Search

Many of the nearly six million autistic adolescents and adults in the United States require support to navigate daily life. Family members often provide the first line of support for autistic youth by providing care and coordinating services. Although considerable research has examined the perspectives of family members caring for young autistic children, comparatively less has focused on those caring for transition-age youth who often struggle to access needed services as they leave child-serving systems of care. This study examined caregiver-reported barriers to service for 174 adolescents and young adults on the spectrum (ages 16-30) and the association between such barriers and unmet service needs. Exploratory factor analysis suggested two service barrier domains: access (e.g., cost) and quality (e.g., providers not trained). Regression models indicated that caregivers whose youth were diagnosed at older ages perceived both greater access and quality barriers. Male caregivers reported fewer access barriers, and those who perceived greater caregiver burdens (daily life disruptions, financial difficulties, and worries) reported more access barriers. Caregivers whose youth lived with them reported fewer quality barriers. Greater access--but not quality--service barriers predicted greater unmet service needs. Findings have implications for service delivery to autistic youth and specific directions for future research.

The quality of adolescent dating relationships is an outcome of developmental importance for young people exposed to intimate partner violence (IPV) in childhood. As adolescents explore romantic interests for the first time, it is important to consider whether youth who have witnessed IPV have an increased likelihood of adolescent dating violence (ADV) victimization and/or perpetration. This systematic review seeks to synthesize empirical literature on ADV victimization and perpetration outcomes in youth exposed to IPV, examine mechanisms that may explain ADV outcomes in IPV-exposed youth, and summarize methodological factors that influence interpretation of findings. Seven bibliographic databases were searched through August 2020 for a broader evidence and gap mapping (EGM) project examining published empirical studies on child outcomes of IPV exposure. Following de-duplication, 350 empirical studies on child IPV exposure outcomes were identified and categorized into child outcome themes, including 29 studies that examine ADV victimization and/or perpetration among IPV-exposed youth. The association between IPV exposure and ADV perpetration and victimization varies widely, with factors such as gender, mental health symptoms, beliefs about violence, and emotion regulation differentially influencing outcomes. Inconsistencies in measurement of IPV, ADV, and sample ages make cross-study comparisons challenging. Practice and research implications are addressed, including the importance of examining strengths-based youth assets and resilient trajectories of healthy dating relationships among IPV-exposed youth., Author(s): Kylie E. Evans [sup.1] , Hyunjune Lee [sup.1] , Katie N. Russell [sup.1] , Megan R. Holmes [sup.1] , Kristen A. Berg [sup.1] [sup.2] , Anna E. Bender [sup.1] [...]

Intimate partner violence (IPV) exposure threatens healthy child development by compromising outcomes across a range of domains including academic functioning. However, research suggests variability in the strength and nature of the association between IPV exposure and academic functioning, and the extent to which it varies by different academic outcomes and co-occurring risk factors (e.g., child maltreatment). This systematic review seeks to clarify the relation between IPV exposure and academic functioning by distilling overall outcome trends and critically assessing the existing literature's strengths and limitations. Seven databases were searched to identify relevant articles published through August 2020. Studies were included if (a) at least 80% of the sample were from birth to 18 years of age; (b) valid tools were used to measure outcome variables, and (c) outcomes of children exposed to IPV were compared with children who experienced other forms of violence and/or no violence exposure. After screening, the review yielded 13 articles examining academic functioning. The majority (76.9%, n = 10) of the studies found a negative association between IPV exposure and academic functioning, but results varied among subdomains of academic functioning (subjective performance, objective performance, and conduct). Findings from several studies indicate that the combined experience of IPV exposure and maltreatment negatively affects academic functioning. Results highlight the need for: 1) additional research examining IPV exposure and academic functioning 2) early detection of IPV-exposed children, and 3) the development and implementation of evidence-based interventions to support academic functioning., Author(s): Jamie Cage [sup.1] , Julia M. Kobulsky [sup.2] , Sherise J. McKinney [sup.3] , Megan R. Holmes [sup.4] , Kristen A. Berg [sup.4] [sup.5] , Anna E. Bender [sup.4] [...]

Both in the United States and across the world, intimate partner violence (IPV) is a widespread social problem. It often occurs in households with children, and IPV exposure during childhood is associated with negative sequelae across developmental domains. This systematic review synthesizes the literature on the effects of IPV exposure on social-emotional competence (i.e., social competence, empathy, emotion regulation) from infancy through late adolescence. Seven bibliographic software databases were searched for relevant citations up to August 2020, and a total of 15,354 citations were identified after deduplication. Following a screening process by two research assistants, 381 citations were included in a broader Evidence and Gap Map. Data extraction was completed for included citations, and all were coded into child outcome categories and subcategories. Twenty-six studies examined social-emotional competence. Across studies examining social competence, a majority found that IPV-exposed children demonstrated lower levels of social competence and emotional regulation than a comparison group. Limited evidence was found to indicate that IPV-exposed children also exhibited fewer empathic skills compared with non-exposed peers. Social-emotional competence was additionally identified to significantly mediate and/or moderate the association between IPV exposure and other outcomes (e.g., aggressive behaviors, psychological distress), underscoring that social-emotional competence may be a malleable factor that could promote resilience among children exposed to IPV. These findings highlight the need to further explore the associations between social-emotional competence and other child adjustment outcomes, and develop and implement programming to foster social-emotional competence among IPV-exposed children., Author(s): Anna E. Bender [sup.1] , Sherise J. McKinney [sup.2] , Megan M. Schmidt-Sane [sup.3] , Jamie Cage [sup.4] , Megan R. Holmes [sup.1] , Kristen A. Berg [sup.1] [sup.5] [...]

