Karla Ausderau PhD, OTR/L, FAOTA

Objectives: High school-based parenting programs have been identified as a way to support teen mothers as they manage their complex roles as parent and student. The purpose of this study was to describe components within a high school-based parenting program that support the overall success of the mother and child through the perspectives of current students, program alumni, and staff.

Methods: We conducted a phenomenological study using semi-structured interviews with current students (n = 8) and program alumni (n = 11) from one high school-based parenting program and staff from seven high school-based parenting programs (n = 12). Thematic analysis was used to identify essential program supports within and between the three different groups. Member checking was completed to verify that the final themes represented the experiences shared in the interviews.

Results: Four themes were identified supporting the success of teen mothers in high school-based parenting programs: Things That Make the Program Run, Basic Needs, Classroom Supports, and Connections Outward. Themes were found across all participants with comparison between groups revealing nuances in their experience and perception of supports.

Conclusions for practice: High school-based parenting programs need to move beyond providing traditional supports to focus on facilitating social connections, ensuring the basic needs are met, and utilizing non-traditional learning strategies. Programs should name and measure strategies used to measure program effectiveness to understand the academic, health, and well-being implications for both parent and child short- and long-term.

Keywords: Expectant and parenting teens, High school parenting program, School-based support, Social support.

Feeding challenges for autistic children are heterogeneous, often including aversions to various sensory food properties, and unique eating patterns that are different from other family members. This pilot study aimed to evaluate the effectiveness of the Engaged Eaters Program in achieving mealtime goals for families with autistic children who have feeding challenges. Using a quasi-experimental, one-group pre-posttest design, twenty-nine caregiver-child dyads participated in the Engaged Eaters Program: a 6-month caregiver-mediated feeding intervention (caregiver coaching, direct intervention, and caregiver training) delivered in-home (n = 13) or via telehealth (n = 16). Goal Attainment Scaling (GAS) T-scores were calculated to evaluate the effectiveness of the intervention. Caregiver-child dyads achieved significantly higher outcomes than expected based on standardized GAS T-scores, M = 58 (SD=13), t(28) = 3, p = .002 overall. No significant difference was detected between the in-home delivery method, 61 (SD = 12), and the telehealth delivery method, 55 (SD = 14), t(27) = 1, p = 0.223. The study findings can inform future efficacy testing and provide initial evidence for the caregiver-mediated intervention in improving eating skills and mealtime behaviors in autistic children, utilizing multiple delivery methods. The results support the use of family-centered interventions in ecologically valid contexts for addressing mealtime challenges.

Keywords. Autism, Eating, Mealtime, Family, Caregiver, Intervention

Aims. This project aimed to (1) Describe feeding self-help skills in autistic children with feeding challenges and (2) Identify the relationships among feeding self-help skills, feeding challenge severity, family mealtime factors, and adaptive behavior.

Methods. This study used data from a cross-sectional national survey of 358 caregivers of autistic children (ages 2-12 years) with feeding challenges, recruited through a national research registry. Data were captured using validated caregiver-report measures. Descriptive statistics were completed to characterize feeding self-help skills and additional variables within the sample. Pearson's R correlations were run to investigate relationships among variables.

Results. Feeding self-help skills, feeding challenge severity, and adaptive behavior scores were widely heterogeneous. Overall, children in the study required higher levels of support from caregivers to participate in feeding and had lower adaptive behavior than expected for their age. Significant Pearson r correlations ranging from 0.11 to 0.60 were observed between feeding self-help skills, feeding challenge severity, family mealtime factors, and adaptive behavior.

Conclusions. Feeding self-help skills and adaptive behavior are essential to evaluate in autistic children with feeding challenges. Future research should explore component skills, (e.g. use of utensils) in addition to behavior and sensory components of feeding to inform child-centered evaluation and intervention.

