Global report on COVID-19 vaccination and reasons not to vaccinate among adults with intellectual disabilities: Results from secondary analyses of Special Olympics' program planning.

The COVID-19 pandemic has disproportionately affected people with intellectual disabilities worldwide. The objective of this study was to identify global rates of COVID-19 vaccination and reasons not to vaccinate among adults with intellectual disabilities (ID) associated with country economic income levels. The Special Olympics COVID-19 online survey was administered in January-February 2022 to adults with ID from 138 countries. Descriptive analyses of survey responses include 95% margins of error. Logistic regression and Pearson Chi-squared tests were calculated to assess associations with predictive variables for vaccination using R 4.1.2 software. Participants (n = 3560) represented 18 low (n = 410), 35 lower-middle (n = 1182), 41 upper-middle (n = 837), and 44 high (n = 1131) income countries. Globally, 76% (74.8-77.6%) received a COVID-19 vaccination while 49.5% (47.9-51.2%) received a COVID-19 booster. Upper-middle (93% (91.2-94.7%)) and high-income country (94% (92.1-95.0%)) participants had the highest rates of vaccination while low-income countries had the lowest rates (38% (33.3-42.7%)). In multivariate regression models, country economic income level (OR = 3.12, 95% CI [2.81, 3.48]), age (OR = 1.04, 95% CI [1.03, 1.05]), and living with family (OR = 0.70, 95% CI [0.53, 0.92]) were associated with vaccination. Among LLMICs, the major reason for not vaccinating was lack of access (41.2% (29.5-52.9%)). Globally, concerns about side effects (42%, (36.5-48.1%)) and parent/guardian not wanting the adult with ID to vaccinate (32% (26.1-37.0%)) were the most common reasons for not vaccinating. Adults with ID from low and low-middle income countries reported fewer COVID-19 vaccinations, suggesting reduced access and availability of resources in these countries. Globally, COVID-19 vaccination levels among adults with ID were higher than the general population. Interventions should address the increased risk of infection for those in congregate living situations and family caregiver apprehension to vaccinate this high-risk population.

Modular cognitive behavioral therapy for autism-related symptoms in children: A randomized controlled trial.

OBJECTIVE: To date, no one-on-one psychotherapy protocol for elementary and middle school-aged children with autism spectrum disorder (ASD) has been found to be efficacious for treating autism-related symptoms such as failure to initiate social interactions. This study compared modular cognitive behavioral therapy (CBT) with enhanced standard community treatment (ESCT) in terms of impact on the severity of autism-related symptoms. METHOD: Children with ASD (N = 107; aged 6-13 years) were randomly assigned to a treatment condition (CBT or ESCT). Both treatments provided 32 therapy sessions. The CBT condition utilized a modular design, matching specific evidence-based treatment elements to each child's clinical needs (e.g., social-communication symptoms). The ESCT condition provided social skills training and cognitive behavioral training in a structured and linear group therapy format. The primary outcome measure was independent evaluator ratings of peer engagement during school recess using a structured and validated observation system. Parents also made session-by-session ratings on personalized autism-related symptom profiles throughout treatment. RESULTS: CBT outperformed ESCT on the primary outcome measure (p < .001; d = .50; 95% CI [.06, .93]) and the secondary outcome measure (p = .003; d = .87; 95% CI [.45, 1.27]). CONCLUSIONS: The modular one-on-one CBT program evaluated in this study may be beneficial for reducing the severity of autism-related symptoms in some children with ASD. Further research is needed to clarify the extent of the treatment effect and the feasibility of implementation for therapists in the community. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Peer-mentored preparedness (PM-Prep): a new disaster preparedness program for adults living independently in the community.

The authors studied a health promotion program called PM-Prep (Peer-Mentored Prep), which was designed to improve disaster preparedness among adults living independently in the community. PM-Prep consists of four 2-hour classes co-taught by a health educator and peer-mentors. Adults were randomly assigned to an experimental arm or a wait-list control arm. Earthquake safety knowledge and preparedness supplies were assessed prior to the intervention and at 1 month after the intervention (N  =  82). Adults in the experimental arm significantly increased preparedness by 19 percentage points, from 56% to 75% completed (p < .0001), and improved their knowledge by 8 percentage points, from 79% to 87% correct (p  =  .001). This is the first peer-mentored, targeted, and tailored disaster preparedness program tested with this population.

Vaccine-related beliefs and practices of parents of children with autism spectrum disorders.

