Parent and family impact of autism spectrum disorders: a review and proposed model for intervention evaluation. Clin Child Fam Psychol Rev. 2012;15:247-277. [PMID: 22869324 DOI: 10.1007/s10567-012-0119-6]

Personalized Theta Burst Stimulation Enhances Social Skills in Young Minimally Verbal Children With Autism: A Double-Blind Randomized Controlled Trial

BACKGROUND

Minimally verbal children with autism are understudied and lack effective treatment options. Personalized continuous theta burst stimulation (cTBS) targeting the amygdala and its circuitry may be a potential therapeutic approach for this population.

METHODS

In a double-blind randomized controlled trial, minimally verbal children with autism (ages 2-8 years) received 4 weeks of cTBS. An amygdala-optimized functional connectivity (AOFC) group (n = 23) received personalized stimulation targeting a left dorsolateral prefrontal cortex site functionally connected with the amygdala. A non-optimized (NO) control group (n = 21) received stimulation at a standard prefrontal site. We assessed changes in Autism Diagnostic Observation Schedule scores, amygdala volume, spontaneous neural activity, and FC.

RESULTS

Personalized AOFC-guided cTBS improved social and communication skills with an effect size twice that of the NO group (Cohen's d = 0.55 vs. 0.24). The AOFC group showed greater reductions in amygdala volume, spontaneous neural activity, and hyperconnectivity. Network-level amygdala connectivity changes with default mode, frontoparietal, and dorsal attention networks were correlated with clinical improvements. Field mapping analysis revealed that greater electric field overlap between standard and optimized targets predicted better treatment outcomes.

CONCLUSIONS

Personalized AOFC-guided cTBS enhanced social skills and communication in minimally verbal children with autism by modulating amygdala structure and connectivity. Changes in amygdala network connectivity predicted clinical improvements, suggesting a mechanistic link between neural circuit plasticity and behavioral outcomes. These findings demonstrate the potential of precision-targeted neuromodulation in addressing a critical gap in autism treatment for this understudied population.

Exercise interventions for health outcomes in children with autism spectrum disorder: An umbrella review of meta-analyses of clinical trials

Exercise interventions have gained widespread acceptance due to their cost-effectiveness, ease of implementation, and low incidence of negative effects. However, the overall effects of exercise interventions on the health outcomes of children with autism are not evaluated systematically. To evaluate the effect of exercise interventions on behavioral, motorial, and psychosocial health outcomes in autistic children, as well as to determine the quality of evidence for each outcome. We conducted an umbrella review of meta-analyses investigating the associations between exercise interventions and health outcomes in autistic children from inception to November 27, 2024. Following exercise interventions, maladaptive behavior [standardized mean difference (SMD): -0.73; 95 % confidence interval (95 % CI): -0.71, -0.03] showed a substantial improvement. However, no discernible impact on stereotyped behavior (SMD: 0.09; 95 % CI: -0.30, 0.48) was observed. Sensitivity analysis revealed that all overall effect sizes indicated statistically significant differences, even though the reanalysis of meta-analyses showed no significant effectiveness of exercise interventions on social communication (SMD: -0.09; 95 % CI: -0.61, 0.43), social skill (SMD = -0.22; 95 % CI: -0.99, 0.54), social function (SMD = 2.64; 95 % CI: -0.10, 5.39), and motor skills (SMD: 0.71; 95 % CI: -0.97, 2.39). Exercise interventions are suggested to improve maladaptive behaviors and may help with social communication, social skills, social function, and motor skills. The evidence for the effectiveness of exercise interventions in reducing stereotyped behaviors is weak, but it still merits investigation. We need more carefully planned randomized controlled studies.

Cost-effectiveness of dialectical behavioural therapy versus treatment as usual for autism with suicidal behaviours: single-blind randomised controlled trial

OBJECTIVE

This study evaluated the cost-effectiveness of dialectical behaviour therapy (DBT) compared to treatment as usual (TAU) for autistic adults with suicidal behaviours.

METHOD

In a randomised controlled trial, 123 autistic outpatients were assessed over 12 months. Healthcare costs and societal costs were calculated in accordance with the Dutch standard. Outcomes were quality-adjusted life years (QALYs) and treatment response, defined as a reduction of at least 50% in symptoms of suicidal ideation from t0-t12 as measured by the Suicidal Ideation Attributes Scale (SIDAS), plus achieving SIDAS < 20 at t12 (i.e. below the clinical threshold).

