Parenting aggravation and autism spectrum disorders: 2007 National Survey of Children's Health

Background

Studies suggest autism spectrum disorders (ASDs) are associated with high parenting stress and aggravation. Research on specific risk factors is needed.

Objective/Hypotheses

To assess aggravation level among parents of children with and without ASDs.

Methods

The sample of 73,030 children aged 4 to 17 years in the 2007 National Survey of Children’s Health and their parent respondents were divided into mutually exclusive groups based on child ASD status and other special health care needs. Adjusted prevalence ratios (aPR) for associations between a high Aggravation in Parenting scale score and various risk factors were computed from multivariable models.

Results

High-aggravation percentages were comparable for parents of children with a current ASD (36.6%), ASD reported previously but not currently (35.2%), and another (non-ASD) developmental problem (31.2%) but were significantly lower for parents of children with other special health care needs (6.5%) and no special health care needs (5.1%). Within the current-ASD group, high aggravation was associated with young child age (aPR = 1.8 [1.2-2.6]), lack of health insurance (aPR = 1.5 [1.0-2.4]), lack of a medical home (aPR = 2.2 [1.4-3.5]), recent child mental health treatment (aPR = 2.1 [1.5-3.0]), lack of parenting emotional support (aPR = 1.5 [1.1-2.1]), and ASD severity (aPR = 1.4 [1.0-1.6]). Some of these same factors were associated with aggravation in the non-ASD groups. However, the medical home finding was specific to the ASD groups.

Conclusions

Parenting a child with ASD is associated with high aggravation; however, there is variability within health care and social support subgroups. Strategies to strengthen medical home components for children with ASDs should be considered.     

Parent-reported prevalence of autism spectrum disorders in US-born children: an assessment of changes within birth cohorts from the 2003 to the 2007 National Survey of Children's Health

The prevalence of autism spectrum disorders (ASD) from the 2007 National Survey of Children's Health (NSCH) was twice the 2003 NSCH estimate for autism. From each NSCH, we selected children born in the US from 1990 to 2000. We estimated autism prevalence within each 1-year birth cohort to hold genetic and non-genetic prenatal factors constant. Prevalence differences across surveys thus reflect survey measurement changes and/or external identification effects. In 2003, parents were asked whether their child was ever diagnosed with autism. In 2007, parents were asked whether their child was ever diagnosed with an ASD and whether s/he currently had an ASD. For the 1997-2000 birth cohorts (children aged 3-6 years in 2003 and 7-10 years in 2007), relative increases between 2003 autism estimates and 2007 ASD estimates were 200-600 %. For the 1990-1996 birth cohorts (children aged 7-13 years in 2003) increases were lower; nonetheless, differences between 2003 estimates and 2007 "ever ASD" estimates were >100 % for 6 cohorts and differences between 2003 estimates and 2007 "current ASD" estimates were >80 % for 3 cohorts. The magnitude of most birth cohort-specific differences suggests continuing diagnosis of children in the community played a sizable role in the 2003-2007 ASD prevalence increase. While some increase was expected for 1997-2000 cohorts, because some children have later diagnoses coinciding with school entry, increases were also observed for children ages ≥ 7 years in 2003. Given past ASD subtype studies, the 2003 "autism" question might have missed a modest amount (≤ 33 %) of ASDs other than autistic disorder.     

