IU Indianapolis ScholarWorks :: Browsing by Author "McNally Keehn, Rebecca"

Browsing by Author "McNally Keehn, Rebecca"

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143 Training & Sustaining: Training and learning collaborative outcomes across a statewide network for early diagnosis of children with autism
(Cambridge University Press, 2024-04-03) McNally Keehn, Rebecca; Paxton, Angela; Delaney, Mary; Ciccarelli, Mary; Pediatrics, School of Medicine
OBJECTIVES/GOALS: Community-based primary care autism diagnostic models are one promising solution to delays in autism diagnosis. Our objective is to describe the development and report on outcomes related to primary care professional (PCP) training and sustained engagement in a longitudinal learning collaborative across a statewide network for autism diagnosis. METHODS/STUDY POPULATION: We developed ADAPT (i.e., Accelerating the Diagnosis of Autism with Primary care Training), a training program to prepare PCPs to develop independent competency in evaluation of autism in children ages 14-48 months. ADAPT includes didactic and case-based modules and expert practice-based coaching delivered by a diagnostic specialist; following training PCPs participate in a longitudinal learning collaborative. Aligned with competency-based medical education standards, measures of autism evaluation knowledge and diagnostic competency are collected. RESULTS/ANTICIPATED RESULTS: To date, 13 PCPs have completed ADAPT didactic and practicum training reaching competency in independent autism evaluation. Clinicians demonstrated significant improvement in total autism knowledge following didactic training (p=.02). There was an overall trend toward increased scoring agreement on an autism observational assessment over case observations and practicum evaluations. Similarly, PCPs demonstrated improved evaluation competence, moving on average from Advanced Beginner to Competent Performer as rated by expert trainers. Following training, PCPs attended 57% of monthly learning collaborative sessions. DISCUSSION/SIGNIFICANCE: Training PCPs to deliver autism evaluations as part of community-based models of care is a promising solution to address access and waitlist challenges. ADAPT is an intensive, standard PCP training model which results in achievement of independent competency and sustained engagement in in autism evaluation.
Associations between sensory processing and electrophysiological and neurochemical measures in children with ASD: an EEG-MRS study
(BMC, 2021-01-06) Pierce, Sarah; Kadlaskar, Girija; Edmondson, David A.; McNally Keehn, Rebecca; Dydak, Ulrike; Keehn, Brandon; Pediatrics, School of Medicine
Background: Autism spectrum disorder (ASD) is associated with hyper- and/or hypo-sensitivity to sensory input. Spontaneous alpha power, which plays an important role in shaping responsivity to sensory information, is reduced across the lifespan in individuals with ASD. Furthermore, an excitatory/inhibitory imbalance has also been linked to sensory dysfunction in ASD and has been hypothesized to underlie atypical patterns of spontaneous brain activity. The present study examined whether resting-state alpha power differed in children with ASD as compared to TD children, and investigated the relationships between alpha levels, concentrations of excitatory and inhibitory neurotransmitters, and atypical sensory processing in ASD. Methods: Participants included thirty-one children and adolescents with ASD and thirty-one age- and IQ-matched typically developing (TD) participants. Resting-state electroencephalography (EEG) was used to obtain measures of alpha power. A subset of participants (ASD = 16; TD = 16) also completed a magnetic resonance spectroscopy (MRS) protocol in order to measure concentrations of excitatory (glutamate + glutamine; Glx) and inhibitory (GABA) neurotransmitters. Results: Children with ASD evidenced significantly decreased resting alpha power compared to their TD peers. MRS estimates of GABA and Glx did not differ between groups with the exception of Glx in the temporal-parietal junction. Inter-individual differences in alpha power within the ASD group were not associated with region-specific concentrations of GABA or Glx, nor were they associated with sensory processing differences. However, atypically decreased Glx was associated with increased sensory impairment in children with ASD. Conclusions: Although we replicated prior reports of decreased alpha power in ASD, atypically reduced alpha was not related to neurochemical differences or sensory symptoms in ASD. Instead, reduced Glx in the temporal-parietal cortex was associated with greater hyper-sensitivity in ASD. Together, these findings may provide insight into the neural underpinnings of sensory processing differences present in ASD.
