Reported Wandering Behavior among Children with Autism Spectrum Disorder and/or Intellectual Disability.

OBJECTIVE: To characterize wandering, or elopement, among children with autism spectrum disorder (ASD) and intellectual disability. STUDY DESIGN: Questions on wandering in the previous year were asked of parents of children with ASD with and without intellectual disability and children with intellectual disability without ASD as part of the 2011 Survey of Pathways to Diagnosis and Services. The Pathways study sample was drawn from the much larger National Survey of Children with Special Health Care Needs conducted in 2009-2010. RESULTS: For children with special healthcare needs diagnosed with either ASD, intellectual disability, or both, wandering or becoming lost during the previous year was reported for more than 1 in 4 children. Wandering was highest among children with ASD with intellectual disability (37.7%) followed by children with ASD without intellectual disability (32.7%), and then children with intellectual disability without ASD (23.7%), though the differences between these groups were not statistically significant. CONCLUSIONS: This study affirms that wandering among children with ASD, regardless of intellectual disability status, is relatively common. However, wandering or becoming lost in the past year was also reported for many children with intellectual disability, indicating the need to broaden our understanding of this safety issue to other developmental disabilities.

Diagnosis lost: Differences between children who had and who currently have an autism spectrum disorder diagnosis.

Autism spectrum disorder diagnoses sometimes change due to misdiagnosis, maturation, or treatment. This study uses a probability-based national survey-the Survey of Pathways to Diagnosis and Services-to compare currently diagnosed (n = 1420) and previously diagnosed (n = 187) children aged 6-17 years based on retrospective parental reports of early concerns about their children's development, responses to those concerns by doctors and other healthcare providers, the type of provider who made the first autism spectrum disorder diagnosis, and the autism spectrum disorder subtype diagnoses received (if any). Propensity score matching was used to control for differences between the groups on children's current level of functioning and other current characteristics that may have been related to diagnosis loss. Approximately 13% of the children ever diagnosed with autism spectrum disorder were estimated to have lost the diagnosis, and parents of 74% of them believed it was changed due to new information. Previously diagnosed children were less likely to have parents with early concerns about verbal skills, nonverbal communication, learning, and unusual gestures or movements. They were also less likely to have been referred to and diagnosed by a specialist. Previously diagnosed children were less likely to have ever received a diagnosis of Asperger's disorder or autistic disorder.

Socioeconomic disadvantage and developmental delay among US children aged 18 months to 5 years.

BACKGROUND: Few studies have examined the relationship between sociodemographic factors and a population-based measure of developmental delay in US children. We identify sociodemographic factors associated with unlikely, probable and possible developmental delay in preschool US children using nationally representative data. METHODS: All children aged 18 months to 5 years in the 2007 National Survey of Children's Health were categorised into three groups based on the likelihood of developmental delay (unlikely delay, possible delay and probable delay) using a modified survey version of the Parents' Evaluation of Developmental Status questionnaire. Bivariate and multivariate multinomial logistic regressions were used to assess relations between sociodemographic variables and risk of developmental delay. RESULTS: Children had increased odds of probable delay (compared with unlikely delay) if they were older (adjusted OR (aOR)=1.41/additional year above the youngest age group (18 months-2 years), p<0.001), male (aOR=1.55, p<0.001), low birth weight (aOR=2.08, p<0.001), non-Hispanic black (aOR=1.50, p<0.01) or Hispanic in a non-English-speaking household (aOR=2.53, p<0.001) versus non-Hispanic white, had lower household income (aOR=1.33 for each decreasing category of poverty level, p<0.001), or received >10 h/week of care at another family's home (aOR=1.71, p<0.05). Only four characteristics (being older, male, low birth weight and Hispanic living in a non-English-speaking household) were associated with increased odds of possible delay compared with unlikely delay. CONCLUSIONS: Multiple factors, including demographic characteristics and indicators of social disadvantage, distinguish children with probable developmental delay from those unlikely to have developmental delay. Fewer factors identify children with possible delay.

Language and immigrant status effects on disparities in Hispanic children's health status and access to health care.

