Publications by authors named "Colby Chlebowski"

21 Publications

  • Page 1 of 1

Severity modeling of propionic acidemia using clinical and laboratory biomarkers.

Genet Med 2021 May 18. Epub 2021 May 18.

Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes of Health (NIH), Bethesda, MD, USA.

Purpose: To conduct a proof-of-principle study to identify subtypes of propionic acidemia (PA) and associated biomarkers.

Methods: Data from a clinically diverse PA patient population ( https://clinicaltrials.gov/ct2/show/NCT02890342 ) were used to train and test machine learning models, identify PA-relevant biomarkers, and perform validation analysis using data from liver-transplanted participants. k-Means clustering was used to test for the existence of PA subtypes. Expert knowledge was used to define PA subtypes (mild and severe). Given expert classification, supervised machine learning (support vector machine with a polynomial kernel, svmPoly) performed dimensional reduction to define relevant features of each PA subtype.

Results: Forty participants enrolled in the study; five underwent liver transplant. Analysis with k-means clustering indicated that several PA subtypes may exist on the biochemical continuum. The conventional PA biomarkers, plasma total 2-methylctirate and propionylcarnitine, were not statistically significantly different between nontransplanted and transplanted participants motivating us to search for other biomarkers. Unbiased dimensional reduction using svmPoly revealed that plasma transthyretin, alanine:serine ratio, GDF15, FGF21, and in vivo 1-C-propionate oxidation, play roles in defining PA subtypes.

Conclusion: Support vector machine prioritized biomarkers that helped classify propionic acidemia patients according to severity subtypes, with important ramifications for future clinical trials and management of PA.
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http://dx.doi.org/10.1038/s41436-021-01173-2DOI Listing
May 2021

Characterizing therapist delivery of evidence-based intervention strategies in publicly funded mental health services for children with autism spectrum disorder: Differentiating practice patterns in usual care and AIM HI delivery.

Autism 2021 Aug 28;25(6):1709-1720. Epub 2021 Mar 28.

Child and Adolescent Services Research Center, University of California, San Diego, USA.

Lay Abstract: This study was conducted to identify patterns of therapist delivery of evidence-based intervention strategies with children with autism spectrum disorder receiving publicly funded mental health services and compare strategy use for therapists delivering usual care to those trained to deliver AIM HI ("An Individualized Mental Health Intervention for ASD"), an intervention designed to reduce challenging behaviors in children with autism spectrum disorder. For therapists trained in AIM HI, intervention strategies grouped onto two factors, and , while strategies used by usual care therapists grouped onto a broader single factor, . Among usual care therapists, were related to an increase in child behavior problems, whereas for AIM HI therapists, were related with reductions in child behavior problems over 18 months. Findings support the use of active teaching strategies in reducing challenging behaviors in children with autism spectrum disorder and provide support for the effectiveness of training therapists in evidence-based interventions to promote the delivery of targeted, specific intervention strategies to children with autism spectrum disorder in mental health services.
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http://dx.doi.org/10.1177/13623613211001614DOI Listing
August 2021

Chromoanasynthesis as a cause of Jacobsen syndrome.

Am J Med Genet A 2020 11 25;182(11):2533-2539. Epub 2020 Aug 25.

Laboratory of Molecular Immunology, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA.

Jacobsen syndrome (MIM #147791) is a rare multisystem genomic disorder involving craniofacial abnormalities, intellectual disability, other neurodevelopmental defects, and terminal truncation of chromosome 11q, typically deleting ~170 to >340 genes. We describe the first case of Jacobsen syndrome caused by congenital chromoanasynthesis, an extreme form of complex chromosomal rearrangement. Six duplications and five deletions occurred on one copy of chromosome 11q with microhomology signatures in the breakpoint junctions, indicating an all-at-once replication-based rearrangement mechanism in a gametocyte or early post-zygotic cell. Eighteen genes were deleted from the Jacobsen region, including KIRREL3, which is associated with intellectual disability.
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http://dx.doi.org/10.1002/ajmg.a.61824DOI Listing
November 2020

Impact of Therapist Training on Parent Attendance in Mental Health Services for Children with ASD.

