Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
Records 1-30 (of 33 Records) |
Query Trace: Soke G [original query] |
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2020 Ebola virus disease outbreak in Équateur Province, Democratic Republic of the Congo: a retrospective genomic characterisation
Kinganda-Lusamaki E , Whitmer S , Lokilo-Lofiko E , Amuri-Aziza A , Muyembe-Mawete F , Makangara-Cigolo JC , Makaya G , Mbuyi F , Whitesell A , Kallay R , Choi M , Pratt C , Mukadi-Bamuleka D , Kavunga-Membo H , Matondo-Kuamfumu M , Mambu-Mbika F , Ekila-Ifinji R , Shoemaker T , Stewart M , Eng J , Rajan A , Soke GN , Fonjungo PN , Otshudiema JO , Folefack GLT , Pukuta-Simbu E , Talundzic E , Shedroff E , Bokete JL , Legand A , Formenty P , Mores CN , Porzucek AJ , Tritsch SR , Kombe J , Tshapenda G , Mulangu F , Ayouba A , Delaporte E , Peeters M , Wiley MR , Montgomery JM , Klena JD , Muyembe-Tamfum JJ , Ahuka-Mundeke S , Mbala-Kingebeni P . Lancet Microbe 2024 BACKGROUND: The Democratic Republic of the Congo has had 15 Ebola virus disease (EVD) outbreaks, from 1976 to 2023. On June 1, 2020, the Democratic Republic of the Congo declared an outbreak of EVD in the western Équateur Province (11th outbreak), proximal to the 2018 Tumba and Bikoro outbreak and concurrent with an outbreak in the eastern Nord Kivu Province. In this Article, we assessed whether the 11th outbreak was genetically related to previous or concurrent EVD outbreaks and connected available epidemiological and genetic data to identify sources of possible zoonotic spillover, uncover additional unreported cases of nosocomial transmission, and provide a deeper investigation into the 11th outbreak. METHODS: We analysed epidemiological factors from the 11th EVD outbreak to identify patient characteristics, epidemiological links, and transmission modes to explore virus spread through space, time, and age groups in the Équateur Province, Democratic Republic of the Congo. Trained field investigators and health professionals recorded data on suspected, probable, and confirmed cases, including demographic characteristics, possible exposures, symptom onset and signs and symptoms, and potentially exposed contacts. We used blood samples from individuals who were live suspected cases and oral swabs from individuals who were deceased to diagnose EVD. We applied whole-genome sequencing of 87 available Ebola virus genomes (from 130 individuals with EVD between May 19 and Sept 16, 2020), phylogenetic divergence versus time, and Bayesian reconstruction of phylogenetic trees to calculate viral substitution rates and study viral evolution. We linked the available epidemiological and genetic datasets to conduct a genomic and epidemiological study of the 11th EVD outbreak. FINDINGS: Between May 19 and Sept 16, 2020, 130 EVD (119 confirmed and 11 probable) cases were reported across 13 Équateur Province health zones. The individual identified as the index case reported frequent consumption of bat meat, suggesting the outbreak started due to zoonotic spillover. Sequencing revealed two circulating Ebola virus variants associated with this outbreak-a Mbandaka variant associated with the majority (97%) of cases and a Tumba-like variant with similarity to the ninth EVD outbreak in 2018. The Tumba-like variant exhibited a reduced substitution rate, suggesting transmission from a previous survivor of EVD. INTERPRETATION: Integrating genetic and epidemiological data allowed for investigative fact-checking and verified patient-reported sources of possible zoonotic spillover. These results demonstrate that rapid genetic sequencing combined with epidemiological data can inform responders of the mechanisms of viral spread, uncover novel transmission modes, and provide a deeper understanding of the outbreak, which is ultimately needed for infection prevention and control during outbreaks. FUNDING: WHO and US Centers for Disease Control and Prevention. |
Perceptions toward Ebola vaccination and correlates of vaccine uptake among high-risk community members in North Kivu, Democratic Republic of the Congo
Perera SM , Garbern SC , Mbong EN , Fleming MK , Muhayangabo RF , Ombeni AB , Kulkarni S , Tchoualeu DD , Kallay R , Song E , Powell J , Gainey M , Glenn B , Mutumwa RM , Mustafa SHB , Earle-Richardson G , Fukunaga R , Abad N , Soke GN , Prybylski D , Fitter DL , Levine AC , Doshi RH . PLOS Glob Public Health 2024 4 (1) e0002566 The tenth Ebola Virus Disease (EVD) outbreak (2018-2020, North Kivu, Ituri, South Kivu) in the Democratic Republic of the Congo (DRC) was the second-largest EVD outbreak in history. During this outbreak, Ebola vaccination was an integral part of the EVD response. We evaluated community perceptions toward Ebola vaccination and identified correlates of Ebola vaccine uptake among high-risk community members in North Kivu, DRC. In March 2021, a cross-sectional survey among adults was implemented in three health zones. We employed a sampling approach mimicking ring vaccination, targeting EVD survivors, their household members, and their neighbors. Outbreak experiences and perceptions toward the Ebola vaccine were assessed, and modified Poisson regression was used to identify correlates of Ebola vaccine uptake among those offered vaccination. Among the 631 individuals surveyed, most (90.2%) reported a high perceived risk of EVD and 71.6% believed that the vaccine could reduce EVD severity; however, 63.7% believed the vaccine had serious side effects. Among the 474 individuals who had been offered vaccination, 397 (83.8%) received the vaccine, 180 (45.3%) of those vaccinated received the vaccine after two or more offers. Correlates positively associated with vaccine uptake included having heard positive information about the vaccine (RR 1.30, 95% CI 1.06-1.60), the belief that the vaccine could prevent EVD (RR 1.23, 95% CI 1.09-1.39), and reporting that religion influenced all decisions (RR 1.13, 95% CI 1.02-1.25). Ebola vaccine uptake was high in this population, although mixed attitudes and vaccine delays were common. Communicating positive vaccine information, emphasizing the efficacy of the Ebola vaccine, and engaging religious leaders to promote vaccination may aid in increasing Ebola vaccine uptake during future outbreaks. |
Pregnancy planning and its association with autism spectrum disorder: Findings from the Study to Explore Early Development