Intimate partner violence (IPV) exposure continues to be a pervasive problem for children. Although the impact of IPV exposure on children's mental health has been well-documented, the impact of IPV exposure on children's physical health, as well as families' engagement with the medical system for their children's physical health needs (e.g., contact with primary care pediatricians, emergency room visits) remains under-studied. The purpose of this systematic review was to synthesize quantitative studies examining the association between IPV exposure and (a) medical system engagement and (b) physical health outcomes, and to examine methodological factors that may influence findings. A systematic review was conducted using seven electronic bibliographic databases to identify research examining outcomes of IPV-exposed children up to August of 2020. Citations were coded by two independent researchers to determine inclusion and exclusion, and then coded again to identify studies examining medical system engagement and physical health outcomes. A total of 31 citations were included. Consistent results were found across studies in that, compared with non-exposed children, IPV-exposed children were less likely to be up to date on immunizations, had an increased rate of emergency room visits, had more contact with primary care pediatricians, were more likely to have an increased risk of poor lung functioning, obesity, and nutritional deficiencies, and reported more general physical health problems. In addition to further research in this area, this study identifies the need for training healthcare providers to implement consistent IPV screening and provide IPV-exposed children and families with referrals to trauma-informed, community-based interventions., Author(s): Megan R. Holmes [sup.1] , Kristen A. Berg [sup.1] [sup.2] , Anna E. Bender [sup.1] , Kylie E. Evans [sup.1] , Julia M. Kobulsky [sup.3] , Alexis P. Davis [...]

Author(s): Megan R. Holmes [sup.1] , Kristen A. Berg [sup.1] [sup.2] , Anna E. Bender [sup.1] , Kylie E. Evans [sup.1] , Kari O'Donnell [sup.1] , Emily K. Miller [sup.1] [...]

Among children exposed to intimate partner violence (IPV), their appraisals and beliefs about IPV have been identified as key cognitive factors that may explain the linkage between IPV exposure and other adjustment outcomes. Grounded in the cognitive-contextual framework, this systematic review summarizes empirical studies examining child IPV exposure, acceptance of IPV, and appraisals of IPV, including perceived threat, self-blame attributions, and coping efficacy. This study is part of a broader evidence and gap map (EGM) that systematically searched seven databases for quantitative studies examining the effects of IPV exposure on all potential child outcomes. Studies were screened and coded for inclusion if they focused on IPV-exposed children 17 years and younger, used a validated or reliable scale to measure child outcomes, and utilized a comparison group. This review examined a subset of 13 studies measuring children's acceptance and/or appraisals of IPV. Findings suggest that children exposed to IPV tend to have stronger beliefs that the use of violence in intimate relationships is acceptable, with important implications for adolescent dating violence. Additionally, children's appraisals of threat and self-blame regarding their parents' IPV acted as a key variable for understanding links between children's IPV exposure and outcomes such as internalizing problems, social anxiety, and self-efficacy. Few studies examined coping efficacy. This review highlights the importance of children's acceptance and appraisals of IPV as an outcome of IPV exposure, and as an intervening factor between IPV exposure and other adjustment outcomes. Implications for intervention and future research are discussed., Author(s): Kylie E. Evans [sup.1] , Megan M. Schmidt-Sane [sup.2] , Anna E. Bender [sup.1] , Kristen A. Berg [sup.1] [sup.3] , Megan R. Holmes [sup.1] Author Affiliations: (1) grid.67105.35, [...]

Over 25% of youth in the United States are estimated to witness intimate partner violence (IPV) at some point during childhood. Research has synthesized the physical and behavioral health consequences of children's IPV exposure, but evidence of links between witnessing IPV and children's physiological functioning has yet to be integrated. The primary aim of this systematic review is to delineate the patterns by which variation in children's physiological functioning has been measured to associate with IPV exposure. This study was one component of a broader Evidence and Gap Map (EGM) consolidation of how witnessing IPV affects children's wellbeing. Seven bibliographic databases were systematically searched through August 2020 and, of 381 total EGM-included citations, 23 examined children's physiological functioning in the context of IPV exposure. Research evidences a directly deleterious effect of IPV exposure for children's endocrine, nervous, cardiovascular, and immune functioning and a vulnerability effect of physiological dysregulation across other domains of children's wellbeing. Additional research on how specific aspects of IPV exposure affect children's physiologies and wellbeing across time is critical. Future inquiry measuring dynamic associations between various physiological responses in the aftermath of witnessing IPV is needed. Further elucidating the physiological context of children's IPV exposure is important for developing and implementing interventions that maximize children's opportunities for resilience., Author(s): Kristen A. Berg [sup.1] [sup.2] , Kylie E. Evans [sup.2] , Gregory Powers [sup.2] , Scott E. Moore [sup.3] , Stacey Steigerwald [sup.4] , Anna E. Bender [sup.2] , [...]