J Clin Child Adolesc Psychol 2020 Aug 20:1-12. Epub 2020 Aug 20.

Child and Adolescent Services Research Center.

Objective: The current study explored the impact of training therapists in a mental health intervention for children with autism spectrum disorder (ASD) on parent attendance in their children's therapy sessions. We also examined family, therapist, and program factors as potential moderators.

Method: Data were drawn from a cluster-randomized community effectiveness trial of "An Individualized Mental Health Intervention for ASD (AIM HI)". Participants included 168 therapists yoked with 189 children recruited from publicly-funded mental health services. Data included family (caregiver strain, parent sense of competence, race/ethnicity), therapist (background, experience), and program (service setting) characteristics, and parent session attendance. Multilevel models were used to evaluate the effectiveness of AIM HI therapist training on caregiver attendance and identify moderators of training effects on parent attendance.

Results: Parents attended a higher percentage of sessions in the AIM HI training condition compared to the Usual Care condition. Program service setting moderated the effect of AIM HI training, with higher parent attendance in non-school (mostly outpatient) settings compared to school settings and a significantly smaller difference between the settings in the AIM HI condition.

Conclusions: Effective strategies to promote parent engagement, especially in service settings such as schools, are warranted. Findings support the effectiveness of AIM HI training in promoting parent attendance across multiple publicly-funded mental health service settings. The larger effect in school-based programs supports the utility of training in evidence-based interventions such as AIM HI to increase the feasibility of parent attendance in such services.
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http://dx.doi.org/10.1080/15374416.2020.1796682DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7987108PMC
August 2020

Training Community Therapists to Deliver an Individualized Mental Health Intervention for Autism Spectrum Disorder: Changes in Caregiver Outcomes and Mediating Role on Child Outcomes.

J Am Acad Child Adolesc Psychiatry 2021 03 2;60(3):355-366. Epub 2020 Aug 2.

Child and Adolescent Services Research Center, San Diego, California; University of California, San Diego; San Diego State University, California.

Objective: This study examines the impact of training therapists to deliver "An Individualized Mental Health Intervention for Autism Spectrum Disorder (ASD)" (AIM HI) for children with autism spectrum disorder on caregiver outcomes and the mediating role of changes in caregiver outcomes on child outcomes.

Method: Data were drawn from a cluster randomized trial conducted in 29 publicly funded mental health programs randomized to receive AIM HI training or usual care. Therapists were recruited from enrolled programs and child/caregiver participants enrolled from therapists' caseloads. Participants included 202 caregivers of children 5 to 13 years of age with autism spectrum disorder. Caregiver strain and sense of competence were assessed at baseline and 6 month postbaseline. Child behaviors were assessed at baseline and 6, 12, and 18 months postbaseline. Therapist delivery of evidence-based intervention strategies were assessed between baseline and 6 months.

Results: A significant training effect was observed for caregiver sense of competence, with AIM HI caregivers reporting significantly greater improvement relative to usual care. There was no significant training effect for caregiver strain. Observer-rated therapist delivery of evidence-based interventions strategies over 6 months mediated training effects for sense of competence at 6 months. Changes in sense of competence from baseline to 6 months was associated with reduced child challenging behaviors at 6 months and mediated child outcomes at 12 and 18 months.

Conclusion: Combined with research demonstrating effectiveness of therapist AIM HI training on child outcomes, this study provides further evidence of the positive impact of training community therapists in the AIM HI intervention.

Clinical Trial Registration Information: Effectiveness and Implementation of a Mental Health Intervention for ASD (AIM HI); https://clinicaltrials.gov/; NCT02416323.
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http://dx.doi.org/10.1016/j.jaac.2020.07.896DOI Listing
March 2021

Neurodevelopmental Characterization of Young Children Diagnosed with Niemann-Pick Disease, Type C1.

J Dev Behav Pediatr 2020 Jun/Jul;41(5):388-396

Division of Translational Medicine, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, DHHS, Bethesda, MD.

