"Don't Promise Something You can't Deliver:" Caregivers' Advice for Improving Services to Adolescents and Young Adults with Autism.

Approximately 50,000 youths with autism spectrum disorders (ASD) exit U.S. high schools yearly to enter adult systems of care, many of whom remain dependent on family for day-to-day care and service system navigation. As part of a larger study, 174 family caregivers for adolescents or young adults with ASD were asked what advice they would give service providers about how to improve services for youth with ASD. Reflexive thematic analysis identified a framework of five directives: (1) provide a roadmap to services; (2) improve service access; (3) fill gaps to address unmet needs; (4) educate themselves, their families, and society about autism; and (5) operate from a relationship-building paradigm with families. Education, health, and social service providers, as well as policymakers, can use these directives to better assist youth with ASD and their families in the transition to adulthood.

Service Use Among Transition-Age Youth with Autism Spectrum Disorder.

This study explored predictors of service use among 174 transition-age youth (age 16-30) with an Autism Spectrum Disorder using Andersen's (J Health Soc Behav 36(1):1-10, 1995) healthcare utilization model. Family caregivers were interviewed about past 6-month use of 15 services. On average, youth used 6.1 and needed 3.2 additional services. Greater service use was associated with two predisposing (caregiver college educated, caregiver not married/partnered), two enabling (youth has Medicaid waiver, youth in high school), and one need factor (lower adaptive functioning). Use of specific services was most strongly related to enabling (Medicaid waiver, in high school) and need factors (lower adaptive functioning, comorbid mental health diagnosis). Findings provide a snapshot of the "service cliff" faced by families and highlight the need for additional research.

An analysis of music therapy program goals and outcomes for clients with diagnoses on the autism spectrum.

The researchers analyzed data related to goals and outcomes over 2 program years for 40 music therapy clients, ranging in age from 2-49 years, with diagnoses on the autism spectrum. They investigated music therapy interventions, session types, and formats most frequently used; goals most frequently addressed; assessed level of difficulty of clients and their situations; and generalization of skills attained in music therapy to other settings. The most common session type was individual, followed by partner, small or large groups, peer model, or a combination. Primary goal areas were ranked from language/communication (41%), behavioral/psychosocial (39%), cognitive (8%), and musical (7%), to perceptual/motor (5%). One hundred percent of subjects reached their initial objectives in these goal areas within one year or less, regardless of session type, level of difficulty, or goal area. Seventy-seven percent of intermediate objectives were reached within that time. The most frequently utilized interventions were interactive instrument playing, musical instrument instruction, interactive singing, instrument choices, and song choices. Specific interventions chosen did not affect accomplishment of initial objectives. However, there was more variation among interventions in terms of achievement of intermediate objectives. Session formats were ranked from activity-based as most frequent to lesson-based, client-led/"shadow," and ensemble format. All formats were successful when addressing initial objectives, with lesson-based format being most effective in reaching intermediate objectives. Lastly, 100% of parents and caregivers surveyed indicated subjects generalized skills/responses acquired in music therapy to non-music therapy environments.