. Total expenditures increased by 5 % with each year of age; by 23 % between 3-5 and 6-11 year olds, 23 % between 6-11 and 12-16, and 14 % between 12-16 and 17-20 year olds. Use of and expenditures for long-term care, psychiatric medications, case management, medication management, day treatment/partial hospitalization, and respite services increased with age; use of and expenditures for occupational/physical therapy, speech therapy, mental health services, diagnostic/assessment services, and family therapy declined.
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Correlation of cognitive and social outcomes among children with autism spectrum disorder in a randomized trial of behavioral intervention.
Autism
PUBLISHED: 10-08-2013
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Although social impairments are considered the hallmark deficit of autism, many behavioral intervention studies rely on cognitive functioning as a primary outcome. Fewer studies have examined whether changes in cognition are associated with changes in social functioning. This study examined whether cognitive gains among 192 students from 47 kindergarten-through-second-grade autism support classrooms participating in a year-long behavioral intervention study were associated with gains in social functioning. Childrens gains in cognitive ability were modestly associated with independent assessors and teachers evaluations of social functioning but were not associated with changes in parent ratings. Observed social gains were not commensurate with gains in cognition, suggesting the need both for interventions that directly target social functioning and relevant field measures of social functioning.
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How States use medicaid to fund community-based services to children with autism spectrum disorders.
Psychiatr Serv
PUBLISHED: 10-02-2013
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This study examined the extent to which state Medicaid agencies funded 16 services for children with autism spectrum disorders: individual therapy, physical and occupational therapy, in-home supports, speech therapy, diagnostic assessment, behavior modification, family therapy, case management, targeted case management, respite, day treatment, social skills training, habilitation services, treatment planning, family education and training, and assistive communication devices.
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Korean culture and autism spectrum disorders.
J Autism Dev Disord
PUBLISHED: 08-16-2013
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This paper reviews the literature on early child development among Koreans, with a focus on autism spectrum disorders (ASD). The literature review of 951 abstracts in English, 101 abstracts in Korean and 27 full articles published from 1994 to 2011 was performed to understand the presentation of and response to ASD in Korean culture. Based on research to date on the identification, description, and treatment of ASD in Korean populations, we argue that at both conceptual and practical levels, early child development and interventions must be understood within cultural context. Culturally informed research on ASD is vital for increasing awareness of the importance of early intervention and the need for educational and psychological services in countries in which autism is stigmatized, misdiagnosed or undiagnosed.
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Parental depressive symptoms and childrens school attendance and emergency department use: a nationally representative study.
Matern Child Health J
PUBLISHED: 07-05-2013
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We sought to assess the association between parental depressive symptoms and school attendance and emergency department (ED) use among children with and without chronic health conditions. Secondary analysis of the 1997-2004 National Health Interview Survey, a nationally representative survey. Parental depressive symptoms were measured by three questions assessing sadness, hopelessness, or worthlessness in the past month. Children with and without asthma or attention-deficit/hyperactivity disorder (ADHD) were identified, and their school attendance and ED visits were reported by adult household respondents. Children with information on parental depressive symptoms, health conditions, and services use were eligible. We incorporated weights available in the survey for each eligible child to reflect the complex sampling design. 104,930 eligible children were identified. The point prevalence of parental depressive symptoms was low (1.8 %, 95 % CI 1.7-2.0), but greater among children with asthma (2.7 %, 95 % CI 2.4-3.0) and ADHD (3.8 %, 95 % CI 3.2-4.4) than among other children (1.6 %, 95 % CI 1.5-1.7). After adjustment for potential confounders, children whose parents reported depressive symptoms most or all of the time were more likely to report an ED visit (adjusted incident rate ratio [IRR] 1.18, 95 % CI 1.06-1.32) or school absence (adjusted IRR 1.36, 95 % CI 1.14-1.63) than children whose parents did not. The effect of parental depressive symptoms was not modified by child health conditions. Parental depressive symptoms were adversely associated with school attendance and ED use in children. These results suggest the importance of measuring depressive symptoms among adult caregivers of children.