Objective: Niemann-Pick disease type C1 (NPC1) is a lysosomal storage disease characterized by progressive neurodegeneration, with the age of diagnosis ranging from the prenatal period through adulthood. Although neurological symptoms usually precede genetic diagnosis, they do not necessarily prompt diagnosis in the early years. Few prospective data are available to describe neurological onset, including neurodevelopmental delays, in children with NPC1. This dearth of information hinders the planning and implementation of adequate monitoring and treatment for the neurodevelopmental sequelae of NPC1.

Method: Twenty-nine infants, toddlers, and preschoolers younger than 6 years participated in a natural history study and were administered neurodevelopmental assessments using instruments commonly used for early intervention screening in the community.

Results: Twenty-two of 29 participants met the criteria for a significant delay of at least 1.5 SDs below the mean in at least one domain of development; the youngest children often met these criteria for a significant delay based on motor delays, but cognitive and language delays were also common. However, only 11 of the 22 participants were reported to receive early intervention services before study entry.

Conclusion: Although neurological symptoms may not prompt the genetic diagnosis of NPC1, the current findings support the use of a multimethod approach to repeated assessments for young children with the diagnosis because of the frequency of developmental delays or decline in multiple domains. The diagnosis of NPC1 alone should qualify children for evaluation for early intervention services and consideration of investigational therapeutic interventions.
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http://dx.doi.org/10.1097/DBP.0000000000000785DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592416PMC
February 2020

Emergent life events in the delivery of a caregiver-mediated evidence-based intervention for children with autism spectrum disorder in publicly funded mental health services.

Autism 2020 07 31;24(5):1286-1299. Epub 2020 Jan 31.

Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.

Lay Abstract: Mental health clinicians often report significant challenges when delivering evidence-based interventions (EBI) in community settings, particularly when unexpected client stressors (or emergent life events; ELEs) interfere with the therapy process. The current study sought to extend the study of ELEs to children with Autism Spectrum Disorder (ASD) by examining the occurrence and impact of ELEs in the context of a collaborative, caregiver-mediated intervention for reducing challenging behaviors in children with ASD. This intervention was n ndividualized ental ealth ntervention for children with ASD (referred to as AIM HI). Participants included 38 clinicians and child clients who were enrolled in a community effectiveness trial of AIM HI. Video recordings of 100 therapy sessions were coded for caregiver-reported ELEs and also how well clinicians adhered to the AIM HI protocol. Results indicated that mild to severe ELEs were reported in 36% of therapy sessions, and were reported for 58% of children at some point during the intervention. Children who had a greater number of diagnoses (in addition to the autism diagnosis) tended to have more ELEs. In addition, clinicians with less years of experience tended to have sessions with more ELEs. There was no significant link between ELEs and how well clinicians adhered to the AIM HI protocol. Findings offer implications for the implementation of EBI, particularly the importance of incorporating clinician training in addressing complex presentations and crises in the context of EBIs.
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http://dx.doi.org/10.1177/1362361319881084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8115197PMC
July 2020

Using stakeholder perspectives to guide systematic adaptation of an autism mental health intervention for Latinx families: A qualitative study.

J Community Psychol 2020 05 9;48(4):1194-1214. Epub 2019 Dec 9.

Department of Psychiatry, University of California San Diego, San Diego, California.

Embedded within a Hybrid Type 1 randomized effectiveness-implementation trial in publicly funded mental health services, the current study identified stakeholder recommendations to inform cultural adaptations to An Individualized Mental Health Intervention for Autism Spectrum Disorder (AIM HI) for Latinx and Spanish-speaking families. Recommendations were collected through focus groups with therapists (n = 17) and semi-structured interviews with Latinx parents (n = 29). Relevant themes were identified through a rapid assessment analysis process and thematic coding of interviews. Adaptations were classified according to the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) to facilitate fit, acceptability, and sustained implementation of AIM HI and classify the content, nature, and goals of the adaptations. Recommended adaptations were classified through FRAME as tailoring training and intervention materials, changing packaging or materials, extending intervention pacing, and integrating supplemental training strategies. Goals for adaptations included improving fit for stakeholders, increasing parent engagement, and enhancing intervention effectiveness. The current study illustrates the process of embedding an iterative process of intervention adaptation within a hybrid effectiveness-implementation trial. The next steps in this study are to integrate findings with implementation process data from the parent trial to develop a cultural enhancement to AIM HI and test the enhancement in a Hybrid Type 3 implementation-effectiveness trial.
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http://dx.doi.org/10.1002/jcop.22296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261618PMC
May 2020

In-Session Caregiver Behaviors during Evidence-Based Intervention Delivery for Children with ASD in Community Mental Health Services.