Severe injury among Hispanic and non-Hispanic white children in Washington state

OBJECTIVES: The authors' anecdotal experience at a regional Level I trauma center was that Hispanic children were overrepresented among burn patients, particularly among children with burns due to scalding from hot food. This study describes injury incidence and severity among Hispanic and non-Hispanic white infants, children, and adolescents with serious traumatic injuries in Washington State. METHODS: Data from the Washington State Trauma Registry for 1995-1997 were used to identify injured individuals aged < or = 19 years. Ratios of overall and mechanism-specific injury incidence rates for Hispanic children relative to non-Hispanic white children were calculated using denominator estimates derived from U.S. Census Bureau population data. Hispanic children and non-Hispanic white children were also compared on several measures of severity of injury. RESULTS: In 1995-1997, serious traumatic injuries were reported to the Registry for 231 Hispanic children aged < or = 19 years (rate: 54 per 100,000 person-years) and for 2,123 non-Hispanic white children (56 per 100,000 person-years), yielding an overall rate ratio (RR) of 1.0 (95% confidence interval [CI] 0.8, 1.1). Motor vehicle crashes and falls accounted for one-third to one-half of the injuries for each group. Infants, children, and adolescents identified as Hispanic had higher rates of injuries related to hot objects (i.e., burns) (RR=2.3; 95% CI 1.3, 4.1), guns (RR=2.2; 95% CI 1.5 to 3.3), and being cut or pierced (RR=3.5; 95% CI 2.2 to 5.5). The Hispanic group had a lower injury rate for motor vehicle accidents (RR=0.7; 95% CI 0.5, 0.9). Mortality rates were similar (RR=1.1; 95% CI 0.7, 1.7). The mean length of hospital stay was 5.5 days for the Hispanic group and 8.8 days for the non-Hispanic white group (difference=3.3 days; 95% CI -0.7, 7.4). CONCLUSIONS: The study found little difference between Hispanic and non-Hispanic white infants, children, and adolescents in the burden of traumatic pediatric injury. However, burns, guns, drowning, and being pierced/cut appeared to be particularly important mechanisms of injury for Hispanic children. More specific investigations targeted toward these injury types are needed to identify the underlying preventable risk factors involved.     

Cigarette use among Hispanic and non-Hispanic white school children, Albuquerque, New Mexico.

We conducted a survey of cigarette usage among Hispanic and non-Hispanic White school children in Albuquerque, New Mexico. The distributions of current, experimental, and never smokers were similar in the two groups. Among smokers, the average weekly cigarette consumption was 19 for Hispanic White males, 14 for non-Hispanic White males, 16 for non-Hispanic White females, and nine for Hispanic White females. Educational programs are needed to maintain the low-risk status of Southwestern Hispanics for cigarette-related diseases.     

孤独症儿童家庭养育环境特征及与神经心理发育相关性

目的 描述孤独症谱系障碍(ASD)儿童和发育迟缓儿童家庭养育环境分布差异,分析ASD儿童家庭养育环境与发育评估结果的相关性。方法 选取2018年1月—2020年8月在马鞍山市妇幼保健院儿童心理保健科就诊的ASD儿童(n=42)和发育迟缓儿童(n=48)为研究对象。两组儿童均要求完成Gesell发育量表评估,同时要求家长填写《家庭养育环境量表》。结果 本研究中家庭养育环境整体评价结果中“不良环境”33例,占36.7%。其中ASD组家庭养育“不良环境”12例,占28.6%,低于发育迟缓组(43.8%)。ASD儿童“情感温暖”不良的检出率高于发育迟缓组儿童(Z=2.490,P<0.05),家庭养育环境其他维度两组间差异无统计学意义(P>0.05)。此外,家庭养育环境不良的ASD儿童其适应性行为评分均数偏低(F=3.662,P<0.05)。结论 ASD儿童的养育环境促进应受到关注,家庭干预和家长教育可能促进改善其康复效果。     