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School-based mental health program evaluation: childrens school outcomes and acute mental health service use.
J Sch Health
PUBLISHED: 06-21-2013
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This study examined the impact of school-based mental health programs on childrens school outcomes and the utilization of acute mental health services.
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Explaining differences in age at autism spectrum disorder diagnosis: A critical review.
Autism
PUBLISHED: 06-20-2013
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The diagnosis of autism is often delayed, which translates into a missed opportunity to provide treatment during a critical developmental period. This study reviews studies that assessed factors associated with age at autism spectrum disorder diagnosis and provides recommendations on future research, programs, and policies to improve early detection. A search for all peer-reviewed articles containing the words autism, age, and diagnosis in either the title or abstract was performed. A total of 42 studies published from January 1990 through March 2012 were identified. Mean age at diagnosis for all autism spectrum disorders ranged from 38 to 120 months and has decreased over time. Factors associated with earlier diagnosis included greater symptom severity, high socioeconomic status, and greater parental concern about initial symptoms. Family interactions with the health and education systems prior to diagnosis also influenced age at diagnosis. Geographic variation in age at autism spectrum disorder diagnosis was identified in a number of studies, suggesting that community resources and state policies play a role in early identification. Early detection efforts should include enhanced parental and provider education on the early recognition of developmental problems, interventions aimed at streamlining the process from first concern to eventual diagnosis, and strategies that target underserved populations.
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Childrens compliance with American Academy of Pediatrics well-child care visit guidelines and the early detection of autism.
J Autism Dev Disord
PUBLISHED: 04-27-2013
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This study estimated compliance with American Academy of Pediatrics (AAP) guidelines for well-child care and the association between compliance and age at diagnosis in a national sample of Medicaid-enrolled children with autism (N = 1,475). Mixed effects linear regression was used to assess the relationship between compliance and age at diagnosis. Mean age at diagnosis was 37.4 (SD 8.4) months, and mean compliance was 55 % (SD 33 %). Children whose care was compliant with AAP guidelines were diagnosed 1.6 months earlier than children who received no well-child care. Findings support that the timely receipt of well-child care may contribute to earlier detection. Additional research on the contribution of compliance, well-child visit components and provider characteristics on the timely diagnosis of autism is needed.
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Implementation challenges in translating pivotal response training into community settings.
J Autism Dev Disord
PUBLISHED: 04-27-2013
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Implementing evidence-based practices (EBPs) for children with autism is challenging for teachers because these practices are often complex, requiring significant training and resources that are not available in most school settings. This brief investigation was designed to identify areas of strength and difficulty for teachers implementing one such EBP, pivotal response training (PRT). Observational data were gathered from 41 teachers participating in two separate investigations involving PRT. Despite differences in training procedures, teachers demonstrated similarities in areas of strength (clear opportunities/instruction and child choice) and difficulty (turn taking and multiple cues). These findings suggest next steps toward systematic adaptation of PRT for classroom use. The research may serve as a model for the process of adapting EBPs for practice settings.
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The role of treatment fidelity on outcomes during a randomized field trial of an autism intervention.
Autism
PUBLISHED: 04-16-2013
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This randomized field trial comparing Strategies for Teaching based on Autism Research and Structured Teaching enrolled educators in 33 kindergarten-through-second-grade autism support classrooms and 119 students, aged 5-8 years in the School District of Philadelphia. Students were assessed at the beginning and end of the academic year using the Differential Ability Scales. Program fidelity was measured through video coding and use of a checklist. Outcomes were assessed using linear regression with random effects for classroom and student. Average fidelity was 57% in Strategies for Teaching based on Autism Research classrooms and 48% in Structured Teaching classrooms. There was a 9.2-point (standard deviation = 9.6) increase in Differential Ability Scales score over the 8-month study period, but no main effect of program. There was a significant interaction between fidelity and group. In classrooms with either low or high program fidelity, students in Strategies for Teaching based on Autism Research experienced a greater gain in Differential Ability Scales score than students in Structured Teaching (11.2 vs. 5.5 points and 11.3 vs. 8.9 points, respectively). In classrooms with moderate fidelity, students in Structured Teaching experienced a greater gain than students in Strategies for Teaching based on Autism Research (10.1 vs. 4.4 points). The results suggest significant variability in implementation of evidence-based practices, even with supports, and also suggest the need to address challenging issues related to implementation measurement in community settings.