Keywords. Adaptive behavior, autism, family mealtime, feeding challenges, feeding self-help skills

Prenatal Zika virus (ZIKV) exposure can result in outcomes ranging from severe birth defects to subtle developmental delays, yet the underlying mechanisms remain unclear. Using a translational rhesus macaque model, we assess visual, auditory, and neurodevelopmental outcomes through 12 months of age following first-trimester ZIKV inoculation. Pregnant macaques, either flavivirus-naive or with prior dengue virus (DENV) exposure, are inoculated with Asian or African ZIKV lineages. Maternal viremia duration, placental viral burden, and neutralizing antibody titers vary but are not associated with developmental outcomes. At 12 months, ZIKV-exposed infants exhibit altered maternal attachment behaviors and reduced inhibition toward novel sensory stimuli. Visual evoked potentials are impaired at 3 months but normalize by 12 months; hearing loss is more frequent but not statistically significant. These outcomes are driven by ZIKV exposure itself, independent of maternal infection characteristics. Our findings highlight the limitations of maternal biomarkers in risk prediction and support incorporating infant-focused developmental outcomes in studies of maternal interventions.

Keywords. Viral pathogenesis, Virus–host interactions

Purpose. Group exercise provides many benefits, yet adults with intellectual and developmental disabilities are often excluded from participation. As group exercise instructors play a significant role in GE participation, this study sought to gain a better understanding of their perceptions toward the participation of adults with intellectual and developmental disabilities to support the development of more accessible and inclusive community group exercise opportunities.

Methods. Semi-structured interviews were completed with twenty participants aged 21-62 who were actively teaching group exercise classes. Participants shared their perceptions of intellectual and developmental disability concerning group exercise participation. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis.

Results. Three themes were derived from the interviews: Beliefs surrounding modifications, perceived instructor roles, and self-efficacy in teaching adults with intellectual and developmental disabilities.

Conclusions. Instructors emphasized the importance of modifications but expressed mixed self-efficacy in applying these modifications effectively. Further exploration is needed surrounding instructor self-efficacy.

Keywords. Intellectual and developmental disability, group exercise, instructor perceptions, qualitative, teaching

Feeding is a multifaceted process that is frequently disrupted across pediatric populations, in particular among children with medical, developmental, or behavioral challenges. Occupational therapy practitioners possess unique expertise in providing comprehensive evaluations and interventions for feeding and eating skills, child regulation and behavior, mealtime routines, and family-centered goals during this essential activity of daily living. This State of the Science review synthesizes the current state of evaluation, intervention, and policy related to pediatric feeding within occupational therapy; specifically, we identify opportunities for expanded assessment development, intervention research, clinical research partnerships, and policy advocacy. We emphasize the importance of occupational therapy practitioners being part of multidisciplinary teams, consistently being recognized as qualified providers of feeding services, and being reimbursed for service provision across the United States related to pediatric feeding.

Keywords. Child, Feeding Behavior, Health Policy, Occupational Therapy

Autism core characteristics and sensory processing differences can create significant barriers to families accessing and children receiving emergency healthcare in the heightened sensory and fast-paced environment of emergency departments, particularly in rural communities. This project aimed to use a community-collaborative approach to develop and disseminate educational materials, recommend emergency department environmental modifications, and implement sensory regulation supports to enhance the capacity of healthcare providers and staff in supporting autistic children within rural emergency department settings. An interdisciplinary community-academic partnership team including researchers, graduate students, parents, an autistic focused organization, healthcare providers, and hospital staff used an iterative process to co-create materials. The collaboration yielded a multi-faceted toolkit with high acceptability from health care team members. The toolkit products included educational materials, environmental adaptations, and sensory-friendly tools. Future research should explore toolkit modifications to allow for implementation across unique emergency department contexts and assess healthcare related outcomes to measure toolkit effectiveness.