The objective of this study is to estimate Hispanic/non-Hispanic (nH)-white health disparities and assess the extent to which disparities can be explained by immigrant status and household primary language. The 2007 National Survey of Children's Health was funded by the Maternal and Child Health Bureau, and conducted by Centers for Disease Control and Prevention's National Center for Health Statistics as a module of the State and Local Area Integrated Telephone Survey. We calculated disparities for various health indicators between Hispanic and nH-white children, and used logistic regression to adjust them for socio-economic and demographic characteristics, primary language spoken in the household, and the child's immigrant status. Controlling for language and immigrant status greatly reduces health disparities, although it does not completely eliminate all disparities showing poorer outcomes for Hispanic children. English-speaking and nonimmigrant Hispanic children are more similar to nH-white children than are Hispanic children in non-English speaking households or immigrant children. Hispanic/nH-white health disparities among children are largely driven by that portion of the Hispanic population that is either newly-arrived to this country or does not speak primarily English in the household.

Parental characteristics associated with bullying perpetration in US children aged 10 to 17 years.

OBJECTIVES: We identified factors associated with child bullying in the United States. METHODS: We used the 2007 National Survey of Children's Health to examine associations among child, parent, and community factors and bullying perpetration among children aged 10 to 17 years, using bivariate and stepwise multivariable analyses. RESULTS: African American and Latino children and children living in poverty and who had emotional, developmental, or behavioral (EDB) problems had higher odds of bullying, as did children of parents who felt angry with their child or who felt their child bothered them a lot or was hard to care for; suboptimal maternal mental health was associated with higher bullying odds. Children who always or usually completed homework and had parents who talked with them and met all or most of their friends had lower bullying odds. CONCLUSIONS: Assessing children's EDB problems, maternal mental health, and parental perceptions may identify children at risk for bullying. Parent-child communication, meeting children's friends, and encouraging children academically were associated with lower bullying odds; these protective factors may be useful in designing preventive interventions.

Diagnostic history and treatment of school-aged children with autism spectrum disorder and special health care needs.

Data from the 2011 Survey of Pathways to Diagnosis and Services The median age when school-aged children with special health care needs (CSHCN) and autism spectrum disorder (ASD) were first identified as having ASD was 5 years. School-aged CSHCN identified as having ASD at a younger age (under age 5 years) were identified most often by generalists and psychologists, while those identified later (aged 5 years and over) were identified primarily by psychologists and psychiatrists. Nine out of 10 school-aged CSHCN with ASD use one or more services to meet their developmental needs. Social skills training and speech or language therapy are the most common, each used by almost three-fifths of these children. More than one-half of school-aged CSHCN with ASD use psychotropic medication.

Hispanic children with special health care needs from Spanish-language households.

OBJECTIVES: We examined the specific health care needs of Hispanic children with special health care needs (CSHCN) from Spanish-language households, and we compared the needs for children in this group to those for Hispanic and non-Hispanic white CSHCN from English-language households. METHODS: We estimated the prevalence of parent-reported health care needs, health conditions, and functional characteristics by using data from the 2001 and 2005-2006 National Survey of Children With Special Health Care Needs. We used bivariate and multivariate methods to describe the relationship between ethnicity, language, and the demographic, socioeconomic, and health characteristics of CSHCN. RESULTS: Between 2001 and 2005-2006, the prevalence of special health care needs increased significantly among Hispanic and non-Hispanic white children from English-language households but not among Hispanic children from Spanish-language households. In 2005-2006, Hispanic children from Spanish-language households were only one-third as likely as other children to be identified as CSHCN. Relative to both Hispanic and non-Hispanic white CSHCN from English-language households, Hispanic CSHCN from Spanish-language households had a higher prevalence of several developmentally related conditions and of functional difficulties related to gross and fine motor coordination, self-care, speech, and communication but had a lower prevalence of attention-deficit/hyperactivity disorder. Lower use of prescription medications was significantly associated with Hispanic ethnicity (regardless of household language) even after we controlled for demographic and socioeconomic differences. CONCLUSIONS: Hispanic CSHCN from Spanish-language households are distinct from other CSHCN, and stratifying the Hispanic population by using primary household language can reveal important differences in the health and functioning characteristics of Hispanic CSHCN.