RESULTS

From the healthcare perspective, DBT cost €371 less than TAU while gaining an additional 0.184 QALYs, with a 64% likelihood of being the dominant treatment option. From the societal perspective, DBT has higher costs than TAU by €232 per QALY gained, which can be considered cost-effective given a willingness-to-pay of €50,000 per QALY. DBT also showed better treatment response rates, with less suicidal ideation, at lower costs than TAU. Sensitivity analyses supported these findings.

CONCLUSION

DBT is a novel treatment for autistic adults with suicidality. It fills a significant treatment gap in lieu of any evidence-based alternative for this population. DBT reduces suicidality, enhances quality of life and is cost-effective across healthcare and societal perspectives, encouraging broader adoption. Future research should assess DBT's long-term impacts and its transferability to other countries and map pathways towards upscaled implementation.

The Role of Extended Family Members in the Lives of Autistic Individuals and Their Parents: A Systematic Review and Meta-Synthesis

Extended family members play an important role in meeting the care needs of autistic individuals, yet family support policies and practices often overlook this role. We aimed to synthesise qualitative research on the role played by extended family members in the lives of autistic individuals and their parents and identify cultural patterns. We searched eight databases and selected relevant studies through a two-stage screening process. We synthesised the results and discussions described in the selected studies using template analysis. The review included 42 studies (40 qualitative; 2 mixed methods), reporting on 1048 parents and 2140 grandparents. While aunts, uncles, and cousins were not direct participants, their roles were described in participants' narratives. Three main themes were developed: (1) types of support from extended family members, including emotional, financial, instrumental, and informational support; (2) unhelpful or lack of support from extended family members, including misunderstanding about autism, absence of support with caregiving, and negative attitudes and discriminatory behaviours against autistic individuals as well as their parents; (3) factors influencing the role of extended family members, including individuals, family unit, family interaction characteristics, and a journey towards acceptance and cultural influences. Novel findings on the influence of culture suggested in cultures highly valuing family interdependence, extended relatives play a more prominent support role, yet the emphasis on family reputation might hinder the acceptance of autism by extended relatives. Based on a family systems approach, we recommend priorities for intervention development and clinical practice to support the effective involvement of extended family members.

A bibliometric analysis of the current state of research on family interventions for ASD

In recent years, family intervention has become a hot research direction in the field of autism spectrum disorder (ASD) treatment. A large amount of research literature shows that family intervention is effective in ASD rehabilitation. Still, the concept of family intervention is vaguely defined, and there is a lack of descriptions of specific intervention programs and treatment pathways and a diversity of intervention programs have been reported. In this study, we conducted an econometric analysis of the literature on family intervention for ASD to clarify the concept of family intervention and to analyze and explore the research hotspots, effective family intervention models for ASD, intervention techniques, and possible future research directions in this field.

Methods

A metrological analysis of the literature related to ASD family interventions on the Web of Science from 1987 to 2024 was conducted using CiteSpace software to map the network of countries/institutions, journals, authors, co-cited literature, and keywords in the field. The results were visualized and analyzed.

Results

A total of 1,891 documents were retrieved. The United States (1,028) led in the number and relevance of publications, followed by Canada (254) and Australia (209). The trend of publications was upward. Baranek was the most published author (19) and the University of California System was the most published university. Developed countries dominate the research. According to the timeline graph, it can be learned that the current research hotspots in this field are mostly focused on early intervention in family-based, psychological stress in parents of children with autism.

Conclusion

This visual analysis identifies the most influential institutions and countries, as well as cited journals and authors in the field of family therapy autism research. The direction of research in family therapy for autism should be to find effective treatments for autism based on the home environment, and currently, the most prominent family therapy for autism is telemedicine and parent-mediated intervention. The future direction of this research area could be taken by artificial intelligence techniques specifically applied to children with autism in a computer context.

Relational Patterns of Support and Communication in Families with a Child Diagnosed with Autism: an Interpretive Phenomenological Study

BACKGROUND

The impact of autism spectrum disorder (ASD) can be far-reaching for families. Research has shown that neurotypical (NT) siblings can experience negative and positive implications of ASD in their lives. However, researchers have not fully captured the factors associated with successful adaptation to the range of experiences, particularly regarding NT siblings and the relational support from and communication with their parents.

METHODS

We utilized an interpretive phenomenological analysis to illuminate and better understand NT siblings' experiences of parental support and communication.

RESULTS

Analysis of qualitative semi-structured interviews with seven families of parents with at least one sibling over the age of 10 (N = 22) yielded four significant themes: (a) targeted NT sibling time, (b) targeted NT sibling communication, (c) sibling expectations, and (d) understanding autism.