Keywords. Autism, Sensory processing, Emergency department, Accessibility, Health Services Accessibility

Ensuring that research participants accurately reflect patient populations is critical for the equitable distribution of the benefits and burdens of studies; however, many groups experiencing health disparities remain underrepresented in research. This study interviewed research team members (n = 25) interested in inclusive recruitment to understand their perspectives on engaging adults with intellectual and developmental disabilities in general population research. Team-based thematic analysis revealed barriers to the inclusion of adults with intellectual and developmental disabilities including 1) use of direct and indirect exclusionary practices, 2) lack of knowledge and skills, 3) reliance on ad hoc accommodations, 4) perceptions that including adults with intellectual disabilities in research lacks scientific value, and 5) beliefs that people with intellectual and developmental disabilities are not able or willing to participate. However, while team members acknowledged a lack of knowledge and skills to include people with intellectual and developmental disabilities, there was a strong interest in learning.

Keywords. Recruitment science, adults with intellectual and developmental disabilities, health equity, patient engagement, research ethics

Quality of life (QoL) is important for everyone and has been identified as a priority for autistic people. However, studies typically focus on caregiver-proxy-reported QoL and its related individual characteristics, even though self- and caregiver-proxy-reported QoL may differ in autistic children. In 74 autistic children (5.04-10.99 years old, intelligence quotient [IQ] 47-141), we sought to determine the level of agreement between self- and caregiver-proxy-reported QoL and determine if self- and caregiver-proxy-reported QoL are differently related to personal characteristics such as age, IQ, autism features, attention-deficit/hyperactivity disorder (ADHD) features, sleep difficulties, and sensory features. Findings suggested poor inter-rater agreement (ICC = 0.16) between self- and caregiver-proxy-reported QoL. Across both self- and caregiver-proxy reports, sensory features and sleep difficulties related to QoL, but age and IQ did not. We also found an interaction effect of reporter on the relation between QoL and both autism and ADHD features, with these associations driven by caregiver-proxy-reported QoL. These findings emphasize the importance of measuring both self- and caregiver-proxy-reported QoL to provide complementary perspectives. Moreover, these results underscore the importance of understanding a child's sensory features and sleep difficulties, as these two areas were similarly related to both self- and caregiver-proxy-reported QoL.

Keywords. attention-deficit hyperactivity disorder, autism, children, quality of life, sensory, sleep

Sensory processing differences are prevalent among autistic children impacting their participation in daily activities. Sensory subtypes provide a useful approach to understand these differences, as sensory response patterns often co-occur. The purpose of this paper is to apply existing sensory subtype methodology to examine the four sensory subtypes' association with child outcome measures. Autistic children (n = 118) ages 6-18 years old were grouped into four sensory subtypes of mild, sensitive-distressed, attenuated-preoccupied, and extreme-mixed. This study examined associations among the four sensory subtypes and motor skills, core autism features, and adaptive behaviors. Most children were categorized into the mild (n = 53) and sensitive-distressed (n = 45) subtype with very few children falling in the attenuated-preoccupied (n = 9) and extreme-mixed subtype (n = 11). The four subtypes had group differences identified for motor skills, core autism features, and adaptive behaviors. The mild and attenuated-preoccupied had higher motor skills compared to the sensitive-distressed and extreme-mixed subtype. The extreme-mixed subtype had more core autism features, and lower adaptive behavior compared to the mild subtype. Sensory subtypes exhibit differential associations to child outcome measures for autistic children ages 6-18 years old. Understanding these relationships may provide an opportunity for earlier, targeted interventions to address the role sensory differences play in daily activities.

Keywords. Adaptive behaviors, autism features, motor skills, sensory patterns, sensory subtypes

Importance. Comprehensive and validated assessments for use in clinical and research settings are needed to identify and address the complexities of feeding challenges for autistic children.

Objective. To establish the convergent validity of the Feeding and Eating in AutiSm Together (FEAST) questionnaire compared with two other validated parent-reported feeding assessments with similar constructs, the Behavior and Mealtime Behavior Index of Children (BAMBIC) and Screening Tool of Feeding Problems applied to Children (STEP-CHILD).