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Policy to implementation: evidence-based practice in community mental health--study protocol.
Implement Sci
PUBLISHED: 02-23-2013
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Evidence-based treatments (EBTs) are not widely available in community mental health settings. In response to the call for implementation of evidence-based treatments in the United States, states and counties have mandated behavioral health reform through policies and other initiatives. Evaluations of the impact of these policies on implementation are rare. A systems transformation about to occur in Philadelphia, Pennsylvania, offers an important opportunity to prospectively study implementation in response to a policy mandate.
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Genetic testing and genetic counseling among medicaid-enrolled children with autism spectrum disorder in 2001 and 2007.
Hum. Genet.
PUBLISHED: 01-04-2013
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The rise in the prevalence of autism spectrum disorder (ASD) has resulted in increased efforts to understand the causes of this complex set of disorders that emerge early in childhood. Although research in this area is underway and yielding useful, but complex information about ASD, guidelines for the use of genetic testing and counseling among children with ASD conflict. The purpose of this study was to determine the frequency of use of genetic testing and counseling before the widespread implementation of clinical chromosomal microarray (CMA) to establish a baseline for the use of both services and to investigate potential disparities in the use of both services among children with ASD. We found that about two-thirds of children with ASD received genetic testing or counseling and the use of both services is increasing with time, even in the pre-CMA era. Being female and having a comorbid intellectual disability diagnosis both increased the likelihood of receiving genetic testing and genetic counseling. Initial discrepancies in the use of both services based on race/ethnicity suggest that troubling disparities observed in other services delivered to children with ASD and other mental health disorders persist in genetic testing and counseling as well. These results should incentivize further investigation of the impact of genetic testing and counseling on children with ASD and their families, and should drive efforts to explore and confront disparities in the delivery of these services, particularly with the advancing scientific research on this topic.
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Homelessness and Childrens Use of Mental Health Services: A Population-Based Study.
Child Youth Serv Rev
PUBLISHED: 10-26-2011
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This study examined whether children who become homeless differ from other low-income children in their mental health service use before and after their first homeless episode, and to what extent homelessness is associated with an increased likelihood of mental health service use. Differences between children with and without new onset of sheltered homelessness in the use of mental health services emerged following homelessness and widened over time. Sheltered homelessness and foster care placement history were associated with increased odds of receiving inpatient and ambulatory mental health services. Findings underscore the importance of collaborations between homeless assistance, foster care, and mental healthcare in efforts to mitigate family homelessness and collateral needs among homeless children.
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Prevalence and correlates of autism in a state psychiatric hospital.
Autism
PUBLISHED: 08-16-2011
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This study estimated the ASD prevalence in a psychiatric hospital and evaluated the Social Responsiveness Scale (SRS) combined with other information for differential diagnosis. Chart review, SRS and clinical interviews were collected for 141 patients at one hospital. Diagnosis was determined at case conference. Receiver operating characteristic (ROC) curves were used to evaluate the SRS as a screening instrument. Chi-squared Automatic Interaction Detector (CHAID) analysis estimated the role of other variables, in combination with the SRS, in separating cases and non-cases. Ten percent of the sample had ASD. More than other patients, their onset was prior to 12 years of age, they had gait problems and intellectual disability, and were less likely to have a history of criminal involvement or substance abuse. Sensitivity (0.86) and specificity (0.60) of the SRS were maximized at a score of 84. Adding age of onset < 12 years and cigarette use among those with SRS <80 increased sensitivity to 1.00 without lowering specificity. Adding a history substance abuse among those with SRS >80 increased specificity to 0.90 but dropped sensitivity to 0.79. Undiagnosed ASD may be common in psychiatric hospitals. The SRS, combined with other information, may discriminate well between ASD and other disorders.