Evid Based Pract Child Adolesc Ment Health 2019 7;4(1):55-71. Epub 2019 Feb 7.

Department of Psychiatry, University of California, San Diego.

An Individualized Mental Health Intervention for ASD, ("AIM HI"), is a collaborative, caregiver-mediated and child-directed intervention for reducing challenging behaviors in children with autism spectrum disorder developed for delivery in community mental health programs. Using observational data from AIM HI sessions, the present study characterized the occurrence of two types of in-session caregiver behaviors: expressed concerns (i.e., ) and participation engagement (i.e., ). Further analyses examined cultural differences in caregiver behaviors and associations between caregiver behaviors and clinician adherence. Participants included 39 caregiver-clinician dyads enrolled in a community effectiveness trial of AIM HI. Video recordings from 107 sessions during the first two months of treatment were coded for in-session caregiver behaviors and clinician adherence. Results indicated that expressed concerns were observed in 47% of sessions. When controlling for household income, Latinx caregivers were rated lower for and demonstrated lower participation engagement behaviors in session compared with non-Latinx White caregivers, suggesting that cultural factors may impact verbal engagement in sessions. Finally, , , and participation engagement were positively associated with clinician adherence. Findings suggest that some expressed concerns and participation engagement behaviors may be indicators of positive caregiver engagement in the context of a collaborative intervention, and lower levels of such caregiver engagement may actually impede clinicians' delivery of intensive evidence-based intervention in routine care.
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http://dx.doi.org/10.1080/23794925.2019.1565500DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6602542PMC
February 2019

Characterizing Shared and Unique Implementation Influences in Two Community Services Systems for Autism: Applying the EPIS Framework to Two Large-Scale Autism Intervention Community Effectiveness Trials.

Adm Policy Ment Health 2020 03;47(2):176-187

Department of Psychiatry, University of California, Davis MIND Institute, Sacramento, CA, USA.

The purpose of this study was to examine common and unique factors influencing implementation process for two evidence-based interventions for children with autism spectrum disorder (ASD) in mental health and education service contexts. This study prospectively collected qualitative data from intervention developers and research staff on the implementation process within the context of two separate ASD intervention effectiveness trials. Results reveal common and unique factors influencing implementation in both study contexts. Implementation leadership and provider attitudes and motivation emerge as key influences on implementation across systems. These findings provide promising targets for modular implementation interventions that can be leveraged within growing, large-scale translation efforts in usual care.
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http://dx.doi.org/10.1007/s10488-019-00931-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6756990PMC
March 2020

Effectiveness of Training Therapists to Deliver An Individualized Mental Health Intervention for Children With ASD in Publicly Funded Mental Health Services: A Cluster Randomized Clinical Trial.

JAMA Psychiatry 2019 06;76(6):574-583

Child and Adolescent Services Research Center, San Diego, California.

Importance: Publicly funded mental health services play an important role in addressing co-occurring mental health problems in children with autism spectrum disorder (ASD); however, therapists report lacking training to effectively serve this complex population.

Objective: To test the effectiveness of training community therapists in An Individualized Mental Health Intervention for ASD (AIM HI) on challenging behaviors across 18 months among children with ASD and identify moderators and mediators of any intervention effects.

Design, Setting, And Participants: Cluster randomized trial conducted in 29 publicly funded outpatient and school-based mental health programs in southern California from 2012 to 2017. Programs were randomized to receive immediate AIM HI training or provide usual care followed by receipt of AIM HI training. Therapist participants were recruited from enrolled programs, and child participants were recruited from participant therapists' caseloads. Data were analyzed from 202 children with ASD who were aged 5 to 13 years.