Method. Data from the Survey for Characterization of Feeding Challenges in Autistic Children-US (N = 349) were used to determine the convergence between the FEAST, BAMBIC, and STEP-CHILD using Pearson's correlation tests.

Design. Cross-sectional validation study.

Results. The FEAST total score and FEAST Behavior subscale were found to have moderate, positive correlations with comparison measures, supporting the convergent validity of the FEAST. Relationships between the remaining FEAST subscales and BAMBIC and STEP-CHILD subscales were primarily weak or nonsignificant, demonstrating that their respective scores are capturing distinct factors related to feeding. One expected exception was a moderate positive correlation between the FEAST Oral Motor subscale and the STEP-CHILD Chewing Problems subscale.

Conclusions and relevance. The FEAST demonstrates adequate convergent validity the BAMBIC and STEP-CHILD. The weak correlations of the FEAST Gastrointestinal Health, Sensory Processing, and Oral Motor Skills subscales provide evidence that FEAST may capture additional information about the factors that influence feeding challenges. The FEAST provides clinicians and researchers with a new comprehensive assessment of feeding challenges for autistic children.

[MeSH terms substituted for keywords — no author-supplied keywords listed on PubMed.]

Keywords. Autistic Disorder, Child, Child Preschool, Cross-Sectional Studies, Feeding Behavior, Female, Humans, Male, Reproducibility of Results, Surveys and Questionnaires

Prenatal and postnatal Zika virus (ZIKV) exposure can result in a constellation of developmental deficits in human infants that present during early childhood. Translational rhesus macaque models have been developed to interrogate these deficits. Here, we summarize and interpret the developmental findings from rhesus macaque studies of prenatal or postnatal ZIKV exposure. We looked for potential biomarkers that could be used to identify infants at risk for developmental deficits. Visual orientation and motor deficits were the most common developmental deficits across the studies. We identified a potential association between prolonged maternal RNAemia and worse infant developmental outcomes in prenatal exposure studies. Therefore, longitudinal screening of maternal blood for ZIKV RNA may help identify human infants at risk for visual orientation and motor deficits in early childhood; however, the diversity of research protocols across the groups made it challenging to make definitive associations.

Keywords. Zika virus, behavior, congenital infection, neurodevelopment, nonhuman primate model, macaca, prenatal care, zika virus

Zika virus, a mosquito-transmitted orthoflavivirus, has become a pathogen of global health concern ever since the virus caused an epidemic in Brazil in 2015 associated with approximately 700 000 laboratory-confirmed cases of congenital microcephaly. The subsequent spread of the epidemic in 2016 resulted in a wide spectrum of congenital neurological, ophthalmological, and developmental abnormalities across the Americas, Africa, and Asia. In this context, non-human primate models have become essential tools for Zika virus research to understand the pathogenesis of congenital brain injury and perinatal complications and for developing and testing medical countermeasures such as vaccines, diagnostics, and therapeutics. Fetal brain injury has been observed across various non-human primate species and is influenced by factors such as the Zika virus strain, gestational age at inoculation, and inoculation dose and route. Miscarriages are also seen as common outcomes of first trimester Zika virus infections. This Series paper reviews the diverse non-human primate models currently used for Zika virus research to mitigate the public health effects of future Zika virus epidemics.

[MeSH terms substituted for keywords — no author-supplied keywords listed on PubMed.]

Keywords. Animals, Disease Models Animal, Female, Humans, Microcephaly, Pregnancy, Primates, Zika Virus Infection, Zika Virus

Background. Autistic children experience high rates of feeding challenges, negatively affecting their health, eating patterns, and social eating experiences. The Feeding and Eating in AutiSm Together; FEAST, a caregiver-report questionnaire, was developed to characterize feeding challenges in autistic children ages 2 to 12 years. The purpose of this study is to determine the construct validity of the FEAST assessment using a large national sample of autistic children.