孤独症谱系障碍儿童干预成效与父母焦虑抑郁状态变化的关系

目的探讨孤独症谱系障碍(autism spectrum disorder,ASD)儿童的父母焦虑抑郁状态变化及对儿童康复干预成效的影响。方法对2009年1月-2011年12月在该院确诊的孤独症儿童48例及其父母96名分别进行孤独症行为量表(Autism Behavior Checklist,ABC)、儿童期孤独症评定量表(The Childhood Autism Rating Scale,CARS)、抑郁自评量表(Self-rating Depression Scale,SDS)和焦虑自评量表(Self-rating Anxiety Scale,SAS)评估,并在2014年12月-2015年3月期间对上述儿童及其家长进行第2次评估。由于纵向研究时间较长,部分脱落,最终实际调查孤独症儿童40例及其父母80名。结果 ASD儿童初评ABC、CARS得分为(103.96±31.85)分、(37.96±4.90)分,复评(95.50±26.79)分、(35.45±5.40)分,复评得分显著低于初评得分(t=2.57,P0.05;t=4.475,P0.01);父亲SDS、SAS初评得分(46.05±12.00)分、(37.20±9.21)分,复评(45.3±11.60)分、(38.15±8.57)分,初复评比较差异无统计学意义(t=0.50,P0.05;t=-0.94,P0.05);母亲SDS、SAS初评得分(46.35±12.18)分、(39.58±12.30)分,复评(45.03±13.11)分、(41.70±12.28)分,初复评比较差异无统计学意义(t=0.71,P0.05;t=-1.26,P0.05)。母亲SAS初评分与ASD儿童CARS变化值有相关性(r=-0.351,P0.05);父亲SAS初评分、母亲SAS、母亲SDS初评分与ASD儿童ABC变化值有相关性(r=-0.323,P0.05;r=-0.328,P0.05;r=-0.368,P0.05)。结论孤独症儿童阶段性干预成效显著,但是父母的焦虑抑郁状态持续存在,并对儿童康复干预成效产生显著影响。     

Advanced parental age and the risk of autism spectrum disorder

This study evaluated independent effects of maternal and paternal age on risk of autism spectrum disorder. A case-cohort design was implemented using data from 10 US study sites participating in the Centers for Disease Control and Prevention's Autism and Developmental Disabilities Monitoring Network. The 1994 birth cohort included 253,347 study-site births with complete parental age information. Cases included 1,251 children aged 8 years with complete parental age information from the same birth cohort and identified as having an autism spectrum disorder based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. After adjustment for the other parent's age, birth order, maternal education, and other covariates, both maternal and paternal age were independently associated with autism (adjusted odds ratio for maternal age > or =35 vs. 25-29 years = 1.3, 95% confidence interval: 1.1, 1.6; adjusted odds ratio for paternal age > or =40 years vs. 25-29 years = 1.4, 95% confidence interval: 1.1, 1.8). Firstborn offspring of 2 older parents were 3 times more likely to develop autism than were third- or later-born offspring of mothers aged 20-34 years and fathers aged <40 years (odds ratio = 3.1, 95% confidence interval: 2.0, 4.7). The increase in autism risk with both maternal and paternal age has potential implications for public health planning and investigations of autism etiology.     

Self-rated health among Hispanic vs non-Hispanic white adults: the San Luis Valley Health and Aging Study.

OBJECTIVES: This study investigated whether objective health indicators explained lower self-rated health among Hispanics compared with non-Hispanic Whites. It also considered socioeconomic and cultural explanations. METHODS: Health ratings of 429 Hispanics and 583 non-Hispanic Whites aged 20 through 74 were analyzed with logistic regression. RESULTS: Illness indicators were found to be strongly correlated with self-rated health in both ethnic groups, but after such markers were controlled for, Hispanics remained 3.6 times more likely to report fair or poor health (95% confidence interval = 2.4, 5.3). Adjustment for socioeconomic factors accounted for a portion of Hispanics' lower health rating, but the strongest explanatory factor was acculturation. CONCLUSIONS: Because of cultural and economic influences on definitions of health, ethnic differences in self-assessed health may not accurately reflected patterns resulting from objective health measurements.     