CONCLUSION

The findings regarding relational support patterns suggest that NT siblings' experience with autism is positively influenced by parents who dedicate time to the NT siblings, communicate openly with them, and educate them about autism.

Correlates of Impairment and Growth in Families of Young Autistic Children

The purpose of this project was to investigate potential correlates of family life impairment in families of young autistic children. This project incorporated measures of specific child and parent challenges in addition to a commonly used unidimensional measure of autism characteristics. In this way, we could assess whether such challenges explain variance in family life impairment, and whether their inclusion diminish associations between autism characteristics and family life impairment. Cross-sectional data were collected from 564 parents of autistic children aged 2 to 5 years who participated in a larger online study. Participants completed measures on child characteristics (autism characteristics, emotion dysregulation, speaking ability, flexibility, and sleep problems), parent depression, and family life impairment, using the Family Life Impairment Scale (FLIS). Multiple linear regression models were generated to examine whether any of the independent variables were associated with the four domains of the FLIS. Models controlled for child age and sex, parent education, and single-parent homes. All independent variables were associated with impairment in one or more FLIS domains. None of the primary independent variables were significantly associated with positive growth. More overt characteristics and behaviors (e.g., autism characteristics, reactivity, speaking ability, and flexibility) were associated with impairment in domains that reflected a family's ability to navigate the community. However, sleep challenges and parent and child emotional difficulties were most strongly associated with parent impairment. Findings suggests that families may have different needs across contexts and provide new avenues through which they might be better supported.

Care Burden and Care Needs of Mothers of Children With Autism Spectrum Disorders

PURPOSE

This research was conducted to determine the care burden and care needs of mothers of children with autism spectrum disorder and factors related to these.

DESIGN AND METHODS

This study employed a cross-sectional study design. The survey consisted of demographic questions as well as two questionnaires assessing care burden and care needs.

FINDINGS

The value obtained from the Zarit Care Burden Scale in the study shows that the care burden of mothers is at the medium level (47.15 ± 11.89). It was determined that variables such as mother's age, education level of the mother, family education/counseling status, and discrimination/exclusion were affected by the burden of care. Expressions related to the care of the child diagnosed with an autism spectrum disorder such as "Encountering negative expressions and behaviors of other people in social settings," "The society's insufficient knowledge about autism spectrum disorder," and "My child constantly needs my care" were found to be the top three problems experienced by mothers.

PRACTICE IMPLICATIONS

The information provided by studies on this subject will guide child and adolescent psychiatric nurses in terms of developing the right approaches for individuals with these disorders and their relatives.

Impact of a Genetic Diagnosis for a Child's Autism on Parental Perceptions

Genetic testing is recommended as part of an autism assessment, and most parents support genetic testing for their minor children. However, the impact on parents of receiving a monogenetic/ copy number variant diagnosis for autism in their child is not well understood. To explore this, we surveyed and interviewed parents of children in the SPARK study, a study of autism that includes genetic testing. Surveys were administered one month before and one and 12 months after parents received their child's genetic result. Interviews were conducted approximately one month after results disclosure. A genetic diagnosis (GD) for their child appeared to reduce parents' sense of self-blame and feelings of guilt, and this impact was relatively stable. The data also indicate a modest impact on parents' actions related to the condition, perceptions of themselves, and some aspects of life planning for their child, as measured by quantitative instruments at one month and 12 months after receipt of results. Other measures of parental identity and expectations for their child, in contrast, showed little change following receipt of genetic findings. Overall, parents who were told that no GD was identified showed minimal changes in their responses over time. These results suggest a discernable but relatively limited impact of genetic test results on parents of children with autism. These results should be reassuring to clinicians caring for children with autism and are consistent with studies in other areas of medicine that have suggested that genetic results tend to have fewer effects-negative or positive-than were anticipated.

The association between intolerance of uncertainty and psychological burden among caregivers of children with autism and the impact on their quality of life

Introduction

Caregivers of children with Autism Spectrum Disorder (ASD) often face significant stressors, including financial strain, social stigma, emotional exhaustion, and unpredictable daily routines. These challenges can severely impact their quality of life (QoL). This study aimed to examine the relationship between intolerance of uncertainty, caregiver burden, and QoL among caregivers of children with autism.

Methods

A cross-sectional study was conducted with 59 caregivers from six branches of the Obour Company for Human Development in Riyadh. Data were collected electronically using a sociodemographic data sheet, the Intolerance of Uncertainty Scale, the Zarit Burden Interview (short form), and the World Health Organization Quality of Life Scale (brief form).