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Access and outcomes for persons with psychotic and affective disorders receiving vocational rehabilitation services.
Psychiatr Serv
PUBLISHED: 07-05-2011
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This study examined the extent to which individuals with psychotic and affective disorders have access to vocational rehabilitation (VR) services and their employment and entitlement outcomes relative to persons with other disabilities.
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Were all in this together now: group performance feedback to increase classroom team data collection.
J Sch Psychol
PUBLISHED: 04-01-2011
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This studys primary goal was to evaluate the use of performance feedback procedures delivered to a classroom team to increase daily data collection. Performance feedback (PFB) was delivered to four classroom teams responsible for the daily collection of data representing student performance during prescribed instructional activities. Using a multiple-baseline design, the effects of the team performance-feedback were evaluated for the target student, and for generalization to data collection for all classroom students. A secondary question evaluated if student on-task behavior correlated with increased data collection. Finally, social validity was investigated to evaluate team satisfaction with the PFB intervention. The results demonstrate improved data collection across all four classroom teams for the target student in each classroom and generalization within classrooms to all remaining students. Slight increases in student on-task behavior were observed in three of the four classrooms, and teacher satisfaction ratings were high.
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Delayed Parkinsons disease diagnosis among African-Americans: the role of reporting of disability.
Neuroepidemiology
PUBLISHED: 01-29-2011
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Racial differences in the observed prevalence of Parkinsons disease (PD) may be due to delayed diagnosis among African-Americans. We sought to compare the stage at which African-American and white PD patients present for healthcare, and determine whether perception of disability accounts for racial differences.
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Interaction effect of Medicaid census and nursing home characteristics on quality of psychosocial care for residents.
Health Care Manage Rev
PUBLISHED: 01-15-2011
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Numerous studies have identified disparities in nursing home quality of care. Although previous studies have found the overlap among Medicaid census, nursing home characteristics, and negative quality of care outcomes, few studies have examined how the psychosocial well-being of nursing home residents is associated with Medicaid census and other nursing home characteristics.
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Age of diagnosis among Medicaid-enrolled children with autism, 2001-2004.
Psychiatr Serv
PUBLISHED: 08-03-2010
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This study examined child- and county-level factors associated with age of diagnosis of autism among Medicaid-enrolled children and the change in age of diagnosis over time.
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Impact of stoma maturation on pediatric tracheostomy-related complications.
Arch. Otolaryngol. Head Neck Surg.
PUBLISHED: 05-19-2010
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To assess the impact of stoma maturation on pediatric tracheostomy-related complications and to report the incidence of pediatric tracheostomy-related complications.
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County-level variation in the prevalence of medicaid-enrolled children with autism spectrum disorders.
J Autism Dev Disord
PUBLISHED: 03-03-2010
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This study examined how county-level resources are associated with the identification of children with autism spectrum disorders (ASD) in Medicaid. Medicaid claims from 2004 were combined with county-level data. There were 61,891 children diagnosed with ASD in the Medicaid system in 2004. Counties with lower per-student education expenditures, more students, a greater proportion of students in special education, higher per capita number of pediatricians and pediatric specialists, and a greater proportion of Medicaid enrollees and white residents had higher Medicaid prevalence. Within states, counties differ in how they implement Medicaid policies. The results suggest the substitution of education and Medicaid-reimbursed services. Our findings highlight the need for geographically targeted outreach to minority groups and clinicians to improve recognition of ASD.
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Assessment of constipation in children with tracheostomy.
Arch. Otolaryngol. Head Neck Surg.
PUBLISHED: 01-20-2010
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To determine the prevalence of constipation among children with tracheostomy tubes compared with children without tracheostomy tubes. We theorize that patients with tracheostomy may be unable to achieve adequate subglottic pressure for the Valsalva maneuver, which may contribute to constipation.