Interventions: The AIM HI protocol is a package of parent-mediated and child-focused strategies aimed to reduce challenging behaviors in children with ASD who are 5 to 13 years old. It was designed for delivery in publicly funded mental health services based on a systematic assessment of therapist training needs and child clinical needs. The therapist training and consultation process takes approximately 6 months and includes an introductory workshop, 11 structured consultation meetings as the therapist delivers AIM HI with a current client, and case-specific performance feedback from trainers.

Main Outcomes And Measures: Child participants were assessed for challenging behaviors using the Eyberg Child Behavior Inventory (ECBI) and Social Skills Improvement System (SSIS) Competing Problem Behaviors scales based on parent report at baseline and at 6-month intervals for 18 months. Outcomes were analyzed using intent-to-treat models.

Results: In total, 202 children with ASD (mean [SD] age, 9.1 [2.4] years; 170 [84.2%] male; 121 [59.9%] Latinx) were eligible, enrolled, and included in the analyses. Statistically significant group by time interactions for the ECBI Intensity (B = -0.38; P = .02) and ECBI Problem (B = -1.00; P = .005) scales were observed, with significantly larger decreases in ECBI Intensity scores in the AIM HI group (B = -1.36; P < .001) relative to the usual care group (B = -0.98; P < .001) and a significantly larger decrease in ECBI Problem scores in the AIM HI group (B = -1.22; P < .001) relative to the usual care group (B = -0.20; P = .29). Therapist fidelity moderated these intervention effects.

Conclusions And Relevance: The present findings support the effectiveness of training therapists to deliver the AIM HI model to children with ASD receiving publicly funded mental health services.

Trial Registration: ClinicalTrials.gov identifier: NCT02416323.
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http://dx.doi.org/10.1001/jamapsychiatry.2019.0011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6551846PMC
June 2019

Therapists' Adaptations to an Intervention to Reduce Challenging Behaviors in Children with Autism Spectrum Disorder in Publicly Funded Mental Health Services.

J Autism Dev Disord 2019 Mar;49(3):924-934

Department of Psychiatry, University of California, San Diego, CA, USA.

Publicly funded mental health services play an important role in serving children with autism spectrum disorder (ASD). Previous research indicates a high likelihood of adaptations when therapists deliver evidence based practices to non-ASD populations, though less is known about therapists' use of adaptations for children with ASD receiving mental health services. The current study uses a mixed quantitative and qualitative approach to characterize the types and reasons therapists adapted a clinical intervention [An Individualized Mental Health Intervention for Children with ASD (AIM HI)] for delivery with clinically complex children with ASD served in publicly funded mental health settings and identify therapist characteristics that predict use of adaptations. The most common adaptations were characterized as augmenting AIM HI and were done to individualize the intervention to fit with therapeutic style, increase caregiver participation, and address clients' and caregivers' needs and functioning. No therapist characteristics emerged as significant predictors of adaptations. Results suggest that therapists' adaptations were largely consistent with the AIM HI protocol while individualizing the model to address the complex needs of youth with ASD.
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http://dx.doi.org/10.1007/s10803-018-3795-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800992PMC
March 2019

Characterization of autism spectrum disorder and neurodevelopmental profiles in youth with XYY syndrome.

J Neurodev Disord 2018 10 22;10(1):30. Epub 2018 Oct 22.

Developmental Neurogenomics Unit, Human Genetics Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.

Background: XYY syndrome is a sex chromosome aneuploidy that occurs in ~ 1/850 male births and is associated with increased risk for neurodevelopmental difficulties. However, the profile of neurodevelopmental impairments, including symptoms of autism spectrum disorder (ASD) in XYY remains poorly understood. This gap in knowledge has persisted in part due to lack of access to patient cohorts with dense and homogeneous phenotypic data.

Methods: We evaluated a single-center cohort of 64 individuals with XYY aged 5-25 years, using a standardized battery of cognitive and behavioral assessments spanning developmental milestones, IQ, adaptive behavior, academic achievement, behavioral problems, and gold-standard diagnostic instruments for ASD. Our goals were to (i) detail the neurodevelopmental profile of XYY with a focus on ASD diagnostic rates and symptom profiles, (ii) screen phenotypes for potential ascertainment bias effects by contrasting pre- vs. postnatally diagnosed XYY subgroups, and (iii) define major modules of phenotypic variation using graph-theoretical analysis.

