Prevalence and the Understanding of Autism Spectrum Disorder Are on the Rise

The Seaver Center for Autism Research and Treatment at the Icahn School of Medicine at Mount Sinai is advancing the understanding of autism spectrum disorder.

Autism spectrum disorder (ASD) is increasing in prevalence, but so are options for evaluation and therapies, said Paige Siper, PhD, Chief Psychologist for the Seaver Autism Center for Research and Treatment, and Michelle Gorenstein, PsyD, Director of Outreach for the Seaver Center. “The interesting and exciting part about the work that we do is that we get to see toddlers through adults, and I think that is something very unique about this field,” said Dr. Siper, Assistant Professor of Psychiatry, Icahn School of Medicine at Mount Sinai. The virtual talk can be viewed here.

Paige Siper, PhD, Chief Psychologist of the Seaver Center

“Autism Spectrum Disorder Across the Lifespan” was hosted by the Mount Sinai Office for Diversity and Inclusion. It was part of a series featuring speakers from around the Mount Sinai Health System as well as the community to raise awareness and promote an inclusive and equitable health care environment for people with disabilities.

Dr. Gorenstein, Assistant Professor of Psychiatry, Icahn School of Medicine, said that an important tool in the field is Applied Behavioral Analysis, a class of interventions based on principles of operant learning theory—that is, providing positive reinforcement for observable behavior, like asking for a push on a playground swing, or making a choice. Another therapy, Relationship Development Intervention, is a family-based method that builds social and emotional skills. And there are a variety of therapies to treat conditions that can accompany ASD, such as anxiety, ADHD, or epilepsy.

Michelle Gorenstein, PsyD, Director of Outreach for the Seaver Center

ASD is characterized by difficulty with social communication, as well as the presence of repetitive behaviors or restricted interests.  ASD is primarily a genetic disorder but can also be influenced by environmental factors. Dr. Siper said multiple studies have shown that vaccines do not cause ASD, dispelling a common myth.

One in 54 children in the United States are diagnosed with ASD, and boys are four times more likely than girls to receive the diagnosis. ASD can be identified in children as early as age 18 months, which makes early intervention very important in improving social, communication, motor, and daily living skills.  “Early intervention can change outcomes,” Dr. Siper said. “It’s the opposite of watch and wait.”

The Seaver Center is dedicated to caring for people of all ages with ASD, furthering research into risk factors and drug development, and leading clinical trials. “One of the unique things about our Center is that it really does translate the basic sciences to the clinic,” Dr. Siper said. For more information, visit the Seaver Center site.

Additional disabilities-related resources are available on the Mount Sinai Office for Diversity and Inclusion site.

Navigating the Uncertainties of Multiple Sclerosis

Multiple sclerosis is a neuroinflammatory disorder that disrupts the flow of information between the brain or spinal cord and the rest of the body, and may lead to symptoms such as fatigue and problems with mobility, balance, vision.

The symptoms of multiple sclerosis (MS) can vary from person to person, and even from day to day for an individual—and this causes stress and uncertainty for both people with MS and their families. These psycho-social effects, and how to handle them, were the subject of a  virtual talk by Andrea Arzt, LCSW, MSCS, Director of Healthcare Engagement, and Debby Bennett, Program Implementation Manager with the National Multiple Sclerosis  Society. It can be viewed here.

Andrea Arzt, LCSW, MSCS, Director of Healthcare Engagement, National Multiple Sclerosis Society

“MS is variable and unpredictable, with no clear road map,” Ms. Arzt said in the talk, “Multiple Sclerosis: A Clinicians Update,” which was hosted by the Mount Sinai Office for Diversity and Inclusion. It was part of a series featuring speakers from around the Mount Sinai Health System as well as the community to raise awareness and promote an inclusive and equitable health care environment for people with disabilities.

MS is a neuroinflammatory disorder that affects the central nervous system. It disrupts the flow of information between the brain or spinal cord and the rest of the body, and may lead to symptoms such as fatigue, problems with mobility, balance, vision, and bowel and bladder function. Many of these symptoms are not visible to casual observers, adding another layer of challenges for people with MS as they seek accommodation and support. “It’s the ‘but you look so good’ syndrome,” Ms. Arzt said.