Method. A large national sample (N = 396) of caregivers completed the online survey. An ordinal confirmatory factor model using a robust weighted least squares approach validated the four predicted groupings of feeding challenges (sensory processing; behavior; oral motor skills; and gastrointestinal) with generally strong loadings onto the four distinct factors.

Results. Model fit statistics indicated good model fit (Robust Root Mean Square Error of Approximation = .080, Robust Comparative Fit Index = .909, Robust Tucker-Lewis Index = .901). Findings provide preliminary confirmation of the construct validity of the FEAST assessment to characterize feeding difficulties for autistic children ages 2–12. Small to medium correlations between all factors indicate items successfully targeted four unique areas of feeding challenge. For all factors, the largest correlation was with behavior.

Conclusion. Assessments developed to address the complex feeding and mealtime challenges for autistic children are essential to identify and integrate the most appropriate intervention approaches. FEAST offers researchers and clinicians with a comprehensive and psychometrically sound assessment tool to address autistic children's unique feeding challenges.

Keywords. Autism spectrum disorder, feeding, factor analysis, assessment, sensory, oral motor, gastrointestinal, behavior

Importance. At least 10 million people in the United States have an intellectual and/or developmental disability (IDD). People with IDD experience considerably higher rates of poor overall health, chronic conditions including diabetes, mental health challenges, maternal mortality, and preventable deaths. This Special Communication proposes national goals based on a community-led consensus model that advances priority health outcomes for people with IDD and their caregivers/partners and identifies critical policy opportunities and challenges in achieving these goals. A community-led consensus agenda offers a foundation for focusing research, improving data collection and quality measurement, enhancing coverage and payment for services, and investing in a prepared clinical workforce and infrastructure in ways that align with lived experiences and perspectives of community members.

Observations. People with IDD prioritize holistic health outcomes and tailored supports and services, driven by personalized health goals, which shift over their life course. Caregivers/partners need support for their own well-being, and easy access to resources to optimize how they support loved ones with IDD. Development of an adequately prepared clinical workforce to serve people with IDD requires national and regional policy changes that incentivize and structure training and continuing education. Ensuring effective and high-value coverage, payment, and clinical decisions requires investments in new data repositories and data-sharing infrastructure, shared learning across public and private payers, and development of new technologies and tools to empower people with IDD to actively participate in their own health care.

Conclusions and Relevance. Consensus health priorities identified in this project and centered on IDD community members' perspectives are generalizable to many other patient populations. Public and private payers and regulators setting standards for health information technology have an opportunity to promote clinical data collection that focuses on individuals' needs, quality measurement that emphasizes person-centered goals rather than primarily clinical guidelines, and direct involvement of community members in the design of payment policies. Clinical education leaders, accrediting bodies, and investors/entrepreneurs have an opportunity to innovate a better prepared health care workforce and shared data infrastructure to support value-based care programs.

Background. People with developmental disabilities make important contributions to research. However, inaccessible research ethics trainings present a barrier to them taking on some research roles.

Objectives. We developed a social-behavioral research ethics training that leads to certification tailored to the accessibility needs and roles of community research partners with developmental disabilities.

Methods. We collaborated with diverse partners (people with developmental disabilities, a disability service provider, health researchers, human research participant protections experts) to develop the research ethics training. To identify potential training content, we conducted a rapid scoping review of ethical, legal, and social issues in social-behavioral research with adults with developmental disabilities and reviewed national research ethics curricula. Through discussions and a modified Delphi process, we worked with partners to identify content to teach; partners also provided guidance on accessibility.

Results. The training and rapid scoping reviews and input from partners resulted in 93 potential educational content elements to include. After completing the modified Delphi process, partners recommended inclusion of 83 of these content elements in the educational training and provided input on depth and approach to teaching this content. Research Ethics for All is a freely available training that includes 5 units, delivered via didactic and active learning, and assessment activities to verify understanding. Research Ethics for All should be facilitated by an experienced researcher.