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Sleep behaviors and sleep quality in children with autism spectrum disorders.
Sleep
PUBLISHED: 12-23-2009
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(1) Compare sleep behaviors of children with autism spectrum disorders (ASD) with sleep behaviors of typically developing (TD) children using the Childrens Sleep Habits Questionnaire (CSHQ); (2) compare sleep quality--defined as mean activity, sleep latency, number of awakenings, sleep efficiency and total sleep time--of the cohort of children with ASD and TD, as measured by 10 nights of actigraphy; and (3) estimate the prevalence of sleep disturbances in the ASD and TD cohorts.
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Explaining low rates of autism among Hispanic schoolchildren in Texas.
Am J Public Health
PUBLISHED: 12-17-2009
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In data from the Texas Educational Agency and the Health Resources and Services Administration, we found fewer autism diagnoses in school districts with higher percentages of Hispanic children. Our results are consistent with previous reports of autism rates 2 to 3 times as high among non-Hispanic Whites as among Hispanics. Socioeconomic factors failed to explain lower autism prevalence among Hispanic schoolchildren in Texas. These findings raise questions: Is autism underdiagnosed among Hispanics? Are there protective factors associated with Hispanic ethnicity?
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Autism.
Lancet
PUBLISHED: 10-12-2009
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Autism spectrum disorders are characterised by severe deficits in socialisation, communication, and repetitive or unusual behaviours. Increases over time in the frequency of these disorders (to present rates of about 60 cases per 10,000 children) might be attributable to factors such as new administrative classifications, policy and practice changes, and increased awareness. Surveillance and screening strategies for early identification could enable early treatment and improved outcomes. Autism spectrum disorders are highly genetic and multifactorial, with many risk factors acting together. Genes that affect synaptic maturation are implicated, resulting in neurobiological theories focusing on connectivity and neural effects of gene expression. Several treatments might address core and comorbid symptoms. However, not all treatments have been adequately studied. Improved strategies for early identification with phenotypic characteristics and biological markers (eg, electrophysiological changes) might hopefully improve effectiveness of treatment. Further knowledge about early identification, neurobiology of autism, effective treatments, and the effect of this disorder on families is needed.
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Involvement of Youths with Autism Spectrum Disorders or Intellectual Disabilities in Multiple Public Service Systems.
J Ment Health Res Intellect Disabil
PUBLISHED: 10-08-2009
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The objectives of this study were to estimate the prevalence of autism spectrum disorders (ASD) and intellectual disability (ID) among youths active in at least one of five public service systems - mental health [MH], educational services for youth with serious emotional disturbance [SED], child welfare [CW], juvenile justice [JJ], and alcohol and drug services [AD].This study also reports the characteristics and patterns of system involvement among these youths. Results indicate that approximately 12% of a random sample of youths involved in these public service systems had ID or ASD. These disabilities were particularly prevalent in youth in the SED (25%), MH (13%), and CW (13%) systems and were less prevalent in the JJ and AD systems (4% each). Youths with ID or ASD were more likely than other youths to be Caucasian, have a higher socioeconomic status, and be more likely to have externalizing psychiatric and other problems. Of those with ASD or ID, approximately one third were served in more than one service system, with the MH and SED systems most likely to be serving youths with externalizing psychiatric disorders. These findings have important implications for service provision, treatment planning, and workforce development.
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Treatment disparities in Parkinsons disease.
Ann. Neurol.
PUBLISHED: 09-11-2009
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We sought to identify racial disparities in the treatment of Parkinsons disease (PD). We identified 307 incident PD cases using Pennsylvania State Medicaid claims, and extracted claims for medications, physical therapy, and healthcare visits for the 6 months after diagnosis. After controlling for age, sex, and geography, African-Americans were four times less likely than whites to receive any PD treatment (odds ratio, 0.24; 95% confidence interval, 0.09-0.64), especially indicated medications. In a group with the same healthcare insurance, disparities in PD treatment exist. Physician and community awareness of these racial differences in PD treatment is the first step in addressing healthcare disparities.