Harris ST , Schieve LA , Drews-Botsch C , DiGuiseppi C , Tian LH , Soke GN , Bradley CB , Windham GC . Matern Child Health J 2024 OBJECTIVES: To examine associations between pregnancy planning and autism spectrum disorder (ASD) in offspring. METHODS: The Study to Explore Early Development (SEED), a multi-site case-control study, enrolled preschool-aged children with ASD, other DDs, and from the general population (POP). Some children with DDs had ASD symptoms but did not meet the ASD case definition. We examined associations between mother's report of trying to get pregnant (pregnancy planning) and (1) ASD and (2) ASD symptomatology (ASD group, plus DD with ASD symptoms group combined) (each vs. POP group). We computed odds ratios adjusted for demographic, maternal, health, and perinatal health factors (aORs) via logistic regression. Due to differential associations by race-ethnicity, final analyses were stratified by race-ethnicity. RESULTS: Pregnancy planning was reported by 66.4%, 64.8%, and 76.6% of non-Hispanic White (NHW) mothers in the ASD, ASD symptomatology, and POP groups, respectively. Among NHW mother-child pairs, pregnancy planning was inversely associated with ASD (aOR = 0.71 [95% confidence interval 0.56-0.91]) and ASD symptomatology (aOR = 0.67 [0.54-0.84]). Pregnancy planning was much less common among non-Hispanic Black mothers (28-32% depending on study group) and Hispanic mothers (49-56%) and was not associated with ASD or ASD symptomatology in these two race-ethnicity groups. CONCLUSION: Pregnancy planning was inversely associated with ASD and ASD symptomatology in NHW mother-child pairs. The findings were not explained by several adverse maternal or perinatal health factors. The associations observed in NHW mother-child pairs did not extend to other race-ethnicity groups, for whom pregnancy planning was lower overall. |
Social and language regression: characteristics of children with autism spectrum disorder in a community-based sample
Reyes N , Soke GN , Wiggins L , Barger B , Moody E , Rosenberg C , Schieve L , Reaven J , Reynolds AM , Hepburn S . J Dev Phys Disabil 2023 This study investigated the prevalence, and the developmental, behavior and emotional outcomes of 675 preschoolers with ASD with or without a history of regression, who participated in the Study to Explore Early Development (SEED). The SEED project is a cross-sectional case-control study that collected data between 2007 and 2011. Children’s history of regression, adaptive skills, and behavior problems were assessed using the Autism Diagnostic Interview-Revised (ADI-R), the Vineland Adaptive Behavior Scales-Second Edition (Vineland-2), and the Child Behavior Checklist (CBCL), respectively; and children’s developmental levels were assessed using the Mullen Scales of Learning (MSEL). Findings from this study indicated that 26% of children experienced social and language regression, and of those with regression, 76% had regained lost skills upon completion of the study. Compared to children without a history of regression, children with social regression demonstrated increased internalizing problems and decreased fine motor skills, and children with language regression demonstrated poorer language skills. Also, children with language and social regression displayed poorer adaptive communication skills than children without regression. Children who experienced regression in one area of development demonstrated better outcomes than those who experience regression in multiple areas. To conclude, children with regression are at risk for poorer outcomes during their preschool years. © 2023, This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply. |
Revisiting the minimum incubation period of Zaire ebolavirus
Kofman AD , Haberling DL , Mbuyi G , Martel LD , Whitesell AN , Van Herp M , Makaya G , Corvil S , Abedi AA , Ngoma PM , Mbuyi F , Mossoko M , Koivogui E , Soke N , Gbamou N , Fonjungo PN , Keita L , Keita S , Shoemaker TR , Richards GA , Montgomery JM , Breman JG , Geisbert TW , Choi MJ , Rollin PE . Lancet Infect Dis 2023 23 (10) 1111-1112 Ebola virus disease (EVD) caused by Ebola virus species Zaire ebolavirus (EBOV) is a major global health challenge causing sporadic outbreaks with high mortality. The minimum incubation period of EBOV, or the time from infection with the virus to the development of first symptoms, is thought to be 2 days and was initially established during the first EVD investigation in 1976.1 A published observation from the investigation noted that, “in one case of the disease, the only possible source of infection was contact with a probable case 48 hours before the latter developed symptoms”, and this observation was restated in another publication.2, 3 However, concluding that the minimum incubation period for EBOV is 2 days based on these reports is flawed for several reasons. First, the presumed source of the infection was a probable case of EVD and was not laboratory-confirmed; it is therefore uncertain whether the source truly had EVD. Second, since the report describes the contact between the source and the case occurring before the source developed symptoms, this implies asymptomatic transmission, which has been established to not occur with EBOV.4, 5, 6 Finally, the report's description of 48 h refers to the time between the case's contact with the alleged source and the source's onset of symptoms, which is itself not an incubation period. |
Ebola vaccine uptake and attitudes among healthcare workers in North Kivu, Democratic Republic of the Congo, 2021
Doshi RH , Garbern SC , Kulkarni S , Perera SM , Fleming MK , Muhayangabo RF , Ombeni AB , Tchoualeu DD , Kallay R , Song E , Powell J , Gainey M , Glenn B , Mutumwa RM , Hans Bateyi Mustafa S , Earle-Richardson G , Gao H , Abad N , Soke GN , Fitter DL , Hyde TB , Prybylski D , Levine AC , Jalloh MF , Mbong EN . Front Public Health 2023 11 1080700 INTRODUCTION: During the 2018-2020 Ebola virus disease (EVD) outbreak in the eastern part of the Democratic Republic of the Congo (DRC), prevention and control measures, such as Ebola vaccination were challenging by community mistrust. We aimed to understand perceptions regarding Ebola vaccination and identify determinants of Ebola vaccine uptake among HCWs. METHODS: In March 2021, we conducted a cross-sectional survey among 438 HCWs from 100 randomly selected health facilities in three health zones (Butembo, Beni, Mabalako) affected by the 10th EVD outbreak in North Kivu, DRC. HCWs were eligible if they were ≥ 18 years and were working in a health facility during the outbreak. We used survey logistic regression to assess correlates of first-offer uptake (i.e., having received the vaccine the first time it was offered vs. after subsequent offers). RESULTS: Of the 438 HCWs enrolled in the study, 420 (95.8%) reported that they were eligible and offered an Ebola vaccine. Among those offered vaccination, self-reported uptake of the Ebola vaccine was 99.0% (95% confidence interval (CI) [98.5-99.4]), but first-offer uptake was 70.2% (95% CI [67.1, 73.5]). Nearly all HCWs (94.3%; 95% CI [92.7-95.5]) perceived themselves to be at risk of contracting EVD. The most common concern was that the vaccine would cause side effects (65.7%; 95% CI [61.4-69.7]). In the multivariable analysis, mistrust of the vaccine source or how the vaccine was produced decreased the odds of first-time uptake. DISCUSSION: Overall uptake of the Ebola vaccine was high among HCWs, but uptake at the first offer was substantially lower, which was associated with mistrust of the vaccine source. Future Ebola vaccination efforts should plan to make repeated vaccination offers to HCWs and address their underlying mistrust in the vaccines, which can, in turn, improve community uptake. |
Genetic liability for gastrointestinal inflammation disorders and association with gastrointestinal symptoms in children with and without autism