Many of the nearly six million autistic adolescents and adults in the United States require support to navigate daily life. Family members often provide the first line of support for autistic youth by providing care and coordinating services. Although considerable research has examined the perspectives of family members caring for young autistic children, comparatively less has focused on those caring for transition-age youth who often struggle to access needed services as they leave child-serving systems of care. This study examined caregiver-reported barriers to service for 174 adolescents and young adults on the spectrum (ages 16–30) and the association between such barriers and unmet service needs. Exploratory factor analysis suggested two service barrier domains: access (e.g., cost) and quality (e.g., providers not trained). Regression models indicated that caregivers whose youth were diagnosed at older ages perceived both greater access and quality barriers. Male caregivers reported fewer access barriers, and those who perceived greater caregiver burdens (daily life disruptions, financial difficulties, and worries) reported more access barriers. Caregivers whose youth lived with them reported fewer quality barriers. Greater access–but not quality–service barriers predicted greater unmet service needs. Findings have implications for service delivery to autistic youth and specific directions for future research. Prior studies have described the roadblocks, or barriers, to needed services experienced by families with young autistic children, but less research has focused on those faced by autistic adolescents and young adults. In this study, we wished to understand the barriers to service experienced by autistic adolescents and young adults and their families. We surveyed 174 caregivers of autistic youth between 16 to 30 years old. We found that caregivers who felt more caregiving burden had more difficulty accessing services for their youth. Specifically, caregivers who felt more strongly that their daily lives had been disrupted, felt more financial strain, and worried more about their youth well-being experienced more roadblocks to getting services for the youth. Male caregivers also reported fewer difficulties related to service access. Importantly, the older the youth was when they had been diagnosed with autism, the more service barriers their caregivers reported. We did not see any differences in the level of barriers experienced by youth who lived in urban versus suburban settings, or between white and non-white families. However, when youth lived with their caregivers (rather than, for example, in a group home), fewer quality-related barriers to services were reported. Finally, greater access (but not quality) barriers were linked to youth having more unmet service needs. These findings can help to reduce the barriers to service experienced by autistic adolescents and young adults and their families. [ABSTRACT FROM AUTHOR]

We examined the influence of racial and ethnic identity of residents and housing market economic conditions on redlining. Data were extracted from archival area description forms from the Home Owners' Loan Corporation for 568 Ohio neighborhoods from 1934–1940. Logistic regression analysis was used to analyze the relationships between neighborhood characteristics and redlining. Bivariate results indicated a strong association between the presence of African American residents and neighborhood redlining (OR = 40.9, 95% CI 22.9-72.8). Multivariable analysis demonstrated that some neighborhood characteristics were contributors to the decision to redline, including homes in poor condition (OR = 4.3, 95% CI 1.2-15.1), home vacancy (OR = 1.4, 95% CI 1.1-1.6), and housing prices (per thousand dollars) (OR = 0.7, 95% CI 0.4-1.2). Adjusting for these and other factors, the presence of African American residents remained a powerful predictor of redlining (OR = 13.8, 95% CI 4.4-42.8). Racial discrimination was the overriding factor in decisions to redline neighborhoods. [ABSTRACT FROM AUTHOR]

Despite having a higher prevalence and severity of obstructive sleep apnea (OSA), African Americans have lower adherence to continuous positive airway pressure (CPAP) compared to other groups. Information regarding challenges faced by African Americans prescribed CPAP are lacking. To determine the barriers and facilitators to optimal management of OSA with CPAP among African Americans and to understand the role bed partners may play. We conducted semi-structured in-depth interviews via video conferencing with African American patients of an urban safety-net health care system with OSA prescribed CPAP and their bed partners. Recruitment continued until theoretical saturation was achieved. Verbatim transcripts were analyzed using the principles of thematic analysis. 15 patients (12 women) diagnosed with OSA and prescribed CPAP a mean 2.6 years prior along with 15 bed partners (3 women) were individually interviewed. Four themes emerged regarding impediments to CPAP use: 1) inadequate education and support, 2) CPAP maintenance and hygiene, 3) inconvenient design of CPAP interfaces, and 4) impediment to intimacy. Four themes emerged as facilitators to CPAP use: 1) provider and technical support, 2) properly fitted CPAP masks, 3) active support from partner and family, and 4) experiencing positive results from CPAP. African American patients with OSA and their bed partners identified several unique barriers and facilitators to CPAP use. Active involvement by bed partners was considered by both patients and partners as helpful in improving CPAP adherence. Interventions to improve OSA outcomes in this population should focus on patients and their bed partners. [ABSTRACT FROM AUTHOR]