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State variation in psychotropic medication use by foster care children with autism spectrum disorder.
Pediatrics
PUBLISHED: 07-20-2009
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The objective of this study was to compare on a national cohort of children with autism spectrum disorder (ASD) the concurrent use of >or=3 psychotropic medications between children in foster care and children who have disabilities and receive Supplemental Security Income, and to describe variation among states in the use of these medications by children in foster care.
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Use of vocational rehabilitative services among adults with autism.
J Autism Dev Disord
PUBLISHED: 06-09-2009
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This study examined the experiences of individuals with autism spectrum disorders (ASD) in the US Vocational Rehabilitation System (VRS). Subjects included all 382,221 adults ages 18-65 served by this system whose cases were closed in 2005; 1,707 were diagnosed with ASD. Adults with ASD were more likely than adults with other impairments to be denied services because they were considered too severely disabled. Among those served, adults with ASD received the most expensive set of services. They and adults with MR were most likely to be competitively employed at case closure. Post hoc analyses suggest that their employment was highly associated with on-the-job supports. The results suggest the importance of the VRS in serving adults with ASD.
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Predictors of residential placement following a psychiatric crisis episode among children and youth in state custody.
Am J Orthopsychiatry
PUBLISHED: 06-03-2009
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This study examined the extent and correlates of entry into residential care among 603 children and youth in state custody who were referred to psychiatric crisis services. Overall, 27% of the sample was placed in residential care within 12 months after their 1st psychiatric crisis screening. Among the children and youth placed in residential care, 51% were so placed within 3 months of their 1st crisis screening, with an additional 22% placed between 3 and 6 months after screening. Risk behavior and functioning, psychiatric hospitalization following screening, older age, placement type, and caregivers capacity for supervision were associated with increased residential placement. The findings highlight the importance of early identification and treatment of behavior and functioning problems following a crisis episode among children and youth in state custody to reduce the need for subsequent residential placement. Having an inpatient psychiatric episode following a crisis episode places children at greater risk for residential placement, suggesting that the hospital is an important point for diversion programs. Children and youth in psychiatric crisis may also benefit from efforts to include their families in the treatment process.
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Racial differences in the diagnosis of Parkinsons disease.
Mov. Disord.
PUBLISHED: 05-05-2009
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The objective of this cohort study was to determine the incidence of Parkinsons disease (PD) and the effects of race/ethnicity, other demographic characteristics, geography, and healthcare utilization on probability of diagnosis. The authors used the Pennsylvania state Medicaid claims dataset from 1999 to 2003 to identify newly diagnosed cases of PD among the 182,271 Medicaid enrolled adults age 40-65; 319 incident cases of PD were identified. The 4-year cumulative incidence of PD was 45 per 100,000; 54 per 100,000 among whites, 23 per 100,000 among African-Americans and 40 per 100,000 among Latinos (P < 0.0001), corresponding to a relative risk (RR) of PD of 0.43 for African-Americans (P < 0.0001) compared with whites. After adjusting for age, sex, geography, reason for Medicaid eligibility, and average number of visits, African-Americans were still half as likely to be diagnosed with PD as whites (RR 0.45, P < 0.0001). Older age, more healthcare visits and Medicaid eligibility because of income alone also were significantly associated with PD diagnosis, while male sex was not. Observed racial differences in incidence of PD are not explained by differences in age, sex, income, insurance or healthcare utilization but still may be explained by biological differences or other factors such as education or aging beliefs. Better understanding of the complex biological and social determinants of these disparities is critical to improve PD care.
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Timing of identification among children with an autism spectrum disorder: findings from a population-based surveillance study.
J Am Acad Child Adolesc Psychiatry
PUBLISHED: 03-26-2009
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At what age are children with an autism spectrum disorder (ASD) identified by community providers? What factors influence the timing of when children are identified with ASDs? This study examined the timing of when children with ASDs are identified.