Results: Although there was marked inter-individual variability, the average profile was characterized by some degree of developmental delay, and decreased IQ and adaptive behavior. Impairments were most pronounced for language and socio-communicative functioning. The rate of ASD was 14%, and these individuals exhibited autism symptom profiles resembling those observed in ASD without XYY. Most neurodevelopmental dimensions showed milder impairment among pre- vs. postnatally diagnosed individuals, with clinically meaningful differences in verbal IQ. Feature network analysis revealed three reliably separable modules comprising (i) cognition and academic achievement, (ii) broad domain psychopathology and adaptive behavior, and (iii) ASD-related features.

Conclusions: By adding granularity to our understanding of neurodevelopmental difficulties in XYY, these findings assist targeted clinical assessment of newly identified cases, motivate greater provision of specialized multidisciplinary support, and inform future efforts to integrate behavioral phenotypes in XYY with neurobiology.

Trial Registrations: ClinicalTrials.gov NCT00001246 , "89-M-0006: Brain Imaging of Childhood Onset Psychiatric Disorders, Endocrine Disorders and Healthy Controls."
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http://dx.doi.org/10.1186/s11689-018-9248-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198503PMC
October 2018

Implementing an intervention to address challenging behaviors for autism spectrum disorder in publicly-funded mental health services: Therapist and parent perceptions of delivery with Latinx families.

Cultur Divers Ethnic Minor Psychol 2018 Oct 19;24(4):552-563. Epub 2018 Jul 19.

Department of Psychiatry.

Objectives: As implementation of evidence-based practices (EBPs) in publicly funded children's mental health services has become increasingly common, concerns have been raised about the appropriateness of specific EBPs to the diverse client populations served in these settings. Exploring stakeholder perspectives can provide direction for refinements of EBPs when delivered with Latinx families. The current study used qualitative methods to examine therapist and Latinx parent perceptions of therapist-parent interactions and the intervention process when therapists are trained to deliver AIM HI (), a structured, parent-mediated intervention for autism spectrum disorder (ASD).

Method: Therapist and parent participants were a subset of participants from a large-scale community effectiveness trial. Perceptions were gathered through focus groups with therapists ( = 17) and semistructured interviews with Latinx parents ( = 29). Therapists were 94% female, 35% Latinx, and 47% were fluent in Spanish. Parents were 93% female, 100% Latinx, and 66% preferred Spanish. A coding, consensus, co-occurrence and comparison approach was used to analyze data.

Results: Three primary themes emerged: (a) limited parental knowledge about ASD and the need to address knowledge gaps; (b) differing perceptions regarding parental participation in treatment; and (c) identification of influences on parent-therapist interaction, including the cultural value of /deference (emphasized by therapists), and importance of /personal connection (emphasized by parents).

Conclusions: The themes provide specific direction for enhancements to AIM HI to maximize engagement of Latinx families. The themes also have broader implications for intervention development and community implementation including refinement of EBPs to facilitate fit and sustained implementation. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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http://dx.doi.org/10.1037/cdp0000215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6188834PMC
October 2018

Characterizing psychiatric comorbidity in children with autism spectrum disorder receiving publicly funded mental health services.

Autism 2018 11 15;22(8):938-952. Epub 2017 Sep 15.

3 Child and Adolescent Services Research Center, USA.

Publicly funded mental health programs play a significant role in serving children with autism spectrum disorder. Understanding patterns of psychiatric comorbidity for this population within mental health settings is important to implement appropriately tailored interventions. This study (1) describes patterns of psychiatric comorbidity in children with autism spectrum disorder who present to mental health services with challenging behaviors and (2) identifies child characteristics associated with comorbid conditions. Data are drawn from baseline assessments from 201 children with autism spectrum disorder who participated in a community effectiveness trial across 29 publicly funded mental health programs. Non-autism spectrum disorder diagnoses were assessed using an adapted Mini-International Neuropsychiatric Interview, parent version. Approximately 92% of children met criteria for at least one non-autism spectrum disorder diagnosis (78% attention deficit hyperactivity disorder, 58% oppositional defiant disorder, 56% anxiety, 30% mood). Logistic regression indicated that child gender and clinical characteristics were differentially associated with meeting criteria for attention deficit hyperactivity disorder, oppositional defiant disorder, an anxiety, or a mood disorder. Exploratory analyses supported a link between challenging behaviors and mood disorder symptoms and revealed high prevalence of these symptoms in this autism spectrum disorder population. Findings provide direction for tailoring intervention to address a broad range of clinical issues for youth with autism spectrum disorder served in mental health settings.
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http://dx.doi.org/10.1177/1362361317712650DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6491206PMC
November 2018