Morrill V , Benke K , Brinton J , Soke GN , Schieve LA , Fields V , Farzadegan H , Holingue C , Newschaffer CJ , Reynolds AM , Fallin MD , Ladd-Acosta C . Am J Med Genet B Neuropsychiatr Genet 2023 195 (1) e32952 Children with autism spectrum disorder (ASD) have a greater prevalence of gastrointestinal (GI) symptoms than children without ASD. We tested whether polygenic scores for each of three GI disorders (ulcerative colitis, inflammatory bowel disease, and Crohn's disease) were related to GI symptoms in children with and without ASD. Using genotyping data (564 ASD cases and 715 controls) and external genome-wide association study summary statistics, we computed GI polygenic scores for ulcerative colitis (UC-PGS), inflammatory bowel disease (IDB-PGS), and Crohn's disease (CD-PGS). Multivariable logistic regression models, adjusted for genetic ancestry, were used to estimate associations between each GI-PGS and (1) ASD case-control status, and (2) specific GI symptoms in neurotypical children and separately in ASD children. In children without ASD, polygenic scores for ulcerative colitis were significantly associated with experiencing any GI symptom (adjusted odds ratio (aOR) = 1.36, 95% confidence interval (CI) = 1.03-1.81, p = 0.03) and diarrhea specifically (aOR = 5.35, 95% CI = 1.77-26.20, p = 0.01). Among children without ASD, IBD-PGS, and Crohn's PGS were significantly associated with diarrhea (aOR = 3.55, 95% CI = 1.25-12.34, p = 0.02) and loose stools alternating with constipation (aOR = 2.57, 95% CI = 1.13-6.55, p = 0.03), respectively. However, the three PGS were not associated with GI symptoms in the ASD case group. Furthermore, polygenic scores for ulcerative colitis significantly interacted with ASD status on presentation of any GI symptom within a European ancestry subset (aOR = 0.42, 95% CI = 0.19-0.88, p = 0.02). Genetic risk factors for some GI symptoms differ between children with and without ASD. Furthermore, our finding that increased genetic risks for GI inflammatory disorders are associated with GI symptoms in children without ASD informs future work on the early detection of GI disorders. |
COVID-19 vaccine perceptions among ebola-affected communities in North Kivu, Democratic Republic of the Congo, 2021
Garbern SC , Perera SM , Mbong EN , Kulkarni S , Fleming MK , Ombeni AB , Muhayangabo RF , Tchoualeu DD , Kallay R , Song E , Powell J , Gainey M , Glenn B , Gao H , Mutumwa RM , Mustafa SHB , Abad N , Soke GN , Prybylski D , Doshi RH , Fukunaga R , Levine AC . Vaccines (Basel) 2023 11 (5) Populations affected by humanitarian crises and emerging infectious disease outbreaks may have unique concerns and experiences that influence their perceptions toward vaccines. In March 2021, we conducted a survey to examine the perceptions toward COVID-19 vaccines and identify the factors associated with vaccine intention among 631 community members (CMs) and 438 healthcare workers (HCWs) affected by the 2018-2020 Ebola Virus Disease outbreak in North Kivu, Democratic Republic of the Congo. A multivariable logistic regression was used to identify correlates of vaccine intention. Most HCWs (81.7%) and 53.6% of CMs felt at risk of contracting COVID-19; however, vaccine intention was low (27.6% CMs; 39.7% HCWs). In both groups, the perceived risk of contracting COVID-19, general vaccine confidence, and male sex were associated with the intention to get vaccinated, with security concerns preventing vaccine access being negatively associated. Among CMs, getting the Ebola vaccine was associated with the intention to get vaccinated (RR 1.43, 95% CI 1.05-1.94). Among HCWs, concerns about new vaccines' safety and side effects (OR 0.72, 95% CI 0.57-0.91), religion's influence on health decisions (OR 0.45, 95% CI 0.34-0.61), security concerns (OR 0.52, 95% CI 0.37-0.74), and governmental distrust (OR 0.50, 95% CI 0.35-0.70) were negatively associated with vaccine perceptions. Enhanced community engagement and communication that address this population's concerns could help improve vaccine perceptions and vaccination decisions. These findings could facilitate the success of vaccine campaigns in North Kivu and similar settings. |
Ebola Virus Disease Outbreak - Democratic Republic of the Congo, August 2018-November 2019.
Aruna A , Mbala P , Minikulu L , Mukadi D , Bulemfu D , Edidi F , Bulabula J , Tshapenda G , Nsio J , Kitenge R , Mbuyi G , Mwanzembe C , Kombe J , Lubula L , Shako JC , Mossoko M , Mulangu F , Mutombo A , Sana E , Tutu Y , Kabange L , Makengo J , Tshibinkufua F , Ahuka-Mundeke S , Muyembe JJ , Ebola Response CDC , Alarcon Walter , Bonwitt Jesse , Bugli Dante , Bustamante Nirma D , Choi Mary , Dahl Benjamin A , DeCock Kevin , Dismer Amber , Doshi Reena , Dubray Christine , Fitter David , Ghiselli Margherita , Hall Noemi , Hamida Amen Ben , McCollum Andrea M , Neatherlin John , Raghunathan Pratima L , Ravat Fatima , Reynolds Mary G , Rico Adriana , Smith Nailah , Soke Gnakub Norbert , Trudeau Aimee T , Victory Kerton R , Worrell Mary Claire . MMWR Morb Mortal Wkly Rep 2019 68 (50) 1162-1165 On August 1, 2018, the Democratic Republic of the Congo Ministry of Health (DRC MoH) declared the tenth outbreak of Ebola virus disease (Ebola) in DRC, in the North Kivu province in eastern DRC on the border with Uganda, 8 days after another Ebola outbreak was declared over in northwest Équateur province. During mid- to late-July 2018, a cluster of 26 cases of acute hemorrhagic fever, including 20 deaths, was reported in North Kivu province.* Blood specimens from six patients hospitalized in the Mabalako health zone and sent to the Institut National de Recherche Biomédicale (National Biomedical Research Institute) in Kinshasa tested positive for Ebola virus. Genetic sequencing confirmed that the outbreaks in North Kivu and Équateur provinces were unrelated. From North Kivu province, the outbreak spread north to Ituri province, and south to South Kivu province (1). On July 17, 2019, the World Health Organization designated the North Kivu and Ituri outbreak a public health emergency of international concern, based on the geographic spread of the disease to Goma, the capital of North Kivu province, and to Uganda and the challenges to implementing prevention and control measures specific to this region (2). This report describes the outbreak in the North Kivu and Ituri provinces. As of November 17, 2019, a total of 3,296 Ebola cases and 2,196 (67%) deaths were reported, making this the second largest documented outbreak after the 2014-2016 epidemic in West Africa, which resulted in 28,600 cases and 11,325 deaths.(†) Since August 2018, DRC MoH has been collaborating with partners, including the World Health Organization, the United Nations Children's Fund, the United Nations Office for the Coordination of Humanitarian Affairs, the International Organization of Migration, The Alliance for International Medical Action (ALIMA), Médecins Sans Frontières, DRC Red Cross National Society, and CDC, to control the outbreak. Enhanced communication and effective community engagement, timing of interventions during periods of relative stability, and intensive training of local residents to manage response activities with periodic supervision by national and international personnel are needed to end the outbreak. |