Conclusions. Research Ethics for All includes foundational social-behavioral research ethics content designed to support community research partners with developmental disabilities to take on new research responsibilities.

Keywords. Accessibility, Community-based participatory research, Ethics, Inclusive research, Intellectual and developmental disability

Objective. To evaluate caregiver outcomes (stress, self-efficacy, and positive feeding responses and confidence) after participation in the Engaged Eaters Program.

Design. Quasi-experimental pretest–posttest design.

Setting. In-home via telehealth.

Participants. Fourteen primary caregivers of an autistic child (ages 2–7 yr) with feeding challenges.

Intervention. The Engaged Eaters Program–Telehealth, a caregiver-mediated 6-mo in-home telehealth feeding intervention for autistic children ages 2 to 7 yr that included 24 intervention visits, eight caregiver training modules, and consultation with a dietician.

Outcomes and Measures. Relationships between child feeding challenge severity and caregiver outcomes and individual differences in caregivers’ intervention responses were evaluated. We assessed caregivers’ stress (Parenting Stress Index, Fourth Edition Short Form), self-efficacy (Parent Sense of Competence Scale), Positive Feeding Responses and Confidence (PFRC; composite score of items from other assessments), and individual intervention response using pre- to postintervention change in scores.

Results. Exploration of individual differences revealed that only caregivers with intake PFRC scores below the mean made significant improvements by the end of the intervention. No significant group-level changes were identified for stress, self-efficacy, or PFRC. Feeding challenge severity was not significantly related to caregiver outcomes.

Conclusions and Relevance. The results emphasize the importance of considering baseline practices, efficacy, and caregiver confidence when engaging caregivers in intervention. Future research should explore the nuanced relationship between caregiver outcomes and child characteristics.

Plain-Language Summary. Caregivers are essential partners with feeding interventions that build on family routines and practices. When working with caregivers, occupational therapists should consider caregivers’ readiness for and responses to an intervention because intervention practices may differentially affect caregivers’ parenting practices, confidence, and self-efficacy. Caregivers’ responses may also affect the overall effectiveness of a caregiver-mediated intervention.

Positionality Statement. The term caregiver-mediated is used throughout this article in place of parent-mediated to be inclusive of all types of caregivers.

Attention-deficit/hyperactivity disorder (ADHD) commonly co-occurs in autistic children. However, additional research is needed to explore the differences in motor skills and sensory features in autistic children with and without ADHD, as well as the impacts of these factors on daily living skills (DLS). This observational study sought to fill this gap with 67 autistic children (6.14-10.84 years-old), 43 of whom had ADHD. Autistic children with ADHD demonstrated higher sensory features and lower motor skills than autistic children without ADHD. In examining autism and ADHD features dimensionally, we found that overall sensory features, seeking, and hyporesponsiveness were driven by both autism and ADHD features, whereas motor skills, enhanced perception, and hyperresponsiveness were driven by only autism features. Additionally, in using these dimensional variables of autism and ADHD features, we found that differences in motor skills, sensory and autism features, but not ADHD features, impact DLS of autistic children, with autism features and motor skills being the strongest individual predictors of DLS. Together, these results demonstrate the uniqueness of motor skills and sensory features in autistic children with and without ADHD, as well as how autism features, sensory features, and motor skills contribute to DLS, emphasizing the importance of a comprehensive understanding of each individual and complexities of human development when supporting autistic children.