Caregiver-Teacher Concordance of Challenging Behaviors in Children with Autism Spectrum Disorder Served in Community Mental Health Settings.

J Autism Dev Disord 2017 06;47(6):1780-1790

Department of Psychiatry, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA.

Children with autism spectrum disorder (ASD) exhibit high rates of challenging behaviors that impair functioning and represent the primary presenting problem in mental health (MH) services. Obtaining symptom reports from multiple informants is critical for treatment planning. This study evaluated caregiver-teacher concordance of ratings of the intensity of challenging behaviors in children with ASD receiving MH services, and identified child clinical factors associated with concordance. This sample included 141 children (M = 9.07 years), their caregivers, and teachers. Caregiver-teacher concordance of challenging behaviors was low and impacted by the degree and type of child psychiatric comorbidity. Findings support need for increased attention to the range of psychiatric problems children with ASD present to tailor treatment recommendations and service delivery.
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http://dx.doi.org/10.1007/s10803-017-3101-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5984039PMC
June 2017

Psychiatric comorbidity in autism spectrum disorder: Correspondence between mental health clinician report and structured parent interview.

Autism 2017 10 11;21(7):841-851. Epub 2016 Jul 11.

1 University of California, San Diego, USA.

Publicly funded mental health services are critical in caring for children with autism spectrum disorder. Accurate identification of psychiatric comorbidity is necessary for effective mental health treatment. Little is known about psychiatric diagnosis for this population in routine mental health care. This study (1) examined correspondence between psychiatric diagnoses reported by mental health clinicians and those derived from a structured diagnostic interview and (2) identified predictors of agreement between clinician-reported and diagnostic interview-derived diagnoses in a sample of 197 children aged 4-14 years with autism spectrum disorder receiving mental health services. Data were drawn from a randomized effectiveness trial conducted in publicly funded mental health services. Non-autism spectrum disorder diagnoses were assessed using an adapted version of the Mini-International Neuropsychiatric Interview, parent version. Cohen's kappa was calculated to examine agreement between Mini-International Neuropsychiatric Interview, parent version and clinician-reported diagnoses of comorbid conditions. Children met criteria for an average of 2.83 (standard deviation = 1.92) Mini-International Neuropsychiatric Interview, parent version diagnoses. Agreement was poor across all diagnostic categories (κ values: 0.06-0.18). Logistic regression identified child gender and clinical characteristics as significant predictors of agreement for specific diagnoses. Results underscore the need for training mental health clinicians in targeted assessment of specific psychiatric disorders and prioritizing treatment development and testing for specific diagnoses to improve care for children with autism spectrum disorder served in publicly funded mental health settings.
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http://dx.doi.org/10.1177/1362361316654083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5226915PMC
October 2017

Characterizing the Use of Research-Community Partnerships in Studies of Evidence-Based Interventions in Children's Community Services.

Adm Policy Ment Health 2016 Jan;43(1):93-104

University of San Diego, San Diego, CA, USA.

This study characterized the use of research community partnerships (RCPs) to tailor evidence-based intervention, training, and implementation models for delivery across different childhood problems and service contexts using a survey completed by project principal investigators and community partners. To build on previous RCP research and to explicate the tacit knowledge gained through collaborative efforts, the following were examined: (1) characteristics of studies using RCP models; (2) RCP functioning, processes, and products; (3) processes of tailoring evidence-based practices for community implementation; and (4) perceptions of the benefits and challenges of collaborating with community providers and consumers. Results indicated that researchers were solely or jointly involved in the formation of almost all of the RCPs; interpersonal and operational processes were perceived as primary challenges; community partners' roles included greater involvement in implementation and participant recruitment than more traditional research activities; and the partnership process was perceived to increase the relevance and "fit" of interventions and research.
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http://dx.doi.org/10.1007/s10488-014-0622-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500757PMC
January 2016

Large-scale use of the modified checklist for autism in low-risk toddlers.