Debby Bennett, Program Implementation Manager, National Multiple Sclerosis  Society

When a person and their family are affected by MS, there may be grieving and depression as they face the ups and downs of the unpredictable disease, she said. Although there is no cure for MS, focusing on general wellness is an important piece of managing this disease. This includes continuing treatments, controlling things that one is able to control, such as diet and exercise, and increasing skills of resilience.

Ms. Arzt pointed out that Mount Sinai’s Corinne Goldsmith Dickinson Center for Multiple Sclerosis, offers holistic and compassionate care for people with MS.  The team includes neurologists, nurse practitioners, a neuropsychologist, and social workers. And the Center collaborates with specialists in ophthalmology, rehabilitation, urology, pain management, neuroradiology, psychiatry, and any other area that people with MS might need. The Center also participates in advanced research and offers enrollment in clinical trials.

Ms. Bennett said that the hopeful vision of the Multiple Sclerosis Society for the future is a world free of MS. “To that end we are guided by a plan to mobilize all human and financial resources to find solutions for people with MS every day,” she said.  Advocacy, research, and volunteerism are the foundation of the National Multiple Sclerosis Society. To learn more about clinical treatment of MS, to get support, or to learn how to get involved as a volunteer, visit this site.

Additional disabilities-related resources are available on the Mount Sinai Office for Diversity and Inclusion site.

 

Mount Sinai Seminar on Racism and Mental Health Draws an International Audience of Nearly 500 Participants


As the COVID-19 pandemic continues to reveal the significant racial disparities that exist in health care access and treatment across the United States, Mount Sinai’s neuroscience community is additionally exploring the profound connections between racism and mental health through a new seminar series.

The first seminar, “The Impact of Racism on Mental Health,” held virtually on Monday, January 25, featured two guest speakers, and drew nearly 500 members of the general public, and researchers and students from 35 universities across eight nations. It was sponsored by The Friedman Brain Institute, as part of its Diversity in Neuroscience initiative known as #DiverseBrains, and the Mount Sinai Office for Diversity and Inclusion. The seminars aim to raise awareness and address the inequities—and amplify the work of researchers studying the various effects of racism on minds and bodies.

The seminar was organized and moderated by Aya Osman, PhD, a third-year postdoctoral fellow at the Seaver Autism Center for Research and Treatment. Dr. Osman is studying the role of the gut microbiome in various neuropsychiatric disorders, including autism and addiction, in the lab of Drew Kiraly, MD, PhD. It was co-moderated by Joseph Simon, a fourth-year PhD neuroscience student studying social influences on decision-making in the laboratory of Erin Rich, MD, PhD, in the Nash Family Department of Neuroscience.

Participants included, clockwise from top left: co-moderator Joseph Simon; speaker Tanja Jovanovic, PhD; Aya Osman, PhD, event organizer and moderator; and speaker Monnica Williams, PhD, ABPP.

The aim of the seminars, said Dr. Osman, is to make research findings more accessible to the public and to increase scientific collaboration with researchers studying similar topics. “We hope this lecture series will open our eyes to the ways racism can be perpetuated and spark dialogue around dismantling structural racism in the mental health field and discuss ways to heal from its impact,” Dr. Osman said.

Eric J. Nestler, MD, PhD, Nash Family Professor of Neuroscience, Director of The Friedman Brain Institute, and Dean for Academic and Scientific Affairs at the Icahn School of Medicine at Mount Sinai, welcomed the participants. “We launched #DiverseBrains about five and a half years ago to promote diversity and inclusion, and to create an optimal climate throughout The Friedman Brain Institute,” said Dr. Nestler. “And no conversation is more at the heart of our original goals than today’s topic.”

Invited speaker Monnica Williams, PhD, ABPP, Associate Professor, School of Psychology, University of Ottawa, and Canada Research Chair for Mental Health Disparities, gave a presentation on “Racial Trauma and New Directions in Healing,” which drew from existing research data. “We know there are profound connections between racism and mental health,” said Dr. Williams. “We have research over the past 20 years that shows definitive links to just about every major mental illness to experiences of racism and discrimination,” she said, citing post-traumatic stress disorder (PTSD), stress, anxiety, depression, obsessive-compulsive disorder, substance and alcohol abuse, eating disorders, severe psychological distress, psychosis, disability, and suicide.

