CTS176 - Artículos

Timing of parents’ concerns related to autism spectrum disorder and its diagnosis: A mediation analysis

Timing of parents’ concerns related to autism spectrum disorder and its diagnosis: A mediation analysis Garrido del Águila, Dunia; Carballo García, María Gloria; Artis, Jonet; García Retamero Imedio, María Del Rocío Parents are the first to indicate concerns about their child’s development in up to 80% of children with autism spectrum disorders (ASD). They often notice symptoms related to ASD around the first two years, but the average age of diagnosis is 3.5 years old. This study examined the relationships between parents’ early concerns and the time lag between suspicion and diagnosis. Forty-eight Spanish-speaking families were enrolled in this study. Parents were asked about early signs that made them think that their child could possibly have ASD. Mediation analyses showed that the child’s age at suspicion mediated between sibling status and the time lag between suspicion and a formal diagnosis. Having another child with typical development accelerated parents’ detection of ASD signs. The number of social-communication concerns that parents detected mediated this relationship. Parents who reported more social-communication concerns perceived these signs earlier, but have to cope with a longer time lag until diagnosis than those who reported more concerns related to restrictive and repetitive behaviors and interests, or other developmental concerns. Moreover, this relationship between concerns of ASD and the diagnoses was explained by the child’s age. Training pediatricians on how to respond to parent questions and concerns could reduce the time lag between parents’ concerns and diagnosis of ASD. This research was supported by a grant from the Spanish Ministerio de Economía y Competitividad, PSI2014–51842–R; and the Spanish Ministerio de Ciencia, Innovación y Universidades, FPU14/00723.

Language and motor skills in siblings of children with autism spectrum disorder: A meta‐analytic review

Language and motor skills in siblings of children with autism spectrum disorder: A meta‐analytic review Garrido del Águila, Dunia; Petrova, Dafina; Watson, Linda R; García Retamero Imedio, María Del Rocío; Carballo García, María Gloria Children with autism spectrum disorder (ASD) show significant linguistic and motor impairments compared to children with typical development (TD). Findings from studies of siblings of children with ASD show similarities to conclusions from studies of children with ASD. The current meta-analysis reviewed studies reporting linguistic and/or motor skills in siblings of children with ASD compared to siblings of children with TD. Thirty-four studies published between 1994 and 2016 met all inclusion criteria. We compared three different age groups (12 months or younger, 13 to 24 months, and 25 to 36 months). At 12 months, compared to siblings of children with TD, siblings of children with ASD had worse receptive language (d52.43, 95% CI [2.53, 2.33]) and expressive language skills (d52.40, 95% CI [2.57, 2.23]), and these effects were sustained at 24 and 36 months. Similar, albeit smaller differences in fine motor skills were detected at 12 months (d52.22, 95% CI [2.39, 2.04]), and these differences were larger at 36 months (d52.36, 95% CI [2.54, 2.17]). There were differences in gross motor skills at 12 months (d52.22, 95% CI [2.40, 2.04]), but only a few studies were available at later ages. Compared to siblings of children with TD, infants who have siblings with ASD have worse linguistic and motor skills. These differences are detectable as early as when infants are 12 months old and seem to be sustained until they are 3 years old. Differences in language skills are larger than those in motor skills, especially during the first year.

Siblings of Children with Autism Spectrum Disorders: Social Support and Family Quality of Life

Siblings of Children with Autism Spectrum Disorders: Social Support and Family Quality of Life Garrido del Águila, Dunia; Carballo García, María Gloria; García Retamero Imedio, María Del Rocío Purpose Autism spectrum disorder (ASD) often has a significant impact on all family members, including parents and siblings of the person who suffers the disorder. This case–control study explores potential factors that help explain the impact of having an older sibling with ASD on several developmental domains, and to test whether these factors could explain their satisfaction on family quality of life (FQoL). Methods A total of 78 unaffected siblings of children with ASD (Sibs-ASD) and siblings of children with typical development (Sibs-TD) from 6 to 12 years old were evaluated. Results Our analyses show significant differences between groups in motor skills, severity of autistic traits, satisfaction on FQoL, and social support (ps < .05). Moreover, social support acts as positive factor protecting from the negative effect of having a sibling with ASD on satisfaction of FQoL (R2 = .32). Conclusions Our findings highlight the variability in the developmental abilities of the unaffected school-age children with familiar risk factors and emphasize the need for supervising development of all Sibs-ASD over different time points. Social support may be a critical aspect to consider in interventions for improving the satisfaction on FQoL.