Pediatrics 2013 Apr 25;131(4):e1121-7. Epub 2013 Mar 25.

Department of Psychiatry, University of California, San Diego, San Diego, California, USA.

Objective: The purpose of the study was to examine use of the Modified Checklist for Autism in Toddlers (M-CHAT) as an autism-specific screening instrument in a large, geographically diverse pediatrics-based sample.

Methods: The M-CHAT and the M-CHAT Follow-Up (M-CHAT/F) were used to screen 18,989 toddlers at pediatric well-child visits in 2 US geographic regions. Pediatricians directly referred children to ascertain potential missed screening cases. Screen-positive children received the M-CHAT/F; children who continued to screen positive after the M-CHAT/F received a diagnostic evaluation.

Results: Results indicated that 54% of children who screened positive on the M-CHAT and M-CHAT/F presented with an autism spectrum disorder (ASD), and 98% presented with clinically significant developmental concerns warranting intervention. An M-CHAT total score cutoff of ≥3 identifies nearly all screen-positive cases, and for ease of scoring the use of only the M-CHAT total score cutoff is recommended. An M-CHAT total score of 7 serves as an appropriate clinical cutoff, and providers can bypass the M-CHAT/F and refer immediately to evaluation and intervention if a child obtains a score of ≥7.

Conclusions: This study provides empirical support for the utility of population screening for ASD with the use of the M-CHAT in a primary care setting. Results suggest that the M-CHAT continues to be an effective screening instrument for ASD when the 2-step screening process is used. The M-CHAT is widely used at pediatric offices, and this study provides updated results to facilitate use and scoring of the M-CHAT by clinical providers.
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http://dx.doi.org/10.1542/peds.2012-1525DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608483PMC
April 2013

Age of first words predicts cognitive ability and adaptive skills in children with ASD.

J Autism Dev Disord 2013 Feb;43(2):253-64

Department of Psychology, University of Connecticut, 406 Babbidge Road, U-1020, Storrs, CT 06269, USA.

Acquiring useful language by age 5 has been identified as a strong predictor of positive outcomes in individuals with Autism Spectrum Disorders (ASD). This study examined the relationship between age of language acquisition and later functioning in children with ASD (n = 119). First word acquisition at a range of ages was probed for its relationship to cognitive ability and adaptive behaviors at 52 months. Results indicated that although producing first words predicted better outcome at every age examined, producing first words by 24 months was a particularly strong predictor of better outcomes. This finding suggests that the historic criterion for positive prognosis (i.e., "useful language by age 5") can be updated to a more specific criterion with an earlier developmental time point.
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http://dx.doi.org/10.1007/s10803-012-1558-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386060PMC
February 2013

Using the childhood autism rating scale to diagnose autism spectrum disorders.

J Autism Dev Disord 2010 Jul;40(7):787-99

Department of Psychology, University of Connecticut, Storrs, CT 06269-1020, USA.

This study investigated the childhood autism rating scale (CARS) as a tool for ASD diagnoses for 2-year-old (n = 376) and 4-year-old (n = 230) children referred for possible autism. The cut-off score to distinguish autistic disorder from PDD-NOS was 32 in the 2-year-old sample (consistent with Lord in J Child Psychol Psychiatry Allied Discipl, 36, 1365-1382, 1995), and 30 in the 4-year-old sample, with good sensitivity and specificity at both ages. The cut-off score to distinguish ASD from non-ASD at both ages was 25.5, with good sensitivity and specificity. Results confirm the utility of the CARS in distinguishing autistic disorder from PDD-NOS, and distinguishing ASD from other developmental disorders and typical development and suggest that an ASD cutoff around 25, which is in common clinical use, is valid.
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http://dx.doi.org/10.1007/s10803-009-0926-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3612531PMC
July 2010
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