Dr. Williams also discussed the growing use of medical psychedelics and the research that shows it may hold promise in helping to decrease the negative impact of racial trauma in minority populations. However, she pointed out that her own research has uncovered that minorities are greatly underrepresented in psychedelic medicine studies, with 82.3 percent of the people involved in these studies, as both patients and researchers, being white. “We can now make a strong case that future clinical trials need to examine the efficacy of psychedelics as an adjunct to psychotherapy for individuals with race-based trauma,” Dr. Williams said.

Speaker Tanja Jovanovic, PhD, Professor of Psychiatry and Behavioral Neurosciences, and the David and Patricia Barron Chair for PTSD Neurobiology at Wayne State University in Detroit, addressed the topic of “The Biological Impacts of Racism—Implications for Negative Health Outcomes.” Dr. Jovanovic’s research focuses on the interaction of traumatic experiences, neurophysiology, neuroendocrinology, and genetics in stress-related disorders in adults and children in high-risk populations. In her seminar presentation, she examined racial differences related to neurobiology and how the stressors of racism affect the brain.

“Racism impacts biology and should be treated as an illness,” she said. Dr. Jovanovic presented research showing the biological effects in those experiencing the chronic stress of racial discrimination. Altered physiological measures include higher levels of cell-free mitochondrial DNA, a biomarker associated with stress, aging, inflammatory processes, and cell death. Further, her research shows that racial discrimination may alter the automatic nervous system by increasing the activity of the sympathetic nervous system (increasing startle response, accelerating heart rate, constricting blood vessels, and raising blood pressure), and decreasing the peripheral nervous system, or vagal tone, which is associated with rest and regulation of stress responses.

The Mount Sinai Health System has an ongoing commitment to accelerate efforts to dismantle racism and advance equity through priorities established by the Office for Diversity and Inclusion. The BioMedical Laureates Program, for example, is one of the first in the nation to recruit underrepresented candidates and enhance diversity among senior research faculty. It includes an initiative to recruit and mentor Junior Laureates, those just starting their postdoctoral fellowships. Forming the foundation for these and future efforts is the Mount Sinai Health System Task Force to Address Racism, which was established to make Mount Sinai an anti-racist health care and learning institution that intentionally addresses structural racism.

Participants agreed that much work—at many levels—needs to be done on racism and research. Dr. Osman cited a need for an increase in Black faculty, and diversity training among principal investigators. Said Mr. Simon: “We must continue this dialogue in many different forms, and it’s important that we make this information and this outreach understandable for all.”

Indeed, educating the public is a key component of this effort, said Dr. Osman, who cites a need for solid, clear, science-based information that is understandable by the general public, which is driving her extensive public outreach through social and mass media. As this seminar series continues to invite speakers and discuss this topic, an additional goal is to explore grants that would fund further research into the impact of racism on health, and ways to eradicate it. The second seminar is planned for early spring 2021.

 

 

No Quality Without Equity: The 2021 Maternal and Child Health Equity Virtual Summit Proceedings

Elizabeth Howell, MD, MPP

“Systemic racism has taken an extraordinary toll on the health and wellness of Black women and babies. We are here today to develop actionable items to improve maternal and infant health equity.”

This powerful sentiment is how Elizabeth Howell, MD, MPP, Chair of the Department of Obstetrics and Gynecology at the Perelman School of Medicine and the University of Pennsylvania Health System, opened the Maternal and Child Health Equity Virtual Summit on January 12.

The five-hour summit was held on the New York Academy of Medicine Zoom platform and included featured presentations and panels of diverse members including leaders in medicine, nursing, community-based-organizations, and perinatal and maternal health research.