Infants at-Risk for Autism Spectrum Disorder: Patterns of Vocalizations at 14 Months

Infants at-Risk for Autism Spectrum Disorder: Patterns of Vocalizations at 14 Months Garrido del Águila, Dunia; Watson, Linda R.; Carballo García, María Gloria; García Retamero Imedio, María Del Rocío; Crais, Elisabeth R. Differences in the early development of children are crucial for early detection of autism spectrum disorder (ASD). Previous studies have shown large differences between children later diagnosed with ASD and their typically developing peers in the early use of canonical vocalizations (i.e., vocalizations that include well-formed consonant–vowel syllables) and the use of vocalizations for communicative purposes. In this prospective study, we examined the extent to which infant vocalizations at 14 months would predict Autism Diagnostic Observation Schedule (ADOS) diagnostic symptom groups, that is, Autism, Spectrum, and Non-ASD, for 82 community-identified at-risk infants at 23 months. Thirty-minute video samples were coded with the intention to categorize and quantify speech (canonical/noncanonical and directed/nondirected) and nonspeech vocalizations (atypical, distress, and pleasure vocalizations). Our results revealed that more canonical directed (OR51.039, P5.036), and fewer noncanonical directed (OR5.607, P5.002) and noncanonical nondirected (OR51.200, P5.049) vocalizations were associated with a greater likelihood of being in the Non ASD group versus the Autism group, with no variables significantly predicting Autism versus Spectrum group membership. Despite some statistically significant findings, models performed poorly in classifying children into correct ASD symptom group at age 23 months based on vocalizations at 14 months. Thus, the utility of infant vocalizations alone for predicting toddler clinical outcomes among infants initially identified at an elevated risk for ASD appears limited; however, considering the structure and function of early vocalizations combined with other early developmental and behavioral features may improve the confidence for clinicians in making an early diagnosis of ASD.

Anticipated prehospital decision delay in response to different symptom clusters in acute coronary syndrome: Results from the Spanish Cardiobarometer study

Anticipated prehospital decision delay in response to different symptom clusters in acute coronary syndrome: Results from the Spanish Cardiobarometer study Petrova, Dafina; Garrido del Águila, Dunia; Catena Martínez, Andrés; Ramírez Hernández, José Antonio; Blakoe, Mitti; Fernández Martínez, Nicolás Francisco; Pérez-Gómez, Beatriz; Sánchez Pérez, María José; García Retamero Imedio, María Del Rocío Background and objective: Reducing patient decision delay – the time elapsed between symptom onset and the moment the patient decides to seek medical attention – can help improve acute coronary syndrome survival. Patient decision delay is typically investigated in retrospective studies of acute coronary syndrome survivors that are prone to several biases. To offer an alternative approach, the goal of this research was to investigate anticipated patient decision delay in the general population in response to different symptom clusters. Methods: We developed scenarios representing four commonly experienced symptom clusters: classic (chest symptoms only), heavy (a large number of very intense symptoms including chest pain), diffuse (mild symptoms including chest pain), and weary (mild symptoms without clear chest involvement). The scenarios were administered in random order in a representative survey of 1002 adults ≥55 years old from the non-institutionalized general population in Spain. We measured helpseeking intentions, anticipated patient decision delay (waiting >30 min to seek help), and symptom attribution. Results: Patient decision delay was most common in the diffuse scenario (55%), followed by the weary (34%), classic (22%), and heavy (11%) scenarios. Attributing the symptoms to a cardiovascular cause and intentions to call emergency services were least frequent in the weary and diffuse scenarios. Women were less likely to intend to seek help than men in the classic (OR = 0.48, [0.27, 0.85], diffuse (OR = 0.67, [0.48, 0.92]), and weary (OR = 0.66, [0.44, 0.98]) scenarios, despite being more likely to attribute symptoms to cardiovascular causes. Participants with traditional cardiovascular risk factors (e.g., diabetes, hypercholesterolemia, hypertension) reported faster help-seeking, whereas participants with obesity and history of depression were more likely to delay. Discussion: The diverse manifestations of acute coronary syndrome generate fundamentally different appraisals. Anticipated patient decision delay varies as a function of socio-demographic characteristics and medical history, supporting findings from studies with patients who experienced ACS. Measuring anticipated patient decision delay in the general population can help reveal potential barriers to help-seeking and capture effects of population interventions.