Keywords. Attention-deficit hyperactivity disorder, Autism spectrum disorder, Daily living skills, Motor skills, Sensory features

The purpose of this study was to understand caregivers' experience of participating in a caregiver-mediated in-home feeding intervention, the Engaged Eaters Program, for their young autistic child. This qualitative study utilized a thematic approach to analyze post-intervention semi-structured interviews with thirteen mothers of autistic children between the ages of 2 to 7 years after they participated in the intervention. Interview questions focused on the child and family experience, what worked well, what could be improved, and how the intervention integrated into family routines. Four major themes were identified: In-Home Intervention, Parent Skill and Knowledge, Increased Social Participation, and Parent Responsibilities and Challenges. Sub-themes provided descriptions of learning practical tools to support their child, increasing self-efficacy, and impacts on family life. Mothers described an increase in tangible skills that were easily practiced in the home environment that improved their confidence and self-efficacy in feeding their children. They also described how participation did require more work and time commitment for them beyond their regular responsibilities. The caregiver experience is essential to understand for intervention effectiveness while simultaneously addressing child, caregiver, and family needs. By focusing on the mothers' experiences, individualized needs, and self-efficacy, we were able to better understand how integrating an intervention into the family context and daily routines may be beneficial for the whole family.

Keywords. Autistic Disorder, Caregivers, Child, Feeding and Eating, Mother

Feeding challenges are common for autistic children. Currently, research and intervention for feeding challenges focuses on single factors (e.g. behavior or sensory). Research is needed to understand the complexity of feeding challenges. This study provides a comprehensive description of feeding challenges. Furthermore, this study identifies what factors predict the severity and type of feeding challenges experienced by autistic children. Using the Survey for Characterization of Feeding Challenges in Autistic Children-United States, 427 caregivers of autistic children provided information about their child's feeding challenges. Children were between the ages of 2 and 12 with an average age of 8.42 years. Children in the study had a wide variety of feeding difficulties including challenges in early childhood, sensory challenges, difficulty with family mealtime, and variable self-help skills. On average children's feeding challenges were present prior to their autism diagnosis. We found that children who had early feeding challenges had more severe feeding challenges in later childhood. Also, specific early feeding challenges predicted the types of feeding challenges children would have later in childhood. For example, children who had difficulty transitioning to table foods and who continued to restrict their diet over time were more likely to have sensory-based feeding challenges. Results from this study show how feeding challenges present in a wide variety of ways for autistic children. The findings also highlight the importance of screening for feeding challenges in early childhood and collaborating with families to understand individualized feeding challenge experiences. These results could be used to inform evaluation and intervention for feeding.

Keywords. autism spectrum disorders, interventions—psychosocial/behavioral, nutrition/feeding, screening

Background. Children with prenatal Zika virus exposure are at an increased risk of developing neurodevelopmental deficits in early childhood. Travel to Zika virus-endemic regions during pregnancy elevates the risk of offspring developing complications. This study examined developmental outcomes of children from Wisconsin with maternal or partner travel history to Zika virus-endemic regions during pregnancy compared to gestation and age-matched controls.

Methods. A retrospective chart review compared outcomes of cases (n = 181) with prenatal travel history to Zika virus-endemic regions to gestational and birth date-matched controls (n = 172) up to 7 years old. We reported Zika virus testing and travel, birth outcomes, standardized developmental screening tests, and specialist referral rates.

Results. There were no differences in referral rates and standardized developmental screening test outcomes, but cases tended to have more referrals for early intervention compared to the controls (P = 0.059). One Zika virus-positive case was identified with complications surrounding birth, and 2.2% of children had documentation in their health records noting potential Zika virus exposure. Regardless of groups, limited referrals were made at 9 (0%), 18 (60%), and 24 (40%) months based on Ages and Stages Questionnaire-version 3 (ASQ-3) recommendations.

Conclusions. This study found similar developmental screening outcomes and referral rates between groups. Longitudinal care of children whose mothers traveled to Zika virus-endemic regions could be improved with better documentation of prenatal Zika virus exposure in the child's medical record, use of standardized developmental screening tools at every recommended well-child visit, and referral when developmental screening test scores are low.

Keywords. Zika virus, prenatal exposure, neurodevelopmental screening, case-control study, Wisconsin

Background. Adults with intellectual and developmental disabilities (IDD) experienced significant disruptions in their access to health care, support services, and essential daily activities such as work, leisure, and routine daily care during COVID-19.