Results

Findings revealed that two-thirds of caregivers experienced high to moderate levels of intolerance to uncertainty and a moderate burden, while 13.6% reported a high burden. Nearly 60% of participants reported low overall QoL, particularly in the psychological and social domains. A significant positive correlation was found between intolerance of uncertainty and caregiver burden. Additionally, significant negative associations were observed between QoL scores and both intolerance of uncertainty and caregiver burden, except in the environmental domain. Intolerance of uncertainty emerged as a significant inverse predictor of overall QoL.

Discussion

These results emphasize the psychological toll of caregiving for children with ASD. Interventions such as family- and community-based support programs and child behavioral training are essential to reduce caregiver burden and enhance QoL. Tailored services should be prioritized in clinical practice to support caregivers more effectively.

Factors predicting parenting stress in the autism spectrum disorder context: A network analysis approach

Elevated levels of parenting stress have been reported in parents raising an Autistic child. Previous studies have identified a multitude of predictors of parenting stress, including both child-related and parent-related factors, though findings across studies are not always in agreement. In the present study we investigate the determinants of parenting stress using a Network Analysis approach, which is then used to inform a subsequent structural equation model. New Zealand parents (n =  490) of a child diagnosed with Autism Spectrum Disorder (ASD) provided data on their Autistic child (e.g., ASD core symptoms, problem behaviours) and themselves (i.e., parenting stress). The analysis revealed that both child and parent demographic factors were poor predictors of parenting stress, while the child's current language and communication ability were correlated with diagnostic age and parenting stress. An earlier diagnostic age, in turn, suggested better behavioural and emotional outcomes for children. Overall, the Network Analysis showed itself to be an informative approach to understanding parenting stress in the ASD context. Findings further advocate for the implementation of ASD-related and language-related interventions as early as possible, and that language delays during early infancy justify prompt clinical assessment.

Lost in Transition: Delayed Diagnosis of Autism Spectrum Disorder Following Early Migration

We present the case of a 16-year-old male whose diagnosis of autism spectrum disorder (ASD) was significantly delayed due to the masking effect of early migration. At the age of five, during a critical window for neurodevelopmental identification, he migrated from Portugal to the United Kingdom following an eight-month separation from his primary caregiver. In the years that followed, early autistic features such as language regression, sensory sensitivities, and social withdrawal were attributed to cultural adjustment and second-language acquisition. A comprehensive retrospective developmental assessment in adolescence ultimately revealed that these behaviours were not solely adaptive responses but reflected longstanding features of ASD. This case underscores how environmental transitions during key developmental periods may hinder early identification of neurodevelopmental conditions. It highlights the need for meticulous developmental history-taking and culturally sensitive assessment, particularly when evaluating migrant children whose presentation may be shaped by both intrinsic vulnerabilities and external contextual factors.

Launching! To Adulthood, A Culturally Adapted Treatment Program for Military-Dependent Autistic Young Adults and Their Military Parents: A Pilot Study

INTRODUCTION

Military-dependent young adults (17-25 years old) with autism spectrum disorder (ASD) face significant barriers to accessing services during their transition to adulthood. Frequent relocations, disrupted care, and limited ASD-tailored interventions exacerbate the challenges for these families, with many young adults experiencing a "service cliff" as they age out of pediatric care and school-based services. Addressing these gaps is critical, particularly given the rising mental health challenges and executive dysfunction in this population. This study evaluates the preliminary efficacy of an adapted telehealth intervention, the Military-Launching! program, designed to support young adults with ASD and their military families.

MATERIALS AND METHODS

A repeated measures design was used to evaluate changes in functioning, self-efficacy, and quality of life among 20 military-dependent young adults with ASD and 34 of their parents. Participants completed measures at baseline, mid-treatment, and post-treatment. Young adults met ASD diagnostic criteria and exclusion criteria included intellectual disability (IQ < 75) or severe mental health conditions. Recruitment was facilitated through military programs at bases in Texas.

RESULTS

Significant improvements were observed in young adults' social cognition (η = 0.52, P = .016) and executive functioning (BRIEF-A GEC, η = 0.26, P = .016). Parents reported significant reductions in stress (BRIEF-A BRI, η = 0.28, P = .004) and enhanced quality of life in social relationships (WHOQOL-BREF, P = .047). While adaptive functioning improvements were limited to specific subscales, parent-perceived transition readiness showed a large effect size (η = 0.36).

CONCLUSIONS

Preliminary findings suggest that the Military-Launching! program improves social cognition, executive functioning, and family outcomes for military-dependent young adults with ASD. Tailored, evidence-based interventions addressing co-occurring mental health and military-specific stressors are essential for fostering successful transitions to adulthood.