Peri-Pregnancy Cannabis Use and Autism Spectrum Disorder in the Offspring: Findings from the Study to Explore Early Development
DiGuiseppi C , Crume T , Van Dyke J , Sabourin KR , Soke GN , Croen LA , Daniels JL , Lee LC , Schieve LA , Windham GC , Friedman S , Robinson Rosenberg C . J Autism Dev Disord 2021 52 (11) 5064-5071 The association of autism spectrum disorder (ASD) with self-reported maternal cannabis use from 3 months pre-conception to delivery ("peri-pregnancy") was assessed in children aged 30-68 months, born 2003 to 2011. Children with ASD (N = 1428) were compared to children with other developmental delays/disorders (DD, N = 1198) and population controls (POP, N = 1628). Peri-pregnancy cannabis use was reported for 5.2% of ASD, 3.2% of DD and 4.4% of POP children. Adjusted odds of peri-pregnancy cannabis use did not differ significantly between ASD cases and DD or POP controls. Results were similar for any use during pregnancy. However, given potential risks suggested by underlying neurobiology and animal models, further studies in more recent cohorts, in which cannabis use and perception may have changed, are needed. |
A Survey to Assess Serological Prevalence of Poliovirus Antibodies in Areas With High-Risk for Vaccine-Derived Poliovirus Transmission in Chad
Gamougam K , Jeyaseelan V , Jones KAV , Mainou BA , Palmer T , Diaha A , Wiesen E , Ntezayabo B , Ayangma R , Soke NG , Samba D , Okiror S , Mach O . J Pediatric Infect Dis Soc 2021 11 (2) 55-59 BACKGROUND: World Health Organization African region is wild poliovirus-free; however, outbreaks of vaccine-derived poliovirus type 2 (VDPV2) continue to expand across the continent including in Chad. We conducted a serological survey of polio antibodies in polio high-risk areas of Chad to assess population immunity against poliovirus and estimate the risk of future outbreaks. METHODS: This was a community-based, cross-sectional survey carried out in September 2019. Children between 12 and 59 months were randomly selected using GIS enumeration of structures. Informed consent, demographic and anthropometric data, vaccination history, and blood spots were collected. Seropositivity against all 3 poliovirus serotypes was assessed using a microneutralization assay at Centers for Disease Control and Prevention, Atlanta, GA, USA. RESULTS: Analyzable data were obtained from 236 out of 285 (82.8%) enrolled children. Seroprevalence of polio antibodies for serotypes 1, 2, and 3 was 214/236 (90.7%); 145/236 (61.4%); and 196/236 (86.2%), respectively. For serotype 2, the seroprevalence significantly increased with age (P = .004); chronic malnutrition was a significant risk factor for being type 2-seronegative. INTERPRETATION: Poliovirus type 2 seroprevalence in young children was considered insufficient to protect against the spread of paralytic diseases caused by VDPV2. Indeed, VDPV2 outbreaks were reported from Chad in 2019 and 2020. High-quality immunization response to these outbreaks is needed to prevent further spread. |
New Mixed Methods Approach for Monitoring Community Perceptions of Ebola and Response Efforts in the Democratic Republic of the Congo
Earle-Richardson G , Erlach E , Walz V , Baggio O , Kurnit M , Camara CA , Craig C , Dios LR , Yee D , Soke GN , Voahary I , Prue CE . Glob Health Sci Pract 2021 9 (2) 332-343 BACKGROUND: Efforts to contain the spread of Ebola in the eastern Democratic Republic of the Congo (DRC) during the 2018-2020 epidemic faced challenges in gaining community trust and participation. This affected implementation of community alerts, early isolation, contact tracing, vaccination, and safe and dignified burials. To quickly understand community perspectives and improve community engagement, collaborators from the DRC Red Cross, the International Federation of the Red Cross, and the U.S. Centers for Disease Control and Prevention explored a new method of collecting, coding, and quickly analyzing community feedback. METHODS: Over 800 DRC Red Cross local volunteers recorded unstructured, free-text questions and comments from community members during community Ebola awareness activities. Comments were coded and analyzed using a text-coding system developed by the collaborators. Coded comments were then aggregated and qualitatively grouped into major themes, and time trends were examined. RESULTS: Communities reported a lack of information about the outbreak and the response, as well as concerns about the Ebola vaccination program and health care quality. Some doubted that Ebola was real. The response used the feedback to revise some community engagement approaches. For example, 2 procedural changes that were followed by drops in negative community responses were: using transparent body bags, which allayed fears that bodies or organs were being stolen, and widening the eligibility criteria for Ebola vaccination, which addressed concerns that selectively vaccinating individuals within Ebola-affected communities was unfair. DISCUSSION: This system is unique in that unstructured feedback collected by local volunteers in the course of their work was rapidly coded, analyzed, and given to health authorities for use in making course corrections throughout the response. It provides a platform for local voices to be heard throughout an emergency response and provides a mechanism for assessing the effects of program adjustments on community sentiments. |
Evaluation of sex differences in preschool children with and without autism spectrum disorder enrolled in the Study to Explore Early Development
Wiggins LD , Rubenstein E , Windham G , Barger B , Croen L , Dowling N , Giarelli E , Levy S , Moody E , Soke G , Fields V , Schieve L . Res Dev Disabil 2021 112 103897 BACKGROUND AND AIMS: Research in school-aged children, adolescents, and adults with autism spectrum disorder (ASD) has found sex-based differences in behavioral, developmental, and diagnostic outcomes. These findings have not been consistently replicated in preschool-aged children. We examined sex-based differences in a large sample of 2-5-year-old children with ASD symptoms in a multi-site community-based study. METHODS AND PROCEDURES: Based on a comprehensive evaluation, children were classified as having ASD (n = 1480, 81.55 % male) or subthreshold ASD characteristics (n = 593, 70.15 % male). Outcomes were behavior problems, developmental abilities, performance on ASD screening and diagnostic tests, and parent-reported developmental conditions diagnosed before study enrollment. OUTCOMES AND RESULTS: We found no statistically significant sex differences in behavioral functioning, developmental functioning, performance on an ASD screening test, and developmental conditions diagnosed before study enrollment among children with ASD or subthreshold ASD characteristics. Males in both study groups had more parent reported restricted interests and repetitive behaviors than females, but these differences were small in magnitude and not clinically meaningful. CONCLUSIONS AND IMPLICATIONS: Preschool males and females who showed risk for ASD were more similar than different in the outcomes assessed in our study. Future research could examine sex-based differences in ASD phenotypes as children age. |