A comparison of autism spectrum disorder DSM-IV criteria and associated features among African American and white children in Philadelphia County

BackgroundRacial differences are documented in the timing and type of autism spectrum disorder (ASD) diagnosis among white and African American children. Differences in clinical presentation by race may contribute to these disparities. This study explores documented differences in core ASD symptoms and associated behavioral features among African American and white children.MethodsThis project is a secondary data analysis from the Pennsylvania Autism and Developmental Disabilities Surveillance Program and utilized methodology that evaluates existing records, reviews, and codes for DSM-IV criteria for ASD and 12 associated behavioral features. The sample comprised 343 children meeting surveillance case definition for ASD, from 3 population-based cohorts of children in Philadelphia County.ResultsA higher frequency of white children compared to African American children with ASD have documented DSM-IV criteria of inflexible adherence to nonfunctional routines/rituals (92% vs 81%; p = .005) and persistent preoccupation with parts of objects (67% vs 50%; p = .002). A higher frequency of white children with ASD compared to African American children with ASD have documented abnormal motor development (74% vs 60%; p = .008) and odd responses to sensory stimuli (76% vs 51%; p < .001). There were no significant differences in externalizing behaviors or reciprocal social interaction.ConclusionsThis study suggests differences in the types of ASD symptoms and associated behavioral features exhibited by African American as compared to white children with ASD. Further research is needed to determine if these differences contribute to disparities in the timing or type of ASD diagnosis.     

Parental concern regarding obesity in children with autism spectrum disorder in the United States: National Survey of Children's Health 2016

Background

The prevalence of obesity in children with autism spectrum disorder (ASD) exceeds that of the general population, but the level of parental concern about obesity in these children is unexplored.

海口市学龄前儿童孤独症谱系障碍筛查率及其影响因素

目的 了解海口市学龄前儿童孤独症筛查阳性率及其影响因素。方法 采取分层随机整群抽样的方法,抽取海口市23家幼儿园学龄前儿童共3 844名,使用克氏孤独症量表和自制的影响因素调查问卷进行调查。结果 本次调查的3 844例儿童,年龄分布在24~84个月,男女比例为1.26〖DK〗∶1,城市与农村比例为2.06〖DK〗∶1,汉族与少数民族比例为25.69〖DK〗∶1。孤独症谱系障碍筛查阳性率为5.10%,单因素分析发现,男性、低年龄、农村户籍、父母文化程度低、低出生体重、宫内发育迟缓、高龄产妇组儿童的孤独症谱系障碍筛查阳性率较高,差异有统计学意义。多重线性回归分析发现,父母文化程度高、城市户籍为孤独症谱系障碍的保护因素,男童、低年龄、低出生体重、宫内发育迟缓为孤独症谱系障碍的危险因素。结论 应该以男童、低年龄、农村户籍、有低出生体重、宫内发育迟缓史的学龄前儿童为重点观察对象,加强家长以及幼师对孤独症谱系障碍的认识,做到早期识别,早诊断、早干预。     

Health outcomes among Hispanic subgroups: data from the National Health Interview Survey, 1992-95

BACKGROUND: Within the next 50 years, Hispanics will become the largest minority group in the United States. The largest Hispanic subgroups are those of Mexican, Cuban, and Puerto Rican descent. The Hispanic population is heterogeneous in terms of culture, history, socioeconomic status (SES) and health status. In this report, various health status measures are compared across Hispanic subgroups in the United States. METHODS: National Health Interview Survey (NHIS) data aggregated from 1992 through 1995 were analyzed. NHIS is one of the few national surveys that has a sufficiently large sample size to adequately compare the different subgroups. Data are presented for four Hispanic origin subgroups--Mexican, Cuban, Puerto Rican, and "other Hispanic" persons--for the Hispanic population as a whole and for the non-Hispanic white and non-Hispanic black populations. These groups are compared with respect to several health status outcomes, providing both age-adjusted and unadjusted estimates. RESULTS: The health indicators for Puerto Rican persons are significantly worse than for the other Hispanic origin subgroups. For example, about 21% of Puerto Rican persons reported having an activity limitation, compared with about 15% of Cuban and Mexican persons and 14% of "other Hispanic" persons. In contrast, the health indicators of Cuban persons are often better than those of the other subgroups. For example, Cuban persons reported an average of 3 days per year lost from school or work, compared with about 6 days for Mexican and Puerto Rican persons and 7 days for "other Hispanic" persons. Mexican persons fare better than Puerto Rican persons on measures such as restricted activity days, bed disability days and hospitalizations. CONCLUSION: These data demonstrate clear differences in health status as well as indicators of socioeconomic status across Hispanic subgroups in the United States. Data on Hispanic subgroups facilitate the planning of public health services for various underserved populations.     