Brief transition-focused education for families of autistic youth: preliminary mixed-methods investigation

PURPOSE

The transition to adulthood is one of the most challenging and complex processes for autistic youth and their families. Few evidence-based transition support programs exist, and those that have garnered support require long-term commitments and resources that may prohibit participation by families with financial and time limitations. The current study investigated the feasibility and initial promise of a brief, caregiver-focused educational transition program for families of autistic youth delivered in the community over a single day.

METHODS

Quantitative informant-report and qualitative interview data were collected from 12 caregivers of autistic youth before and after program participation. Using a partially mixed sequential equal status design, quantitative and qualitative data were integrated to evaluate change in caregiver transition knowledge and empowerment, as well as caregivers' perceptions of program feasibility, acceptability, and usefulness.

RESULTS

Caregivers reported significant increases in knowledge of transition-related topics and sense of empowerment regarding their family life. Caregiver perceptions of the intervention suggest they found it feasible, acceptable, and useful.

CONCLUSIONS

Short-term transition programming may be a helpful option for caregivers who seek transition supports for autistic youth.

Screening for Depression in Caregivers of Children with Developmental Disabilities: A Quality Improvement Initiative

INTRODUCTION

Screening for depression in caregivers of children with developmental disabilities is not routine, representing missed opportunities for support.

METHOD

A quality improvement project was initiated in our pediatric clinic. Root causes of limited screening included unclear guidelines for support, caregiver perception that help is unavailable, and lack of a quick screening tool. A clinical pathway was constructed and integrated into existing practice using quality improvement methodology.

RESULTS

Baseline screening rate was 5%-10%. During the 12-week pilot, weekly rates ranged from 46.0% to 91.0% (mean 70.2%). Monthly rates subsequently averaged 55.0%. Approximately 20% had a positive screen; over half were caregivers of children with autism. About 5% had moderate depression, of whom 40% required referral to social workers.

DISCUSSION

Structured depression screening of caregivers of children with developmental disabilities is feasible and sustainable in a busy clinic. Further research is needed to measure the impact on child and family outcomes.

Unveiling missing voices - Lifelong Experiences of fathers parenting autistic sons: An interpretative phenomenological analysis

This study addresses the underrepresentation of fathers in autism research, particularly those with adult-aged autistic offspring. The authors explored the lifelong experiences and interpretations of fathers raising their autistic sons. Ten Hungarian fathers participated in a one-time semi-structured interview. Interpretative phenomenological analysis revealed four Group Experience Themes: 'A revolving cycle around losing and regaining control', 'Crossing boundaries: accepting and adapting', 'Being in the world as a father: experiences of eternality and liminality', and 'Personal growth through pervading experience'. The findings highlight unique fatherhood experiences and offer implications for professionals and service providers.Lay abstractBeing a father of an autistic son is a profound and complex experience. Fathers adapt to their autistic sons' unique needs and are always in search of services to ease uncertainties about their sons' present and future. We interviewed 10 Hungarian fathers who have adult-aged autistic children. We asked them about their experiences raising their autistic sons during childhood and adulthood. Our study focused on fathers of adult-aged sons because most research has studied mothers' experiences of autistic children under 18 years old. It is also essential to know how to be like a father with adult-aged autistic children. Fathers shared their ongoing struggle with uncertainty, always seeking the best possible solutions for their sons. They also talked about how they understand and adapt to autism and accept their sons with their special, autism-related characteristics. The findings of this research provide a deeper understanding of fathers' parenting experience, giving suggestions for professionals on supporting them and making their experiences valuable to the community of parents raising autistic children.

Differing relationships between parenting stress, parenting practices and externalising behaviours in autistic children