Although the assertion of a link between vaccines and autism has been scientifically rejected, the theory continues to be popular and may influence the attitudes of parents of children with autism spectrum disorders. The authors sought to assess how often parents change or discontinue their child's vaccine schedule after autism spectrum disorder diagnosis and whether beliefs about the etiology of autism affect their decision to do so. The authors surveyed 197 (43%) of 460 eligible parents of children under 18 years of age with autism spectrum disorders who were enrolled in a state-funded agency that provides services to those with developmental disabilities in western Los Angeles County. Half of the parents discontinued or changed vaccination practices, and this was associated with a belief that vaccines contributed to autism spectrum disorders, indicating a potential subset of undervaccinated children. Educational tools should be designed to assist physicians when talking to parents of children with autism spectrum disorders about vaccination.

The Healthy Lifestyle Change Program: a pilot of a community-based health promotion intervention for adults with developmental disabilities.

BACKGROUND: Although adults with developmental disabilities are at high risk for obesity and its sequelae, few community-based lifestyle interventions targeting those with developmental disabilities exist. DESIGN: The study was a single group, community-based demonstration project with pre-post test evaluation conducted from December 2005 to June 2006. SETTING/PARTICIPANTS: Eligible participants were 431 community-dwelling adults with developmental disabilities, aged 18-65 years, who were overweight/obese (BMI > or =25) with another risk factor for diabetes or metabolic syndrome or who had a diagnosis of diabetes, and received services from a community agency. Eighty-five signed up (20% of those eligible), 68 participated in an initial class, and 44 completed the program (35% attrition rate). INTERVENTION: The Healthy Lifestyle Change Program (HLCP) is a community-based health intervention developed and implemented using community-based participatory research methods by members of the developmental disabilities community, in collaboration with academic researchers. The HLCP was a 7-month, twice-weekly education and exercise program to increase knowledge, skills, and self-efficacy regarding health, nutrition, and fitness among adults with developmental disabilities. Peer mentors served as participant leaders and primary motivators. MEASURES: Changes in weight, BMI, abdominal girth, access to care, and self-reported nutrition, physical activity, and life satisfaction were each measured. RESULTS: Two thirds of participants maintained or lost weight, with a mean weight loss of 2.6 pounds and a median weight loss of 7 lbs (range: 2-24 lbs). Average BMI decreased by 0.5 kg/m(2) (p=0.04). Abdominal girth decreased in 74% of participants (mean= -1.9 inches). Sixty-one percent of participants reported increased physical activity. Mean exercise frequency increased from 3.2 times to 3.9 times per week (p=0.01). Mean exercise duration increased from 133 minutes to 206.4 minutes per week (p=0.02). Significant improvements in nutritional habits and self-efficacy were reported. Over half (59%) of participants showed improvements in life satisfaction. Participants received 206 referrals for needed medical care. The HLCP and its dissemination increased participants' and peer mentors' ability to act as community advocates and partners in research. CONCLUSIONS: The HLCP resulted in improved lifestyles, weight loss success, and increased community capacity, indicating that a community-based program with significant participation of those with developmental disabilities is feasible. This program should be expanded and evaluated with larger populations with developmental disabilities.

Off-label prescribing to children in the United States outpatient setting.

OBJECTIVE: The aim of this study was to determine the frequency of off-label prescribing to children at United States outpatient visits and to determine how drug class, patient age, and physician specialty relate to off-label prescribing. METHODS: Data from the 2001 through 2004 National Ambulatory Medical Care Surveys (NAMCS) consisted of a sample of 7901 outpatient visits by children aged 0 through 17 years in which prescriptions were given, representative of an estimated 312 million visits. We compared FDA-approved age and indication to the child's age and diagnoses. We used multivariate logistic regression to determine adjusted differences in probabilities of off-label prescribing. RESULTS: Sixty-two percent of outpatient pediatric visits included off-label prescribing. Approximately 96% of cardiovascular-renal, 86% of pain, 80% of gastrointestinal, and 67% of pulmonary and dermatologic medication prescriptions were off label. Visits by children aged <6 years had a higher probability of off-label prescribing (P < .01), especially visits by children aged <1 year (74% adjusted probability). Visits to specialists also involved a significantly increased probability (68% vs 59% for general pediatricians, P < .01) of off-label prescribing. CONCLUSIONS: Despite recent studies and labeling changes of pediatric medications, the majority of pediatric outpatient visits involve off-label prescribing across all medication categories. Off-label prescribing is more frequent for younger children and those receiving care from specialist pediatricians. Increased dissemination of pediatric studies and label information may be helpful to guide clinical practice. Further research should be prioritized for the medications most commonly prescribed off label and to determine outcomes, causes, and appropriateness of off-label prescribing to children.