Dr. Howell, the previous Director of Mount Sinai’s Blavatnik Family Women’s Health Research Institute, partnered with the New York Academy of Medicine, the Institute, and the University of Pennsylvania to establish this important educational summit as the final phase of her NIH-funded research investigating the contribution of hospital quality to racial and ethnic disparities in maternal and infant health. Dr. Howell co-chaired the summit with Danielle Laraque-Arena, MD, a senior scholar-in-residence at the New York Academy of Medicine.

Dr. Howell presented the findings of her research to the more than 450 attendees of the virtual summit, outlining the interactions between structural racism, system factors, clinician factors, patient factors, and community or neighborhood to influence racial and ethnic disparities in maternal and infant morbidity and mortality.

According to their findings, there were clear themes between hospitals that outlined high and low performance of maternal health outcomes. High performing hospitals had a stronger focus on standards and standardized care, stronger nurse-physician communication, and a higher awareness that disparities and racism may be present in hospital settings and could lead to differential treatments.

Dr. Howell’s group went further to analyze within-hospital disparities. After calculating similar risks of severe maternal morbidity for patients within the same hospital insured by Medicaid or commercial insurance, they found that Black women as compared with White women had higher maternal morbidity rates (after adjusting for insurance, obesity, etc.). Dr. Howell and her research clearly demonstrate the health care crisis for moms of color, and the rest of the day’s programming helped bring diverse voices to the conversation and plan action steps to reduce these disparities.

The summit was divided into three parts: Maternal Health, Infant Health, and the Mom-Baby Dyad, each with one featured speaker and a panel of diverse experts. The featured speaker for Maternal Health was  Karen A. Scott, MD, a leading OB/Gyn from UCSF School of Medicine, who outlined the “sacred birth” movement.

“Sacred birth is a radical attitude towards human births, specifically Blackness, Black bodies, and Black births. The movement advocates for safer, respectful more dignified and higher quality participatory birth care,” she said.

Dr. Scott powerfully stated at the summit, “We need to shift power to generate and disseminate knowledge of the QI space that has been usually excluded to hospital administrators and executives over to Black mothers, birthing people, community members and scholars.”

The Maternal Health panel, moderated by Wendy Wilcox, MD, (NYC Health+Hospitals) included Sascha James-Conterelli, DNP, (Lecturer in Nursing, Yale School of Medicine), Chanel Porchia-Albert (Founder, Ancient Song Doula Services), Natalie D. Hernandez, PhD, (Assistant Professor, Morehouse School of Medicine) and Dr. Allison Bryant, MD, (Massachusetts General Hospital). The panel discussed diversification of the labor and delivery workforce, anti-racist medical models, and quality improvement. Dr. Bryant stated one of the most salient quotes of the day: “No quality without equity.”

The second part of the summit, Infant Health, began with Dr. Howell conveying her research findings on infant morbidity and mortality. Dr. Howell led the next section of the summit: Infant Health Inequities.

“Very preterm births account for only 2 percent of all births but 53 percent of all infant deaths, and Black infants are three times more likely than white infants to be born very preterm,” she said. Based on Dr. Howell’s findings, up to 40 percent of the Black-White disparity in very preterm birth morbidity and mortality was due to the difference in which hospital the child was born in.

Jeffrey Horbar, President of Vermont Oxford Network, was the featured speaker and built upon Dr. Howell’s research, noting that white infants are overrepresented at high-quality hospitals in New York City and black infants are underrepresented at those same hospitals. Dr. Horbar’s theme throughout his presentation was clear: the importance of following through for patients.

“Our responsibility to NICU infants and their families extends beyond hospital walls, following through to address their social determinants of health, which will ultimately determine the health and well-being of infants and their families,” he said.

Dr. Horbar also outlined his organization’s new innovation grants to promote health equity, “Take Action to Follow Through,” which can jump start equity and quality improvement programs in NICUs around the country.

The Infant Health panel, moderated by Deborah Campbell, MD, (Albert Einstein College of Medicine) included Dr. Horbar, Teresa Janevic, PhD, MPH, Assistant Professor of  Obstetrics, Gynecology and Reproductive Science, and Population Health Science and Policy at Icahn Mount Sinai, and a member of the Blavatnik Family Women’s Health Institute, and Adrienne Mercer, EdD, (Northern Manhattan Perinatal Partnership). Panelists discussed paid-parent advisor positions to work with physicians, structural racism, and the significance of doulas in supporting birthing people. Dr. Mercer shared the sentiments of one of the women that her organization worked with. In describing her doula, the woman said, “Having a woman I can talk to made me feel supported and that I matter.”