Pica, autism, and other disabilities
Fields VL , Soke GN , Reynolds A , Tian LH , Wiggins L , Maenner M , DiGuiseppi C , Kral TVE , Hightshoe K , Schieve LA . Pediatrics 2021 147 (2) BACKGROUND AND OBJECTIVES: Pica, the repeated ingestion of nonfood items, can be life-threatening. Although case reports describe pica in children with autism spectrum disorder (ASD) or intellectual disability (ID), there has been little systematic study of pica prevalence. We assessed pica in children 30 to 68 months of age (median = 55.4 months) with and without ASD. METHODS: Our sample from the Study to Explore Early Development, a multisite case-control study, included children with ASD (n = 1426), children with other developmental disabilities (DDs) (n = 1735), and general population-based controls (POPs) (n = 1578). We subdivided the ASD group according to whether children had ID and the DD group according to whether they had ID and/or some ASD characteristics. Standardized developmental assessments and/or questionnaires were used to define final study groups, subgroups, and pica. We examined pica prevalence in each group and compared ASD and DD groups and subgroups to the POP group using prevalence ratios adjusted for sociodemographic factors. RESULTS: Compared with the prevalence of pica among POPs (3.5%), pica was higher in children with ASD (23.2%) and DD (8.4%), and in the following subgroups: ASD with ID (28.1%), ASD without ID (14.0%), DD with ID (9.7%), DD with ASD characteristics (12.0%), and DD with both ID and ASD characteristics (26.3%); however, pica prevalence was not elevated in children with DD with neither ID nor ASD characteristics (3.2%). Between-group differences remained after adjustment (adjusted prevalence ratio range 1.9-8.0, all P <.05). CONCLUSIONS: Pica may be common in young children with ASD, ASD characteristics, and ID. These findings inform the specialized health care needs of these children. |
Gastrointestinal symptoms in 2- to 5-year-old children in the Study to Explore Early Development
Reynolds AM , Soke GN , Sabourin KR , Croen LA , Daniels JL , Fallin MD , Kral TVE , Lee LC , Newschaffer CJ , Pinto-Martin JA , Schieve LA , Sims A , Wiggins L , Levy SE . J Autism Dev Disord 2021 51 (11) 3806-3817 Gastrointestinal symptoms (GIS) are commonly reported in children with autism spectrum disorder (ASD). This multi-site study evaluated the prevalence of GIS in preschool-aged children with ASD/(n = 672), with other developmental delays (DD)/(n = 938), and children in the general population (POP)/(n = 851). After adjusting for covariates, children in the ASD group were over 3 times more likely to have parent-reported GIS than the POP group, and almost 2 times more likely than the DD group. Children with GIS from all groups had more behavioral and sleep problems. Within the ASD group, children with developmental regression had more GIS than those without; however, there were no differences in autism severity scores between children with and without GIS. These findings have implications for clinical management. |
Association between pica and gastrointestinal symptoms in preschoolers with and without autism spectrum disorder, Study to Explore Early Development
Fields VL , Soke GN , Reynolds A , Tian LH , Wiggins L , Maenner M , DiGuiseppi C , Kral TVE , Hightshoe K , Ladd-Acosta C , Schieve LA . Disabil Health J 2020 14 (3) 101052 BACKGROUND: Pica, the repeated ingestion of nonfood items, can result in gastrointestinal (GI) outcomes. Children with autism spectrum disorder (ASD) and other developmental disabilities (DDs) are disproportionately affected by both pica and GI symptoms. Study of the inter-relationship between pica, GI symptoms, and ASD/DD is limited. OBJECTIVE/HYPOTHESIS: We assessed associations between pica and GI symptoms in preschool-aged children with and without ASD and other (non-ASD) DDs in the Study to Explore Early Development. METHODS: Our sample included children with ASD (n = 1244), other DDs (n = 1593), and population (POP) controls (n = 1487). Data to define final case-control status, pica, and GI symptoms were from standardized developmental assessments/questionnaires. Prevalence ratios, adjusted for sociodemographic factors (aPRs), and 95% confidence intervals were derived from modified Poisson regression. RESULTS: Within each group (ASD, DD, POP) and for the total sample, pica was associated with vomiting (aPR for total sample 2.6 [1.7, 4.0]), diarrhea (1.8 [1.4, 2.2]), and loose stools (1.8 [1.4, 2.2]). In the DD group, pica was associated with constipation (1.4 [1.03, 1.9]) and pain on stooling (1.8 [1.2, 2.6]). In analyses of the subgroup without pica, increases in GI symptoms were still evident in the ASD and DD groups compared to POP group. CONCLUSION: These findings highlight an important adverse effect of pica, GI symptoms, in children with and without ASD and DDs; nonetheless, pica does not fully explain the increased risk for GI symptoms among children with ASD and DDs. These findings inform the specialized healthcare needs of children with ASD and other DDs. |
Wandering among preschool children with and without autism spectrum disorder
Wiggins LD , DiGuiseppi C , Schieve L , Moody E , Soke G , Giarelli E , Levy S . J Dev Behav Pediatr 2020 41 (4) 251-257 OBJECTIVES: (1) Report the occurrence of wandering, or leaving a supervised space, among children with confirmed autism spectrum disorder (ASD), other developmental delay (DD) with a previous but unconfirmed ASD diagnosis (DDprevASD), DD without a previous ASD diagnosis, and a population comparison group (POP) at an age when wandering is no longer expected and (2) explore whether ASD status is associated with wandering independent of behavioral, developmental, and maternal factors. METHOD: Parents and children aged 4 to 5 years enrolled in the Study to Explore Early Development Phase-1+2. All children were screened for ASD symptoms upon enrollment. Those with ASD symptoms and/or a previous ASD diagnosis received the Mullen Scales of Early Learning (MSEL) to determine their developmental level and 2 ASD diagnostic tests to determine their ASD status. All other children were evaluated with the MSEL alone. Mothers completed the Child Behavior Checklist/1(1/2)-5, which includes an item on whether the child wanders away (categorized as at least sometimes true vs not true) and items assessing behavior problems. RESULTS: Children with ASD (N = 1195) were significantly more likely to wander than children classified as DDprevASD (N = 230), DD (N = 1199), or POP (N = 1272) (60.4%, 41.3%, 22.3%, and 12.4%, respectively, p < 0.01). ASD status, very low developmental level, and affective, anxiety, attention, and oppositional problems were each independently associated with wandering behavior. CONCLUSION: Wandering is significantly more common among children with ASD and those with behavioral and developmental problems compared with other children. These findings can be used to increase the awareness of wandering among children with atypical development. |