There is limited literature on the association between parenting practices, parenting stress and externalising behaviours in autistic children. We investigated whether parenting practices mediate the association between parenting stress and externalising behaviours. Parents of school-aged autistic children (n = 138) completed an online survey on parenting practices, parenting stress and child externalising behaviours. Higher levels of parenting stress were associated with higher levels of externalising behaviours. In contrast to prior literature, parenting practices were not associated with child externalising behaviours and did not have mediating effects on the association between parenting stress and child externalising behaviours. However, higher levels of parenting stress were associated with lower levels of mindful parenting and higher levels of permissive and authoritarian parenting practices. Together, findings suggest that targeting parenting stress can impact parenting practices. Limitations of the study are acknowledged including the cross-sectional design, which limits causality-based inferences, given parent-child associations could occur over time. Implications for research and clinical practice in designing parent-informed programmes focused on reducing parenting stress via parenting practices are discussed.Lay abstractThere is much research on parenting stress and child behaviours of autistic children. However, researchers have rarely explored whether how parents raise their children (called 'parenting practices') links to parenting stress and child behaviours. This is important, as if we know which parenting practices lead to better outcomes, parents can be supported to use parenting practices that are most helpful to them and/or their child. We asked parents of school-aged children to complete a survey on parenting stress, parenting practices and child behaviours. We found that parents who reported being more stressed (i.e. high levels of parenting stress) reported their children showed more observable behaviours that others find challenging such as aggression. Parents who were more stressed also reported lower mindful parenting (i.e. a style of parenting characterised by being present, non-judgementally in the moment) and were more permissive (e.g. giving in) in their parenting. However, these parenting practices did not impact the link between parenting stress and child behaviours. Results suggest we should focus on ways to reduce parents' stress, which could include changing parenting practices which is consistent with strengths-based, neurodiversity-affirming approaches.

The Transition to Adulthood: A Qualitative Study of Autism Spectrum Disorder From Military and Veteran Parents and Military-Dependent Young Adults

INTRODUCTION

Given the unique experiences of military service members and their families, military-dependent young adults (18-25 years old) with autism spectrum disorder (ASD) and their military or veteran families experience unique barriers to accessing quality mental health care during the transition to adulthood. In fact, developing services to address ASD challenges for military families is a burgeoning area of interest for the department of defense. However, there is a limited knowledge on the specific needs of military families as the young adult's transition outside of high school and lose supports.

MATERIALS AND METHODS

The present study conducted 3 focus groups with 16 military and veteran parents, and 3 focus groups with 10 military-dependent young adults to evaluate the needs of military-dependent young adults (17-25 years old) with ASD and military/veteran parents with a young adult with ASD.

RESULTS

Parents reported several key topics, including barriers to services (e.g., permanent change of station, recently moving to a state and lacking awareness of the available resources), defining adulthood in terms working in a cohesive family structure, and therapy recommendations for parents and young adults with ASD transitioning to adulthood. Young adults provided key information, including describing experiences with having a parent in the military, difficulty accessing services during the transition to adulthood, and recommendations on therapy for military-dependent young adults with ASD.

CONCLUSION

Military and veteran families with autistic dependents lack access to important mental-health resources. When developing programs for military families and military-dependent autistic young adults, mental health providers should consider the frequent relocations, lack of access to important transition resources, and common military values. The presence of advocates at military bases should be encouraged to help military families navigate autism services in their local community.

Disorder Type and Severity as Predictors of Mental Health in Siblings of Children with Chronic Disorders

Siblings of children with chronic disorders are at risk of developing mental health problems. Studies are inconclusive about whether sibling mental health is best predicted by the specific diagnoses of the child with disorder or by transdiagnostic factors. The aims of the present study were (1) to examine if specific diagnoses predicted sibling mental health, and (2) to examine if disorder severity in the child with the chronic disorder predicted sibling mental health. Baseline data from a randomized controlled trial were used. Siblings (aged 8 - 16 years) of children with chronic disorders and their parents were recruited from eight municipality and hospital clinics (N = 288). The children with chronic disorders were placed in ICD-10 diagnostic categories based on combined parent report and clinical records. Regression analyses with the most frequent primary diagnoses (ADHD, Asperger syndrome, autism, down syndrome, rare disorders) and a measure of disorder severity as predictors of sibling mental health were run. Father-reported disorder severity predicted sibling-reported internalizing problems and father-reported internalizing and externalizing problems in siblings. Mother-reported disorder severity predicted mother-reported sibling internalizing problems. No single primary diagnosis predicted sibling internalizing or externalizing problems. Disorder severity does to an extent predict sibling mental health, whereas single diagnostic categories do not. Disorder severity may be used to identify siblings at risk and/or in need of interventions. Fathers should be included in assessment and health care for siblings as their reports seem to predict sibling mental health better than the mothers.

Knowledge and practice among caregivers having children with autism in Bangladesh: findings from a cross-sectional study

BACKGROUND

Autism spectrum disorder (ASD) is a term used to describe a group of conditions characterized by difficulties with social skills, speech, repetitive behaviors, and nonverbal communication. There is no cure for autism, however, early diagnosis and intervention can increase the chance of treatment success. If parents or caregivers do not have sound knowledge about autism, problems can become more complicated. The study aimed to assess the knowledge and practice among caregivers having children with ASD in Bangladesh.