The final part of the summit called “Mom-Baby Dyad” began with Jennifer Zeitlin, MA, DSc, an epidemiologist who has been a co-investigator in much of Dr. Howell’s research. She discussed how Black and Latina mom-baby dyads face a double threat, a domain in health care that needs actionable change.

Her research specifically showed that severe maternal morbidity is an independent risk factor for very preterm mortality. She stated that efforts to integrate and strengthen quality improvement in both obstetric and neonatal care at hospitals where Black and Latina women deliver may be a critical step to reduce the co-occurrence of disparities for maternal and child health outcomes.

The final panel of the day, moderated by Lynn Roberts, PhD, (CUNY), included Mary D’Alton, MD, (Columbia), Colette Sturgis (Urban Health Plan), and Jochen Profit, MD, (Stanford) who discussed their own institutions’ efforts to reducing maternal and child morbidity and mortality. Dr. D’Alton discussed the specific significance of maternal mental health as absolutely integral to the overall health of the mother, and Colette Sturgis, the Program Director at Urban Health Plan, discussed how their Maternal and Infant Community Health Center has adapted through the pandemic to support mothers.

Dr. Laraque-Arena of NYAM began the closing remarks of this important event, stating “We have a lot of work to do in deconstructing the entities that have supported inequities in maternal and infant health.”

And Dr. Howell concluded by summarizing action steps for the future, including improving workforce diversity, integrating Black and Brown women’s lived experience into health care, supporting doulas through Medicaid coverage, and engaging community members in quality committees and improvement. Dr. Howell encouraged leaders in executive and administrative positions to be proactive and vocal about these significant issues.

“It takes bold leadership to take a strong stance and say: we have to do better,” she said.

The New York Academy of Medicine has more information on the Maternal and Child Health Equity Virtual Summit, including PDFs of speaker’s presentations and a recording of the entire event.

Mahima Krishnamoorthi, BA, is the Clinical Research Coordinator at Blavatnik Family Women’s Health Research Institute, where she develops and fosters her passion for women’s health and reproductive justice.

 

 

Helping New Yorkers With Disabilities Through the Pandemic

Jonathan Novick, Outreach Manager for the Mayor’s Office for People with Disabilities

Under normal circumstances, people with disabilities face discrimination, inaccessibility to services, and other challenges to independent living.  The COVID-19 global pandemic has added more hurdles for people with disabilities and caregivers, said Jonathan Novick, Outreach Manager for the Mayor’s Office for People with Disabilities (MOPD). Mr. Novick discussed the office’s efforts to address these issues in a virtual talk sponsored by Mount Sinai’s Office for Diversity and Inclusion.  The talk, intended to provide information to the Mount Sinai community on the services and resources available through the MOPD, can be viewed here.

 “As a result of COVID-19 pandemic, a lot of activities for institutions were forced to go online,” Mr. Novick noted. “And if I had to pick out one bright spot at least for the disability community, it enabled a level of social interaction that was not there before.”  

The virtual talk, titled “Providing Resources for People with Disabilities during the Pandemic,” was held in observance of Disability Awareness Month, part of a series featuring speakers from around the Mount Sinai Health System as well as the community to raise awareness and promote an inclusive and equitable health care environment for people with disabilities.

MOPD is a liaison between New York City government and the disability community and works to ensure that the rights and concerns of people with disabilities are addressed in all of the city’s initiatives, programs, and policies. This includes equal access to everything the city has to offer, including housing, employment, transportation, benefits, arts, culture, and parks.

Resources Available in Toolkit, and on Mount Sinai ODI Site

According to the Center for Disease Control and Prevention, people with disabilities are not inherently at higher risk for becoming infected with or having severe illness from COVID-19.  However, some people with disabilities might be at a higher risk of infection or severe illness because of their underlying medical conditions.  For example, adults with disabilities are three times more likely to have heart disease, stroke, diabetes, or cancer than adults without disabilities.