Attentional Disengagement and the Locus Coeruleus – Norepinephrine System in Children With Autism Spectrum Disorder
(Frontiers Media, 2021-08-31) Keehn, Brandon; Kadlaskar, Girija; Bergmann, Sophia; McNally Keehn, Rebecca; Francis, Alexander; Pediatrics, School of Medicine
Background: Differences in non-social attentional functions have been identified as among the earliest features that distinguish infants later diagnosed with autism spectrum disorder (ASD), and may contribute to the emergence of core ASD symptoms. Specifically, slowed attentional disengagement and difficulty reorienting attention have been found across the lifespan in those at risk for, or diagnosed with, ASD. Additionally, the locus coeruleus-norepinephrine (LC-NE) system, which plays a critical role in arousal regulation and selective attention, has been shown to function atypically in ASD. While activity of the LC-NE system is associated with attentional disengagement and reorienting in typically developing (TD) individuals, it has not been determined whether atypical LC-NE activity relates to attentional disengagement impairments observed in ASD. Objective: To examine the relationship between resting pupil diameter (an indirect measure of tonic LC-NE activation) and attentional disengagement in children with ASD. Methods: Participants were 21 school-aged children with ASD and 20 age- and IQ-matched TD children. The study consisted of three separate experiments: a resting eye-tracking task and visual and auditory gap-overlap paradigms. For the resting eye-tracking task, pupil diameter was monitored while participants fixated a central crosshair. In the gap-overlap paradigms, participants were instructed to fixate on a central stimulus and then move their eyes to peripherally presented visual or auditory targets. Saccadic reaction times (SRT), percentage of no-shift trials, and disengagement efficiency were measured. Results: Children with ASD had significantly larger resting pupil size compared to their TD peers. The groups did not differ for overall SRT, nor were there differences in SRT for overlap and gap conditions between groups. However, the ASD group did evidence impairments in disengagement (larger step/gap effects, higher percentage of no-shift trials, and reduced disengagement efficiency) compared to their TD peers. Correlational analyses showed that slower, less efficient disengagement was associated with increased pupil diameter. Conclusion: Consistent with prior reports, children with ASD show significantly larger resting pupil diameter, indicative of atypically elevated tonic LC-NE activity. Associations between pupil size and measures of attentional disengagement suggest that atypically increased tonic activation of the LC-NE system may be associated with poorer attentional disengagement in children with ASD.
Auditory Attentional Disengagement in Children with Autism Spectrum Disorder
(Springer, 2019-06-14) Keehn, Brandon; Kadlaskar, Girija; McNally Keehn, Rebecca; Francis, Alexander L.; Pediatrics, School of Medicine
Despite early differences in orienting to sounds, no study to date has investigated whether children with ASD demonstrate impairments in attentional disengagement in the auditory modality. Twenty-one nine- to fifteen year old children with ASD and 20 age- and IQ-matched TD children were presented with an auditory gap-overlap paradigm. Evidence of impaired disengagement in ASD was mixed. Differences in saccadic reaction time for overlap and gap conditions did not differ between groups. However, children with ASD did show increased no-shift trials in the overlap condition, as well as reduced disengagement efficiency compared to their TD peers. These results provide further support for disengagement impairments in ASD, and suggest that these deficits include disengaging from and shifting to unimodal auditory information.
Brief Report: Reduced Heart Rate Variability in Children with Autism Spectrum Disorder
(SpringerLink, 2020-11) Lory, Catharine; Kadlaskar, Girija; McNally Keehn, Rebecca; Francis, Alexander L.; Keehn, Brandon; Pediatrics, School of Medicine
Dysregulation of the autonomic nervous system (ANS), which can be indexed by heart rate variability (HRV), has been posited to contribute to core features of autism spectrum disorder (ASD). However, the relationship between ASD and HRV remains uncertain. We assessed tonic and phasic HRV of 21 children with ASD and 21 age- and IQ-matched typically developing (TD) children and examined (1) group differences in HRV and (2) associations between HRV and ASD symptomatology. Children with ASD showed significantly lower tonic HRV, but similar phasic HRV compared to TD children. Additionally, reduced tonic HRV was associated with atypical attentional responsivity in ASD. Our findings suggest ANS dysregulation is present in ASD and may contribute to atypical attentional responses to sensory stimulation.