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Sex differences in the evaluation and diagnosis of autism spectrum disorders among children.
Disabil Health J
PUBLISHED: 03-09-2009
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One of the most consistent features of the autism spectrum disorders (ASDs) is the predominance among males, with approximately four males to every female. We sought to examine sex differences among children who met case definition for ASD in a large, population-based cohort with respect to age at first developmental evaluation, age of diagnosis, influence of cognitive impairment on these outcomes, and sex-specific behavioral characteristics.
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Brief report: Quantifying the impact of autism coverage on private insurance premiums.
J Autism Dev Disord
PUBLISHED: 01-22-2009
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Many states are considering legislation requiring private insurance companies to pay for autism-related services. Arguments against mandates include that they will result in higher premiums. Using Pennsylvania legislation as an example, which proposed covering services up to $36,000 per year for individuals less than 21 years of age, this paper estimates potential premium increases. The estimate relies on autism treated prevalence, the number of individuals insured by affected plans, mean annual autism expenditures, administrative costs, medical loss ratio, and total insurer revenue. Current treated prevalence and expenditures suggests that premium increases would approximate 1%, with a lower bound of 0.19% and an upper bound of 2.31%. Policy makers can use these results to assess the cost-effectiveness of similar legislation.
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Comparing cognitive outcomes among children with autism spectrum disorders receiving community-based early intervention in one of three placements.
Autism
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Little comparative research examines which community-based preschool intervention placements produce the best outcomes for which children with autism spectrum disorders. Autism-specific placements can provide intensive evidence-based care; however, inclusion settings provide interaction with typically developing peers, the importance of which is increasingly recognized. This study examined the association between early intervention placement in three settings (autism-only, mixed disability, or inclusive) and cognitive outcomes upon entry into elementary school in an urban school district for 98 preschool-aged children with autism spectrum disorders. Initial child and demographic characteristics were similar among the three placements. Controlling for initial cognitive scores and other covariates, cognitive outcomes for children in inclusive placements were better than those of children in mixed disability settings. A consistent pattern emerged that suggested the particular importance of inclusive placements for children with initially greater social impairments, greater adaptive behavior impairments, and at least a baseline level of language skills. Opportunities to interact with typically developing peers may be particularly beneficial for certain subgroups of young children with autism spectrum disorders. The results provide preliminary insight into important child characteristics to consider when parents and providers make preschool early intervention placement decisions.
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Occurrence and family impact of elopement in children with autism spectrum disorders.
Pediatrics
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Anecdotal reports suggest that elopement behavior in children with autism spectrum disorders (ASDs) increases risk of injury or death and places a major burden on families. This study assessed parent-reported elopement occurrence and associated factors among children with ASDs.
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Validation of an instrument to measure older adults expectations regarding movement (ERM).
PLoS ONE
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Many individuals with Parkinsons disease are not diagnosed and treated. Attitudes about aging and related help-seeking may affect the timely diagnosis of Parkinsons disease. Our objectives were to develop measures of older adults expectations regarding movement with aging, specifically related to parkinsonism, and their beliefs about seeking healthcare for the diagnosis and treatment of parkinsonism.
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Understanding and addressing the impact of autism on the family.
LDI Issue Brief
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Children and adults with autism spectrum disorders (ASDs) have needs that challenge our systems of care. A new study estimates ASDs cost more than $126 billion each year in the U.S.--an amount that reflects both the costs of providing educational and medical services as well as the costs of not intervening early and effectively enough to prevent lifelong disability. This Issue Brief summarizes the implications of childhood autism for parental employment and earnings, and analyzes whether community-based services can reduce costly, psychiatric hospitalizations of children with ASDs.
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Implications of childhood autism for parental employment and earnings.
Pediatrics
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To examine changes in parental labor force participation, hours of work, and annual earnings associated with childhood autism spectrum disorders (ASD).
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What is Visualize?

JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

How does it work?

We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.

Video X seems to be unrelated to Abstract Y...

In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.