Injury-related treatments and outcomes in preschool children with autism spectrum disorder: Study to Explore Early Development (SEED)
DiGuiseppi C , Sabourin KR , Levy SE , Soke GN , Lee LC , Wiggins L , Schieve LA . Res Autism Spectr Disord 2019 66 Background: Evidence about injury management and outcomes in children with autism spectrum disorder (ASD) is limited. Method(s): Cross-sectional analyses included children aged 30-68 months with at least one medically attended injury. Standardized diagnostic instruments determined ASD cases. Parent-reported injury treatments and outcomes were examined in ASD cases (n = 224) versus developmental delays/disorders (DD) (n = 188) and population (POP) (n = 267) controls, adjusting for child and family characteristics using logistic regression. Result(s): Injury characteristics were similar between groups. Most children (82.5%) had emergency care (EC) or hospitalization after injury. Nearly half (46.4%) ever received a medication or injection, mostly analgesics (53.4%) and local anesthetics (23.8%), while 9.4% ever received surgery, most often for open wound (47.0%) or fracture (16.7%). ASD group children were less likely than DD group children to receive medication/injection (41.1% vs. 53.2%, adjusted odds ratio [aOR] = 0.60 [0.40, 0.90]); receipt of EC/hospitalization and surgery were comparable. Children with ASD more often had surgery than POP children (14.3% vs. 4.9%, aOR = 2.62 [1.31, 5.25]); receipt of EC/hospitalization and medication/injection were similar. Loss of consciousness was uncommon (ASD = 6.3%, DD = 5.3%, POP = 3.4%), as was long-term or significant behavior change (ASD = 5.4%, DD = 3.2%, POP = 3.2%); differences were not significant. Conclusion(s): Injured children with ASD received fewer medications/injections than children with non-ASD developmental delays/disorders and more surgical treatments than general population children. Injury management was otherwise similar between groups. Understanding whether these results reflect child or injury characteristics or provider perceptions about behaviors and pain thresholds of children with ASD, and how these may influence care, requires further study. |
Community-based service use in preschool children with autism spectrum disorder and associations with insurance status
Rubenstein E , Croen L , Lee LC , Moody E , Schieve LA , Soke GN , Thomas K , Wiggins L , Daniels J . Res Autism Spectr Disord 2019 66 (101410) Background: ASD-related services can improve outcomes for children, but less is known about service outside of school settings during preschool age. We aimed to describe amount and category of community-based service use among 3-5-year-old children with ASD and examine differences by health insurance. Method(s): We used cross-sectional data on 792 children with ASD diagnoses in the Study to Explore Early Development, a community-based study of neurodevelopment with enrollment between 2012-2016. Mothers reported current child service use and insurance status at study entry. We used log-Poisson and logistic regression to compare service use by insurance group. Result(s): Nearly 40% of children were not receiving community-based services at study entry. Children with public insurance had fewer total services than children with private or both insurances. After adjustment for sociodemographic confounders, insurance status was not associated with amount of different categories of community-based services. However, children with public insurance alone were least likely to receive community-based behavioral therapy and most likely to receive psychotropic medication compared to other insurances. Conclusion(s): Many preschool-aged children do not receive community-based services, with receipt of some service types associated with insurance type. Increasing access and availability for evidence-based service, especially for beneficiaries of public insurance, may improve service use and outcomes. |
Association between breastfeeding initiation and duration and autism spectrum disorder in preschool children enrolled in the Study to Explore Early Development
Soke GN , Maenner M , Windham G , Moody E , Kaczaniuk J , DiGuiseppi C , Schieve LA . Autism Res 2019 12 (5) 816-829 Studies report inconsistent findings on the relationship between ASD and breastfeeding. We explored associations between ASD and breastfeeding initiation (yes/no) and duration (months categorized in tertiles) in the Study to Explore Early Development, a community-based case-control study in six sites in the Unites States. We adjusted for various child and mother demographic and pregnancy factors. Breastfeeding initiation was reported in 85.7% of mothers of children with ASD and 90.6% of mothers of controls. After adjustment, we found no significant difference in breastfeeding initiation (adjusted odds-ratio [aOR]: 0.88 and 95% confidence interval (CI) 0.60-1.28). However, mothers of children with ASD were less likely to report duration of breastfeeding in the high (>/=12 months) versus low tertile (<6 months) (aOR and 95% CI: 0.61 [0.45-0.84]) or the middle (6-<12 months) versus low tertile (0.72: 0.54-0.98). The association of ASD and breastfeeding duration was slightly attenuated when the presence of the broader autism phenotype (BAP) in the mother was accounted for, but still remained for the highest tertile. This association does not appear to be totally explained by maternal BAP. We were unable to distinguish whether the difference in duration was due to difficulties breastfeeding children who later develop ASD, other factors not adjusted in our study, or greater ASD risk resulting from shorter breastfeeding duration. Longitudinal studies that compare reasons why mothers stop breastfeeding between ASD and controls and establish a temporal relation between ASD and breastfeeding are needed. Future studies should also evaluate interactions between ASD risk genes and breastfeeding. Autism Res 2019. (c) 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: In this study, we compared breastfeeding practices between mothers of children with and without autism spectrum disorder (ASD). We found that the percentage of mothers who started breastfeeding was similar between the two groups, but mothers of children with ASD breastfed for a shorter amount of time compared to mothers of children without ASD. Future studies are needed to evaluate the reasons why the duration of breastfeeding was shorter for mothers of children with ASD compared to those without ASD. |
DSM-5 criteria for autism spectrum disorder maximizes diagnostic sensitivity and specificity in preschool children