METHODS

A cross-sectional survey was conducted among 68 caregivers of children with ASD in the selected area of Mymensingh city, Bangladesh. The data were collected from May to June 2021 through face-to-face interviews by a semi-structured questionnaire including informed consent, socio-demographics, as well as questions regarding knowledge (12-item) and practice (6-item) towards children with ASD using a purposive sampling technique. The data were analyzed using the SPSS software (version 25.0).

RESULTS

The mean score of knowledge among caregivers having children with ASD was 7.16 (SD = 2.09) out of 12 (59.67%). The mean score of practice among caregivers having children with ASD was 3.16 (SD = 1.10) out of 6 (52.67%). There were no significant mean differences in the mean knowledge and practice scores among participants' different socio-demographic categories. 95.6% of caregivers have not received any formal training to care for children with ASD, and more than half (57.4%) believed that mixing with good friends would make the necessary change in children with ASD. 97.1% of the children with ASD did not have any health insurance with 72.1% receiving government allowance for ASD.

CONCLUSIONS

The findings indicated inadequate knowledge and practice among caregivers of children with ASD. The study suggests an immediate health education program is needed, as well as appropriate practice for children with ASD in Bangladesh.

Chronic Parenting Stress in Parents of Children with Autism: Associations with Chronic Stress in Their Child and Parental Mental and Physical Health

Parents of children with ASD often demonstrate high levels of stress and associated health problems. A gap in knowledge exists regarding the associations between chronic stress and mental and physical health of parents of young children with ASD, in which fathers have been understudied. In 181 parents (98 mothers, 83 fathers) of 99 young children with ASD chronic stress was measured using parental self-report and hair cortisol concentration (HCC) analysis. Parental mental health and eating behavior was measured using questionnaires. Physical health was evaluated by Body Mass Index, waist circumference, blood pressure, cholesterol, triglycerides, and glucose.. Parental HCC was related with child HCC (rmothers = 0.51, p <.01; rfathers = 0.40, p <.01). Maternal HCC was associated with lower reported parenting stress (r = -.33, p <.01). Parental mental health problems and reported parenting stress were strongly related (r =.55-0.61, p <.01). Mental health problems were twice as frequent as in the norm-population (41.1-45.8% versus 20%). In both parents, reported parenting stress was associated with emotional eating behavior. HCC was associated with higher glucose levels in mothers. There were no associations between chronic stress and the other physical health measures in mothers and fathers. Parents of young children with ASD are at high risk for chronic stress, with impact for their mental and physical health. Additionally, chronic stress of parents, cannot be perceived isolated from the stress in their children with ASD. We encourage future research to investigate whether these correlations are generalizable to the whole ASD population.

Can a Short-Term Intervention Promote Growth Among Parents of Children with ASD?

The present study investigated the effects of a short-term synergic growth mindset intervention towards abilities and towards stress on reducing parental stress and promoting stress-related growth (SRG) among Arab parents of children diagnosed with Autistic Spectrum Disorder (ASD). One hundred and seven parents (70 mothers, 37 fathers) of male children with ASD, completed several questionnaires, including a demographic questionnaire; the Childhood Autism Rating Scale, the Parenting Stress Index-Short Form, the revised Stress- Related Growth Scale, The Implicit Self-Theories Scale, and the Stress Mindset Scale. Seventy- two parents were randomly assigned to an "intervention group", and 35 to a comparison group. Members of the intervention group participated in a short synergic growth mindset intervention, created especially for this research. Six months after the intervention, all participants re-completed the same questionnaires. The intervention significantly increased growth mindset and SRG and decreased parental stress. This study demonstrates the effectiveness of a short-term intervention in promoting growth mindsets, reducing parental stress, and fostering SRG among parents of children with a chronic disorder. These findings are particularly important since many parents of children with chronic disorders often exhibit fixed mindset patterns due to their children's slow progress in various developmental domains.

The experience of mothers of autistic children with a pathological demand avoidance profile: an interpretative phenomenological analysis

PURPOSE

Emergent research literature has identified emotional and behavioural challenges for autistic children with a pathological demand avoidance profile. However, understanding of their parents' experience is limited. This study aimed to explore the experience of parents of autistic children with a pathological demand avoidance profile.

METHODS

Semi-structured interviews were completed with ten parents of autistic children with a pathological demand avoidance profile, aged between 5 and 11 years (M = 8.5, SD = 1.90). All participants were mothers, aged 33-50 years (M = 42, SD = 5.35). To explore what meaning participants gave to their lived experience, an interpretative phenomenological analysis was conducted on interview data.

