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Autism spectrum disorder (ASD) is defined by the American Psychiatric Association as persistent deficits in social communication and interactions and restricted, repetitive patterns of behavior, interests, or activities. There are many potential etiological causes for ASD. In the United States, the combined prevalence of ASD per 1,000 children was 23 in 2018. The American Academy of Pediatrics (AAP) recommends screening specifically for ASD during regular doctor visits at 18 and 24 months to ensure systematic monitoring for early signs of ASD. Most reported concerns from parents relate to abnormal childhood developmental trajectory and history of unusual behaviors, with variability in ages when features suggestive of ASD are most noticeable. Behavioral interventions for ASD focus on minimizing the effects of developmental delays and maximizing speech/language, motor, social-emotional, and cognitive skills. Medications can be used to target comorbid conditions or problematic behaviors that interfere with progress or pose safety concerns. The financial burden on families of children with ASD is correlated with the existing societal financial safety net. Poorer outcomes are expected when the family carries a substantial share of the cost to support the development of children with ASD, especially in lower-income households.
People with intellectual and developmental disabilities (IDD) vary in terms of the nature and severity of their disabilities, but for all, their disability is lifelong. They experience of health inequities in the form of higher rates of poor health when compared with the general population. Together with biological factors relating to impairment or genetic factors, adverse social determinants of health contribute to their high rates of comorbid and secondary conditions that account for their poor health. There is a human rights imperative to address their health inequities through broader social change to reduce their socio-economic disadvantages, and systemic changes to healthcare systems to ensure they are afforded the same access to quality care as others in the community. This chapter explores the nature of the health inequities of people with IDD and identifies factors contributing to their poor health. The chapter ends with a review of strategies that show promise in addressing existing health problems, preventing the onset of poor health and improving healthcare systems.
Tourette's syndrome (TS) is characterized as a disorder of the mind, and tic symptoms the result of psychologic mechanisms. TS begins in childhood and for most patients symptom severity peaks in latency and early adolescence and decreases in adulthood. The diagnosis of TS and other tic disorders is dependent on the presence of motor and vocal tics. Problems with mood and impulse control, obsessive-compulsive behaviors, anxiety, disruptive behavior, attention, and learning are common in clinically ascertained populations of TS subjects. Patient and parent education is perhaps the most important component of treatment. Patients treated with medications for comorbid conditions that co-occur with TS may experience increased tic severity temporally associated with medication use. For many TS patients, the treatment of OCD, ADHD, or other psychiatric disorders may be the most important first step, as these disorders are often more impairing than tics.
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