Wiggins LD , Rice CE , Barger B , Soke GN , Lee LC , Moody E , Edmondson-Pretzel R , Levy SE . Soc Psychiatry Psychiatr Epidemiol 2019 54 (6) 693-701 PURPOSE: The criteria for autism spectrum disorder (ASD) were revised in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The objective of this study was to compare the sensitivity and specificity of DSM-IV-Text Revision (DSM-IV-TR) and DSM-5 definitions of ASD in a community-based sample of preschool children. METHODS: Children between 2 and 5 years of age were enrolled in the Study to Explore Early Development-Phase 2 (SEED2) and received a comprehensive developmental evaluation. The clinician(s) who evaluated the child completed two diagnostic checklists that indicated the presence and severity of DSM-IV-TR and DSM-5 criteria. Definitions for DSM-5 ASD, DSM-IV-TR autistic disorder, and DSM-IV-TR Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) were created from the diagnostic checklists. RESULTS: 773 children met SEED2 criteria for ASD and 288 met criteria for another developmental disorder (DD). Agreement between DSM-5 and DSM-IV-TR definitions of ASD were good for autistic disorder (0.78) and moderate for PDD-NOS (0.57 and 0.59). Children who met DSM-IV-TR autistic disorder but not DSM-5 ASD (n = 71) were more likely to have mild ASD symptoms, or symptoms accounted for by another disorder. Children who met PDD-NOS but not DSM-5 ASD (n = 66), or vice versa (n = 120) were less likely to have intellectual disability and more likely to be female. Sensitivity and specificity were best balanced with DSM-5 ASD criteria (0.95 and 0.78, respectively). CONCLUSIONS: The DSM-5 definition of ASD maximizes diagnostic sensitivity and specificity in the SEED2 sample. These findings support the DSM-5 conceptualization of ASD in preschool children. |
Sleep problems in 2- to 5-year-olds with autism spectrum disorder and other developmental delays
Reynolds AM , Soke GN , Sabourin KR , Hepburn S , Katz T , Wiggins LD , Schieve LA , Levy SE . Pediatrics 2019 143 (3) BACKGROUND: Sleep problems can impact daytime behavior, quality of life, and overall health. We compared sleep habits in young children with autism spectrum disorder (ASD) and other developmental delays and disorders and in children from the general population (POP). METHODS: We included 2- to 5-year-old children whose parent completed all items on the Children's Sleep Habits Questionnaire (CSHQ) in a multisite case-control study: 522 children with ASD; 228 children with other developmental delays and disorders with autism spectrum disorder characteristics (DD w/ASD); 534 children with other developmental delays and disorders without autism spectrum disorder characteristics (DD w/o ASD); and 703 POP. Multivariable analysis of variance compared CSHQ mean total score (TS) and subscale scores between groups. Logistic regression analysis examined group differences by using TS cutoffs of 41 and 48. Analyses were adjusted for covariates. RESULTS: Mean CSHQ TS for children in each group: ASD (48.5); DD w/ASD (50.4); DD w/o ASD (44.4); and POP (43.3). Differences between children with ASD and both children with DD w/o ASD and POP were statistically significant. Using a TS cutoff of 48, the proportion of children with sleep problems was significantly higher in children in the ASD group versus DD w/o ASD and POP groups (adjusted odds ratios [95% confidence intervals]: 2.12 [1.57 to 2.87] and 2.37 [1.75 to 3.22], respectively). CONCLUSIONS: Sleep problems are more than twice as common in young children with ASD and DD w/ASD. Screening for sleep problems is important in young children to facilitate provision of appropriate interventions. |
Prenatal, perinatal, and neonatal factors associated with self-injurious behaviors in children with autism spectrum disorder
Soke GN , Rosenberg SA , Hamman RF , Fingerlin TE , Rosenberg CR , Carpenter L , Lee LC , Giarelli E , Wiggins LD , Durkin MS , DiGuiseppi C . Res Autism Spectr Disord 2019 61 1-9 Background: Studies that examine the role of factors documented before self-injurious behaviors (SIB) occur are important in establishing a temporal relationship between these factors and SIB. Using data from a population-based surveillance system of 8-year-olds with autism spectrum disorder (ASD), we: (1) explored potential associations between SIB and prenatal, perinatal, and neonatal factors identified from birth certificates, and 2) validated associations between SIB and developmental, behavioral, medical factors accounting for the above prenatal, perinatal, and neonatal factors. Method(s): We included 4343 children from the Autism and Developmental Disabilities Monitoring Network from the 2000, 2006, and 2008 surveillance years. Prenatal, perinatal and neonatal characteristics were obtained from birth certificates. SIB and other potential risk factors were abstracted from children's health or education records. The associations between SIB and various potential risk factors were tested using non-linear mixed models. Result(s): Lower maternal educational attainment (adjusted odds-ratio [aOR]: 1.35 [95% confidence interval 1.10-1.67]), prenatal maternal cigarette smoking (1.47 [1.09-1.98]), and electronic fetal monitoring during labor (1.70 [1.02-2.84]) were associated with SIB. In addition, we validated previous associations between SIB and developmental regression, lower IQ, behavioral, sensory and sleep problems, co-occurring developmental and psychiatric diagnoses. Conclusion(s): The associations between SIB and maternal smoking, low maternal education attainment may be due to various factors, including low SES and limited access to specialized ASD services. Electronic fetal monitoring may be a marker for unmeasured perinatal complications. Findings reported in this study have implications for better understanding of factors associated with SIB to guide prevention and interventions. |
Behavioral problems in children with autism spectrum disorder with and without co-occurring intellectual disability
Kurzius-Spencer M , Pettygrove S , Christensen D , Pedersen AL , Cunniff C , Meaney FJ , Soke GN , Harrington RA , Durkin M , Rice S . Res Autism Spectr Disord 2018 56 61-71 Background: Autism spectrum disorder (ASD), intellectual disability (ID), and behavioral problems commonly co-occur, leading to increased impairment, diagnostic confusion, and treatment delays. Using data from a large surveillance population of children with ASD, the objectives of the present study were to compare the relative risk of common behavioral problems in children with ASD, with and without co-occurring intellectual disability. Methods: Data from the Autism and Developmental Disabilities Monitoring (ADDM) Network (2006-2010) on 9378 8-year-old children who met case definition for ASD and had cognitive test scores and information on behavioral problems were analyzed using frequency measures, risk ratios, chi-squared tests, and trend tests. Results: Children with ASD with and without ID had on average six co-occurring behavioral problems. The relative risk (RR) of self-injurious behaviors, unusual fear responses, and eating abnormalities increased with increasing cognitive impairment among children with ASD and ID (all p<0.001). Conversely, RR of mood (p<0.001) and sleep abnormalities (p=0.013) declined with increasing levels of cognitive impairment. Conclusions: Children with ASD and ID are at greater risk of some behavioral problems and lower risk of others as compared to children with ASD only. Successful interventions depend on understanding the complex interactions between co-occurring neurodevelopmental and behavioral problems. |