Objective. The purpose of this study was to describe overall experiences related to COVID-19 among adults with IDD, including the vaccination process, quality of life (QoL), and service satisfaction before and during the pandemic.

Methods. A longitudinal statewide survey of adults with IDD receiving long-term care support using a combination of self- and care partner report was completed prior to (2017; n=331) and during (2021; n=206) the pandemic.

Results. Qualitative results identified specific vaccine barriers, vaccine decision influencers, and general experiences during COVID-19 for adults with IDD. The importance of support staff, vaccine availability, disruption in daily activities, social context, and mental health implications were noted in responses to all three topics. Quantitative results showed lower QoL during COVID-19 (M=2.99 vs. 3.14, p=.028); however, when reporter (self vs. care partner) and age were added to the model, differences between pre- vs. during-COVID were no longer significant. No significant differences in satisfaction of services were noted pre- vs. during-COVID-19. Ninety-six percent of respondents reported access to the vaccine, and 16% experienced barriers getting the vaccine. QoL was associated with receiving the COVID-19 vaccine (r=.15, p=.036), level of agreement that the vaccine is safe (r=.17, p=.024), and level of agreement that getting the vaccine will help protect other vulnerable people in the community (r=.25, p=.001). Level of satisfaction with quality of services was also associated with level of agreement that the vaccine is safe (r=.15, p=.048).

Conclusions. Overall, a better understanding of service continuation, support practices, and experiences related to COVID-19 will prepare us for future environmental and health crises by identifying areas for improvement, intervention, and policy change to meet the ongoing needs of adults with IDD.

Keywords. quality of life, service, satisfaction, COVID-19, self-report

Background. Differences in responding to sensory stimuli, including sensory hyperreactivity (HYPER), hyporeactivity (HYPO), and sensory seeking (SEEK) have been observed in autistic individuals across sensory modalities, but few studies have examined the structure of these "supra-modal" traits in the autistic population.

Methods. Leveraging a combined sample of 3868 autistic youth drawn from 12 distinct data sources (ages 3–18 years and representing the full range of cognitive ability), the current study used modern psychometric and meta-analytic techniques to interrogate the latent structure and correlates of caregiver-reported HYPER, HYPO, and SEEK within and across sensory modalities. Bifactor statistical indices were used to both evaluate the strength of a "general response pattern" factor for each supra-modal construct and determine the added value of "modality-specific response pattern" scores (e.g., Visual HYPER). Bayesian random-effects integrative data analysis models were used to examine the clinical and demographic correlates of all interpretable HYPER, HYPO, and SEEK (sub)constructs.

Results. All modality-specific HYPER subconstructs could be reliably and validly measured, whereas certain modality-specific HYPO and SEEK subconstructs were psychometrically inadequate when measured using existing items. Bifactor analyses supported the validity of a supra-modal HYPER construct (ωH = .800) but not a supra-modal HYPO construct (ωH = .653), and supra-modal SEEK models suggested a more limited version of the construct that excluded some sensory modalities (ωH = .800; 4/7 modalities). Modality-specific subscales demonstrated significant added value for all response patterns. Meta-analytic correlations varied by construct, although sensory features tended to correlate most with other domains of core autism features and co-occurring psychiatric symptoms (with general HYPER and speech HYPO demonstrating the largest numbers of practically significant correlations).

Limitations. Conclusions may not be generalizable beyond the specific pool of items used in the current study, which was limited to caregiver report of observable behaviors and excluded multisensory items that reflect many "real-world" sensory experiences.

Conclusion. Of the three sensory response patterns, only HYPER demonstrated sufficient evidence for valid interpretation at the supra-modal level, whereas supra-modal HYPO/SEEK constructs demonstrated substantial psychometric limitations. For clinicians and researchers seeking to characterize sensory reactivity in autism, modality-specific response pattern scores may represent viable alternatives that overcome many of these limitations.