In one constructive response to the pandemic, Mr. Novick said, MOPD has created a Virtual Activities Toolkit, which offers accessible resources and information in one centralized location. The pandemic also highlighted the importance of communication, such as digital access to COVID-19-related briefings and Department of Health and Mental Hygiene public health guidance and materials.

Weekly calls were set up between MOPD and advocates and organizations to address the needs to people with disabilities during the pandemic. Among the many concerns addressed were access to medical care, personal protective equipment, food/supplies, fear of losing home health providers due to social distancing guidelines, mental health and domestic violence support, and anxiety over health care rationing due to disability.  

To learn more about resources provided by MOPD for New Yorkers with disabilities, please visit NYC.gov/Disability. Additional disabilities-related resources are available on the Mount Sinai Office for Diversity and Inclusion site.

Access-A-Ride Paratransit Services Adjusting to the COVID-19 Pandemic

Donna Fredericksen, Deputy Director of the MTA’s Transit Access-A-Ride (AAR) Paratransit Outreach, with Kevin Funney, Operator, Maggies Paratransit Corp.

The COVID-19 pandemic has affected many parts of city life, including the safe access of New Yorkers with disabilities to services and care. During a talk hosted by the Mount Sinai Office for Diversity and Inclusion (ODI), Donna Fredericksen, Deputy Director of the MTA’s Access-A-Ride (AAR) Paratransit Outreach, described how the program has adjusted to the pandemic and continued to safely provide paratransit service to New Yorkers. The virtual talk can be viewed here.

The session, “Proactive Measures During COVID-19 and Beyond,” was the second in the new Raising Disability Awareness Virtual Talk Series, featuring speakers from around the Mount Sinai Health System as well as the community, in honor of Disability Awareness Month in October. During this time, ODI hosted events to educate, raise awareness and promote an inclusive and equitable health care environment for people with disabilities.

“Access-A-Ride trips are available—24-7 and 365 days a year—for people with disabilities who cannot use the subway or the bus,” Ms. Fredericksen said. “This could be a temporary setback, perhaps a new knee or a new hip, or it might be something more long term.”

Talk on Disability Awareness

During the COVID-19 pandemic, AAR has adjusted its procedures: Riders and drivers must wear masks. All dedicated vehicles are disinfected, and temperature checks are required for drivers. And to allow for social distancing, shared rides are discontinued—though people with disabilities can be accompanied by a personal care attendant (PCA). Applicants are still required to go to an assessment center as part of the eligibility determination process. The sites are open at 25 percent capacity, with COVID-19 safety protocols in place. For many months during the pandemic, fares were suspended, but they resumed on Tuesday, January 19.

The AAR fare for most eligible riders is $2.75, the same as subway or bus fare. If they have a PCA, that person travels free, and AAR customers who are enrolled in the Fair Fares program, which aids lower income New Yorkers, pay $1.35.

AAR is the largest paratransit service in the country, with 160,000 riders. Pre-COVID, it made 24,000 trips a day, Ms. Fredericksen said. Now the weekday trips remain steady at about 70 percent of that level.

Meeting Essential Travel Needs

Ms. Fredericksen and two team members outlined how to apply for eligibility—the required first step—and how to schedule a ride, access language and interpretation services, navigate through the AAR web page, and access the MYmta app, which is available at the Apple App Store and Google Play. Access-A-Ride answers to “a higher authority,” Ms. Fredericksen said, in this case, being in compliance with the FTA (Federal Transit Administration) and the ADA (Americans with Disabilities Act) and prioritizing the needs of people with disabilities. “We want to focus on essential travel, such as taking you to dialysis or chemotherapy appointments, or if you are an essential worker, or you need service immediately,” she said.

“If you have any questions about AAR, please call. Someone is there Monday through Friday from 9 to 5 to help you out.” For the latest information, including a guide to AAR and the AAR newsletter, visit https://new.mta.info/accessibility/paratransit.  Or call 1-877-337-2017.

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