COVID-19 Pandemic Highlights Access Barriers for Children with Autism Spectrum Disorder
(Wolters Kluwer, 2021-09) McNally Keehn, Rebecca; Tomlin, Angela; Ciccarelli, Mary R.; Pediatrics, School of Medicine
Engagement in early intensive behavioral intervention has been shown to improve outcomes and lower lifetime care costs for children with autism spectrum disorder (ASD). However, in most regions of the United States, a medical diagnosis of ASD is necessary to access these interventions. A shortage of expert diagnosticians, inefficient evaluation models, and long evaluation wait times result in substantial delays in ASD diagnosis and markedly later entry into services. These delays are increased for children from diverse racial and socioeconomic backgrounds and underresourced regions. Although systemic barriers require ongoing attention, we highlight here the critical role that insurers play in limiting intervention access through application of inappropriate medical review criteria for ASD diagnostic evaluations. Specifically, to consider a medical diagnosis as valid and authorize specialized interventions, many insurers mandate the use of a specific assessment tool(s) instead of allowing qualified clinicians to use a flexible evidence-informed evaluation protocol. This has become especially problematic during COVID-19, when evaluation practices have rapidly shifted to meet demands for remote and/or socially distanced procedures through implementation of telehealth and use of novel diagnostic tools that are not yet accepted by insurers. When insurers erroneously deem ASD diagnoses as invalid, children are unable to benefit from needed interventions, resulting in a cascade of deleterious consequences.
Diagnostic Accuracy of Primary Care Clinicians Across a Statewide System of Autism Evaluation
(American Academy of Pediatrics, 2023) McNally Keehn, Rebecca; Swigonski, Nancy; Enneking, Brett; Ryan, Tybytha; Monahan, Patrick; Martin, Ann Marie; Hamrick, Lisa; Kadlaskar, Girija; Paxton, Angela; Ciccarelli, Mary; Keehn, Brandon; Pediatrics, School of Medicine
Objectives: To evaluate the diagnostic accuracy of the Early Autism Evaluation (EAE) Hub system, a statewide network that provides specialized training and collaborative support to community primary care providers in the diagnosis of young children at risk for autism spectrum disorder (ASD). Methods: EAE Hub clinicians referred children, aged 14 to 48 months, to this prospective diagnostic study for blinded follow-up expert evaluation including assessment of developmental level, adaptive behavior, and ASD symptom severity. The primary outcome was agreement on categorical ASD diagnosis between EAE Hub clinician (index diagnosis) and ASD expert (reference standard). Results: Among 126 children (mean age: 2.6 years; 77% male; 14% Latinx; 66% non-Latinx white), 82% (n = 103) had consistent ASD outcomes between the index and reference evaluation. Sensitivity was 81.5%, specificity was 82.4%, positive predictive value was 92.6%, and negative predictive value was 62.2%. There was no difference in accuracy by EAE Hub clinician or site. Across measures of development, there were significant differences between true positive and false negative (FN) cases (all Ps < .001; Cohen's d = 1.1-1.4), with true positive cases evidencing greater impairment. Conclusions: Community-based primary care clinicians who receive specialty training can make accurate ASD diagnoses in most cases. Diagnostic disagreements were predominately FN cases in which EAE Hub clinicians had difficulty differentiating ASD and global developmental delay. FN cases were associated with a differential diagnostic and phenotypic profile. This research has significant implications for the development of future population health solutions that address ASD diagnostic delays.