Injury mortality in American Indian, Hispanic, and non-Hispanic white children in New Mexico, 1958-1982

Childhood fatalities from injuries are a serious public health problem in New Mexico, a state which ranks second in the nation in injury-related mortality rates. To determine the extent of injury mortality in children in this state, and to examine time trends and differences in mortality rates in New Mexico's American Indian, Hispanic, and non-Hispanic white children aged 0-14 years, we analyzed vital records collected from 1958 to 1982. American Indian children experienced the highest mortality rates from all external causes combined. Among all three major ethnic groups, children aged 0-4 years were at the highest risk for injury fatalities. Unintentional injuries accounted for 85% of all injury-related deaths. Motor vehicle crashes and drowning were the first and second leading causes of death in all three groups, while other important causes of death included fire, choking on food or other objects, poisoning, and homicide. Although the fatality rates on most types of injuries decreased over the 25-year period, childhood fatality rates for motor vehicle crashes and homicide increased in each ethnic group. Despite the overall decrease in injury mortality rates in New Mexican children, the rates are excessively high compared to other states, especially in American Indian children.     

孤独症谱系障碍儿童的早期诊断与识别

目的:探讨连云港市婴幼儿孤独症谱系障碍患病的早期诊断及识别方法。方法:采用随机分层整群抽样方法对连云港市8 532名0～3岁儿童进行横断面调查研究,用婴幼儿孤独症筛查表(CHAT)筛查出可疑儿童,进一步应用儿童孤独症家长评定量表(ABC)、儿童期孤独症评定量表(CARS)及美国精神障碍诊断和统计手册(DSM-IV)诊断依据进行确诊。结果:8 532名儿童中9名为孤独症阳性,阳性率为10.55/万,其中<1岁1例,1～2岁3例,2～3岁5例;男孩7例,女孩2例。结论:加强对孤独症谱系障碍患儿的早期识别能力,做到早期诊断孤独症患儿,对孤独症患儿的日后康复工作意义重大。     

Characteristics of children eligible for public health insurance but uninsured: data from the 2007 National Survey of Children's Health

To describe the state variation, demographic and family characteristics of children eligible for public health insurance but uninsured. Using data from the National Survey of Children's Health we selected a subset of children living in households with incomes <200 % of the federal poverty level, who are generally eligible for Medicaid or CHIP. We used multiple logistic regression to examine associations between insurance status among this group of eligible children and certain demographic factors, family characteristics, and state of residence. In adjusted models children aged 6-11 and 12-17 years were more likely to be eligible but uninsured compared to those aged 0-5 years (AOR 1.57; 95 % CI 1.15-2.16 and AOR 1.93; 95 % CI 1.41-2.64). Children who received school lunch (AOR 0.67; 95 % CI 0.52-0.86) and SNAP (AOR 0.33; 95 % CI 0.24-0.46) were less likely to be eligible but uninsured compared to those children not receiving those needs based services; however, a majority (58.7 %) of eligible uninsured children were enrolled in the school lunch program. Five states (Texas, California, Florida, Georgia, New York) accounted for 46 % of the eligible uninsured children. Vermont had the lowest adjusted estimate of eligible uninsured children (3.6 %) and Nevada had the highest adjusted estimate (35.5 %). Using nationally representative data we have identified specific state differences, demographic and household characteristics that could help guide federal and local initiatives to improve public health insurance enrollment for children who are eligible but uninsured.