Comparison of unmet health care needs in children with intellectual disability, autism spectrum disorder and both disorders combined.

BACKGROUND: The purpose of this study was to assess the unmet health care needs of children with intellectual disability (ID) compared with children with autism spectrum disorder (ASD) and whether access to health insurance coverage is a contributing factor. Children with ID may be masked in the health care system due to increased diagnosis and awareness of ASD. The needs, unmet needs and insurance coverage of children with ID alone, ASD alone, and co-occurring ID and ASD were assessed in this study. METHODS: The 2016 to 2019 United States' Census Bureau National Survey of Children's Health was used to determine differences in unmet needs, care not received and health insurance coverage during the past year for children with ID and/or ASD. Adjusted odds ratios and 95% confidence intervals for care not received were determined controlling for sex, insurance, race, age and parents' highest education level. RESULTS: Children with ID were nearly four times more likely not to receive needed medical care as children with ASD. Results were similar for unmet hearing and mental health care. Children with both ID and ASD were more likely to have unmet health care but less likely to have unmet medical care compared with children with ASD alone. There were no significant differences for unmet dental or vision care. Children with ID were 3.58 (95% confidence interval: 1.6-8.0) times more likely to have inconsistent health insurance compared with children with ASD. CONCLUSIONS: Children with ID alone are more likely to have unmet medical, hearing and mental health care needs than children with ASD alone. Children with co-occurring ID and ASD have a large amount of general unmet health care needs but less unmet medical needs. Children with ID are less likely to have consistent health insurance than children with ASD. This hinders the ability of children with ID to receive quality care. Further research is needed to determine if the diagnosis of ASD in children in the United States is negatively affecting children with ID alone.

Identification and referral by nurses of children at risk.

This study conducted in a pediatric hospital was initiated to determine whether an educational program focusing on the identification and referral of children at risk for developmental disturbances or variation would increase nurses' ability to identify such children and increase the actual number of referrals. Data analysis comparing pre- and post-intervention referral rates revealed fewer children being referred than should have been. The number of referrals did not differ significantly between pre- and post-education groups. Implications for policy and practice are discussed.

Developmental surveillance by pediatric nurses.

When children at risk for developmental variation are identified at a young age, their chances of success in school and in the future can be greatly enhanced through early intervention programs. Pediatric nurses in community and acute care settings are in key positions to identify children "at risk" and to make appropriate referrals. Nurses are encouraged to engage in "developmental surveillance," that is, a continuous awareness of all activities relating to the detection of developmental problems and the promotion of development during primary child care. A parental interview of six questions can assist the nurse in developmental surveillance and the identification of developmental variations. Once a child is identified as "at risk" the nurse should initiate referrals for more thorough evaluation, diagnosis, and, if warranted, intervention.

Recent developments in the transracial adoption debate.

This article places the controversy over transracial adoption (TRA) in its historical context and analyzes recent developments in the law governing TRA policy. Because unfounded "authority" from the field of mental health infuses current debate, the authors alert psychiatrists to two powerful forces that improperly influence today's legal arena: community preference for same-race families and biased professional norms of mental health professionals.

Developmental approach to injury prevention.

Children's developmentally diverse temperament, motivation, and competencies, when viewed through the lens of the agent-host-environment model, help us understand the child's contribution to the occurrence of injury. Pediatricians can use this information to individualize their safety counseling.

Alcohol-related flushing and the risk for alcoholism in sons of alcoholics.

Ethanol-induced facial flushing was measured in 30 men, aged 21 to 25, who had family histories of alcoholism and in 30 matched controls. The drug was administered as 0.75 ml of 95% ethanol per kilogram of body weight, mixed with a sugar-free soft drink and consumed over 5 minutes. Facial flushing was assessed over 90 minutes using both observational ratings and a plethysmograph. Family history positive (FHP) subjects demonstrated significantly higher levels of flushing than family history negative (FHN) controls on objective measures. Correlations with the flushing response were .83 for blood acetaldehyde, and at least .60 for heart rate and skin temperature. This is the first known demonstration in Caucasians of a possible association between flushing and blood acetaldehyde levels in individuals hypothesized to be at risk for the development of alcoholism.

Platelet monoamine oxidase activity in relatives of alcoholics. Preliminary study with matched control subjects.

Platelet monoamine oxidase (MAO) activity levels were determined before and 180 minutes after ingestion of ethyl alcohol in 30 healthy men aged 21 to 25 years. The subjects included 15 men with alcoholic first-degree relatives who were matched by demography, height-weight ratio, and drinking history with 15 control subjects who had no family history of alcoholism. There was a nonsignificant trend toward lower platelet MAO activities at baseline and after ethyl alcohol ingestion in the group with alcoholic relatives when compared with the control subjects who had no family history of alcoholism. With an arbitrary MAO cutoff of 5.24 nmole/mg of protein per hour, eight of the 15 subjects with alcoholic relatives and 12 of the 15 without alcoholic relatives were correctly identified. However, because of the number of false-positive and false-negative findings, the results have limited clinical usefulness.

Dopamine-beta-hydroxylase activity levels in men at high risk for alcoholism and controls.

Plasma DBH activity levels were determined for 22 nonalcoholic young men with alcoholic close relatives (the FHP or family history positive group) and results compared to family history negative (FHN) controls matched on demography, height/weight ratio, and drinking history. These enzyme levels were then correlated with the usual drinking history over the prior 6 months and with the intensity of intoxication achieved after drinking 0.75 ml of ethanol/kg body weight. The FHP men demonstrated a 20% lower level of DBH (p greater than 0.1) indicating no significant difference between the groups. Base-line DBH activities correlated significantly with the level of intoxication for the FHN group (r = 0.44, p less than 0.025) with a trend for an inverse correlation with the average drinking history. FHP men, on the other hand, demonstrated only a nonsignificant association between peak intoxication level and base-line DBH and a positive correlation (r = 0.37, p less than 0.05) with the average number of drinks/drinking day. These results are not consistent with the probability that a premorbid DBH assay could be used as one indicator of propensity towards alcoholism. The differences between FHP and FHN groups on correlations between DBH and peak intoxication or usual drinking history raise speculations that the "normal" (FHN) relationship between alcohol intake and plasma DBH activity may be impaired in individuals at high risk (FHP) for the future development of alcoholism.