Electrophysiological Measures of Tactile and Auditory Processing in Children With Autism Spectrum Disorder
(Frontiers Media, 2021-12-23) Kadlaskar, Girija; Bergmann, Sophia; McNally Keehn, Rebecca; Seidl, Amanda; Keehn, Brandon; Pediatrics, School of Medicine
Behavioral differences in responding to tactile and auditory stimuli are widely reported in individuals with autism spectrum disorder (ASD). However, the neural mechanisms underlying distinct tactile and auditory reactivity patterns in ASD remain unclear with theories implicating differences in both perceptual and attentional processes. The current study sought to investigate (1) the neural indices of early perceptual and later attentional factors underlying tactile and auditory processing in children with and without ASD, and (2) the relationship between neural indices of tactile and auditory processing and ASD symptomatology. Participants included 14, 6-12-year-olds with ASD and 14 age- and non-verbal IQ matched typically developing (TD) children. Children participated in an event-related potential (ERP) oddball paradigm during which they watched a silent video while being presented with tactile and auditory stimuli (i.e., 80% standard speech sound/a/; 10% oddball speech sound/i/; 10% novel vibrotactile stimuli on the fingertip with standard speech sound/a/). Children's early and later ERP responses to tactile (P1 and N2) and auditory stimuli (P1, P3a, and P3b) were examined. Non-parametric analyses showed that children with ASD displayed differences in early perceptual processing of auditory (i.e., lower amplitudes at central region of interest), but not tactile, stimuli. Analysis of later attentional components did not show differences in response to tactile and auditory stimuli in the ASD and TD groups. Together, these results suggest that differences in auditory responsivity patterns could be related to perceptual factors in children with ASD. However, despite differences in caregiver-reported sensory measures, children with ASD did not differ in their neural reactivity to infrequent touch-speech stimuli compared to TD children. Nevertheless, correlational analyses confirmed that inter-individual differences in neural responsivity to tactile and auditory stimuli were related to social skills in all children. Finally, we discuss how the paradigm and stimulus type used in the current study may have impacted our results. These findings have implications for everyday life, where individual differences in responding to tactile and auditory stimuli may impact social functioning.
Equivalent Behavioral Facilitation to Tactile Cues in Children with Autism Spectrum Disorder
(MDPI, 2021-05-13) Kadlaskar, Girija; Bergmann, Sophia; McNally Keehn, Rebecca; Seidl, Amanda; Keehn, Brandon; Pediatrics, School of Medicine
The alerting network, a subcomponent of attention, enables humans to respond to novel information. Children with ASD have shown equivalent alerting in response to visual and/or auditory stimuli compared to typically developing (TD) children. However, it is unclear whether children with ASD and TD show equivalent alerting to tactile stimuli. We examined (1) whether tactile cues affect accuracy and reaction times in children with ASD and TD, (2) whether the duration between touch-cues and auditory targets impacts performance, and (3) whether behavioral responses in the tactile cueing task are associated with ASD symptomatology. Six- to 12-year-olds with ASD and TD participated in a tactile-cueing task and were instructed to respond with a button press to a target sound /a/. Tactile cues were presented at 200, 400, and 800 ms (25% each) prior to the auditory target. The remaining trials (25%) were presented without tactile cues. Findings suggested that both groups showed equivalent alerting responses to tactile cues. Additionally, all children were faster to respond to auditory targets at longer cue-target intervals. Finally, there was an association between rate of facilitation and RRB scores in all children, suggesting that patterns of responding to transient phasic cues may be related to ASD symptomatology.
Evaluation of Race and Ethnicity Across a Statewide System of Early Autism Evaluation
(Elsevier, 2023-03) Martin, Ann Marie; Ciccarelli, Mary R.; Swigonski, Nancy; McNally Keehn, Rebecca; Pediatrics, School of Medicine
We evaluated racial and ethnic disparities across the Early Autism Evaluation Hub system, a statewide network for autism diagnosis. Our findings suggest that this system has the potential to reduce longstanding disparities in autism spectrum disorder diagnosis for children from racial and ethnic minority backgrounds.

Browsing by Author "McNally Keehn, Rebecca"

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