Prevalence of co-occurring medical and behavioral conditions/symptoms among 4- and 8-year-old children with autism spectrum disorder in selected areas of the United States in 2010
Soke GN , Maenner MJ , Christensen D , Kurzius-Spencer M , Schieve LA . J Autism Dev Disord 2018 48 (8) 2663-2676 We compared the prevalence of various medical and behavioral co-occurring conditions/symptoms between 4- and 8-year-olds with autism spectrum disorder (ASD) from five sites in the Autism and Developmental Disabilities Monitoring Network during the 2010 survey year, accounting for sociodemographic differences. Over 95% of children had at least one co-occurring condition/symptom. Overall, the prevalence was higher in 8- than 4-year-olds for 67% of co-occurring conditions/symptoms examined. Further, our data suggested that co-occurring conditions/symptoms increased or decreased the age at which children were first evaluated for ASD. Similarly, among the 8-year-olds, the prevalence of most co-occurring conditions/symptoms was higher in children with a previous ASD diagnosis documented in their records. These findings are informative for understanding and screening co-occurring conditions/symptoms in ASD. |
Brief report: Self-injurious behaviors in preschool children with autism spectrum disorder compared to other developmental delays and disorders
Soke GN , Rosenberg SA , Rosenberg CR , Vasa RA , Lee LC , DiGuiseppi C . J Autism Dev Disord 2018 48 (7) 2558-2566 We compared the prevalence of self-injurious behaviors (SIB) in preschoolers aged 30-68 months with autism spectrum disorder (ASD) (n = 691) versus other developmental delays and disorders (DD) (n = 977) accounting for sociodemographic, cognitive, and medical factors. SIB prevalence was higher in ASD versus all DD [adjusted odds-ratio (aOR) 2.13 (95% confidence interval (95% CI) 1.53, 2.97)]. In subgroup analyses, SIB prevalence was higher in ASD versus DD without ASD symptoms [aOR 4.42 (95% CI 2.66, 7.33)], but was similar between ASD and DD with ASD symptoms [aOR 1.09 (95% CI 0.68, 1.77)]. We confirmed higher prevalence of SIB in ASD versus DD, independent of confounders. In children with DD, SIB prevalence increased with more ASD symptoms. These findings are informative to clinicians, researchers, and policymakers. |
Injuries in children with autism spectrum disorder: Study to Explore Early Development (SEED)
DiGuiseppi C , Levy SE , Sabourin KR , Soke GN , Rosenberg S , Lee LC , Moody E , Schieve LA . J Autism Dev Disord 2017 48 (2) 461-472 This study examined caregiver-reported medically-attended injuries among 30-68 month old children with autism spectrum disorder (ASD) compared to general population (POP) and non-ASD developmental disorders (DD) controls in the Study to Explore Early Development. Injuries were common in ASD cases (32.3%) as well as POP (30.2%) and DD (27.8%) controls; most resulted in an emergency visit or hospitalization. After accounting for sociodemographic, health, IQ and behavior differences, odds of injury in ASD cases were significantly higher than DD controls but similar to POP controls. Attention problems mediated the relationships. Clinicians caring for children with both ASD and attention problems should consider providing targeted safety advice. Differences in injury risk between children with ASD vs. other developmental disorders need further study. |
Self-injurious behaviors in children with autism spectrum disorder enrolled in the Study to Explore Early Development
Soke GN , Rosenberg SA , Rosenberg CR , Vasa RA , Lee LC , DiGuiseppi C . Autism 2017 22 (5) 1362361316689330 We assessed potential factors associated with "current" or "ever" self-injurious behaviors, reported in the Autism Diagnostic Interview-Revised, among children with autism spectrum disorder (n = 692) from the Study to Explore Early Development. Data on factors examined were obtained from questionnaires, standardized clinical instruments, and birth certificates. We employed a log-binomial regression to assess these associations. Although most associations were quite similar for currently and ever exhibiting self-injurious behaviors, a few differences were noted. We documented previously unreported associations of current self-injurious behaviors with maternal age and cesarean delivery, and ever self-injurious behaviors with maternal age, child sex, gestational age, and maternal race. We also confirmed previously reported associations with adaptive skills, somatic conditions (sleep, gastrointestinal, and sensory abnormalities), and other behavioral problems. These findings are informative for clinical practice and future research. |
Brief report: Estimated prevalence of a community diagnosis of autism spectrum disorder by age 4 years in children from selected areas in the United States in 2010: Evaluation of birth cohort effects
Soke GN , Maenner MJ , Christensen D , Kurzius-Spencer M , Schieve LA . J Autism Dev Disord 2017 47 (6) 1917-1922 We compared early-diagnosed autism spectrum disorder (ASD) (defined as diagnosis by age 4 years) between the 2002 and 2006 birth cohorts, in five sites of the Autism and Developmental Disabilities Monitoring Network. In the 2002 cohort, the prevalence/1000 of early-diagnosed ASD was half the 8-year-old prevalence (7.2 vs. 14.7, prevalence ratio [PR] 0.5 [0.4-0.6]). Overall, the prevalence of early-diagnosed ASD did not differ between birth cohorts (PR 1.1 [0.9-1.3]). However, in three sites with complete case ascertainment, the prevalence of early-diagnosed ASD was higher for those born in 2006 versus 2002 (PR 1.3 [1.1-1.5]), suggesting possible improvement in early identification. The lack of change in two sites may reflect less complete case ascertainment. Studies in more recent cohorts are needed. |
Brief Report: The ADOS calibrated severity score best measures autism diagnostic symptom severity in pre-school children
Wiggins LD , Barger B , Moody E , Soke G , Pandey J , Levy S . J Autism Dev Disord 2017 49 (7) 2999-3006 The severity of autism spectrum disorder (ASD) is often measured by co-occurring conditions, such as intellectual disability or language delay, rather than deficits in social interaction, and restricted interests and repetitive behaviors. The Autism Diagnostic Observation Schedule calibrated severity score (ADOS CSS) was created to facilitate comparison of the diagnostic features of ASD independent of related conditions over time. We examined the relationship between the ADOS CSS, ADOS total score, and clinician rated degree of impairment (DOI) in the Study to Explore Early Development. Like others, we confirmed that, among the measures we evaluated, the ADOS CSS was least influenced by developmental functioning and demographic factors and is therefore the best measure of core features of ASD in pre-school children. |
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