Prenatal SSRI Use and Offspring with Autism Spectrum Disorder or Developmental Delay
Added on 2020-03-16
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Artcilce analysis based on Harrington, R. A., Lee, L. C., Crum, R. M., Zimmerman, A. W., & Hertz-Picciotto, I. (2014). Prenatal SSRI use and offspring with autism spectrum disorder or developmental delay. Pediatrics, 133(5), e1241-e1248.Solution 1The main research question is to examine the association of prenatal use of selective serotonin reuptake inhibitors and the risk of acquiring spectrum disorders.Solution 2Case control study designs are crucial in establishing cause and effect associations between treatments and causality effect. The design is essential in ensuring that it compares patients who have the disease and those who do not have as controls. Hence this gives high level of evidence through comparative analysis for cause effect of treatment allocations. Solution 3The source of this population study is the families who are enrolled child hood autism risks and genetic environment. The choice of the study population is relevant in that these are the patients who are already identified and enrolled in the program for facilitating help, thus they have been selectively been chosen as the study is primary to them being study participants. Solution 4The cases and controls were recruited in the study through careful approaches. Children with Autism Spectrum Disorder and delay development from the general population were identified, with an eligibility criterion of those aged between 2-5 years. Children who are the cases identified through those receiving services from state department. Cases were identifiedthrough state files and were frequently matched with other parameters such as age, gender and regional centre. Solution 5Selection bias in case control studies results when subjects are selected into the study when they are not a representative of the entire population, this might lead to differential loss in follow up and the likelihood of the participants being lost. In this study selection biases has occurred in that only children seeking treatment in state department of health, California could be selectively selected, thus not having a representative sample of the entire population.this has impact on the overall research, is that the findings could be generalised as the selection of the sample is not a representative of the general population suffering from Autism Spectrum Disorder and delay development.1
Solution 6 A.Measure of association Unadjusted Adjusted Number per groupExposure present291140Exposure absent211031Number per group502171B. The difference signified in the study shows the difference on how selection bias could influence the study findings. The unadjusted factors shows high values compared to the adjusted values in the research. Hence the impact of selection biases if not not controlled carefully can have significant impact on the study results. Solution 7SSIR was defined as the usage of the serotonin inhibitor uptake and was measured using self reporting schedule through self reporting from the mothers prior to the pregnancy or conception phase. Solution 8 ASD was defined as the autism spectrum disorder and delayed development was assessed in the studies. ASD referred to children diagnosed with autism disorder and delayed development children defined those with DD. ASD and DD were identified through those receiving treatment and qualified for care services at California State of health department. ASD patients were assed using Autism Diagnostic Interview Revised while DD utilised adaptive behaviour scales of early learning. Solution 9SSRI use was based on the self reporting where it is prone to recall biasness. This can be be occasioned with under reporting or over reporting , further the data source which is the prenatal record may not capture the SSRI prescriptions, thus indicating recall biases.On the ASD and DD, the participants were identified using those quantifying health services from the state department, those that may not having qualifying for the services could have been included in the study. The recall bias in these case was limited since the participants were selectively identified and were assessed using the appropriate assessment tools. Solution 10 A.There will be an increased in exposure levels of the treatment effect on the participants. 2
Unadjusted Adjusted Number per groupExposure present311242Exposure absent211031Number per group522273Calculated odd ratio ad/bc31*10/21*12Calculated odds ratio is 1.23B.This could be attributed to misclassification biases as the pregnant women were not supposedto be categorised and are grouped wrongfully in the study. Hence calling wrong treatment allocation approaches. The women were wrongfully classified to SSRI exposure relative to the truth. Solution 11Precision refers to the resolution of the representation of the study participants. In the study the level of precision shows that ASD children showed similar birth weight with TD children.Further with p value of 0.001, delayed development children were more likely to be female population. The main items of determination included the level of socio economic aspects towards access to health services in determining growth aspects of the children. I assessed theprecision using the calculated p-values and the standards deviation mean shown from the study findings. Solution 12 In statistical terms confounder are the variables which influence both the dependant and independent variables in any study causing a spurious association. In this study breast feedingwas a identified as confounding factor, however it was not associated with prenatal SSRI exposure thus could be include as a confounding factor to study results. Possible exposure misclassification was assessed in this study so as to identify the confounder. Solution 13 There is higher risk observed among the ASD compared to TD in the study. The adjustment of confounders shows that there are increased risks of autism occurrence among the adjusted group. While in the DD category there was a relatively high risk of delayed development when compared with TD among boys when the confounding factors were assessed. The impact of confounder adjustment was assessed using multivariate analysis of the result and further assessing the RR of the disease in maternal health among the participants. 3
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