RESULTS

Four main themes were developed from the interpretative phenomenological analysis; the benefit of a shared understanding about pathological demand avoidance to the parents and their children, the power of pathological demand avoidance and the impact on families, the emotional experience of mothers, and the various ways in which they coped.

CONCLUSION

The need for further recognition and understanding about pathological demand avoidance is emphasised through recommendations for future research. As is the need for flexible, informed, and appropriate support for demand avoidant children and their families.

Mapping the landscape and evidence of cross-sectoral collaboration models targeting individuals referred for assessment of attention-deficit hyperactivity disorder or autism spectrum disorder: protocol for a scoping review

INTRODUCTION

Neurodevelopmental disorders, notably attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), present substantial challenges in mental health. Individuals referred for assessment in a psychiatric unit experience complex needs. This implies that their needs necessitate coordination across multiple sectors. Cross-sectoral collaboration models have emerged as essential strategies for addressing the complexities of these disorders. However, evidence of their existence, implementation and success remains limited. This protocol aims to outline a scoping review where we will explore existing collaboration models, evaluate their implementation and gain an understanding of how cross-sectoral collaboration models can be developed to ultimately benefit individuals referred for assessment of ADHD or ASD.

METHODS AND ANALYSIS

This proposed scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A comprehensive search will be conducted across PubMed, CINAHL, Embase, PsycINFO and Google Scholar, as well as grey literature sources, between 1 December 2024 and 1 January 2025. Inclusion criteria will encompass studies focusing on cross-sectoral collaboration for individuals referred for assessment of ADHD or ASD, published in English, Danish, Norwegian or Swedish. The search will use a three-block search string, with iterative refinement guided by familiarity with the evidence base. Data extraction will involve study characteristics and implementation details, using the Consolidated Framework for Implementation Research in combination with Proctor et al's implementation outcomes framework. Results will be synthesised into descriptive tables, providing a comprehensive mapping of existing models and emphasising implementation feasibility.

ETHICS AND DISSEMINATION

Ethical approval is not required for this protocol since it involves the review of existing literature without the involvement of human participants or personal data. Findings will be disseminated at national and international conferences and will be integrated into future efforts to develop cross-sectoral collaboration models in Denmark.

Resilience in Families of Autistic Children and Children With Intellectual Disability During the COVID-19 Pandemic

Resilience in families of autistic children and children with intellectual disability is associated with factors such as family functioning, social support, and financial strain. Little is known about family resilience during the COVID-19 pandemic when many resources were limited. This study examined the association of family resilience with child characteristics, family resources, and socioecological factors during the pandemic. Data collected during the COVID-19 pandemic from 734 United Kingdom parents/caregivers of children who are autistic and/or have intellectual disability were analyzed using path analysis. Greater family resilience was significantly associated with fewer child behavior problems, absence of intellectual disability, higher financial status, and greater family functioning, though not school support. These factors might guide future research and practices to support vulnerable families at risk of low resilience.

Relationship between service receipt during the COVID-19 pandemic and autistic children's multisystem outcomes and autism severity: A SPARK dataset analysis

Children with autism spectrum disorder (ASD) display a variety of core and co-occurring difficulties in social, communication, everyday functioning, cognitive, motor, and language domains. Receiving a combination of services to accommodate needs of autistic individuals is essential for improving their future outcomes. During the COVID-19 pandemic, reduced service access negatively impacted autistic children's outcomes. This study aimed to examine the relationship between service receipt and parental perceived outcomes in autistic children while accounting for various demographic, child, and parental factors. We utilized parental COVID-19 impact survey data from the SPARK study (N = 6067). Ordinal logistic regression analyses were used to predict perceived child outcomes. Demographic, child, and parental factors were included in the prediction models. Service receipt of SLT, ABA, PT/OT, MED, and MH were associated with perceived child outcomes. PT/OT and ABA predicted improvements in domains of social interaction, everyday activity, and overall autism severity; SLT and ABA contributed to improved perceived communication outcomes. Receiving MH and MED services was associated with worsening of perceived outcomes on all domains. Younger age, males, higher family income, lower autism severity, lower motor, function, and cognitive delay, greater language delay, and the absence of parental mental health issues were associated with greater improvements in various perceived outcomes. Overall, PT/OT and ABA services are associated with improved perceived social and functional outcomes whereas SLT and ABA services are associated with improved perceived communication outcomes. We also provide a wholistic view of factors affecting relationships between service receipt and perceived child outcomes during the pandemic.

A multi-constituent qualitative examination of facilitators and barriers to caregiver coaching for autistic children in publicly funded early intervention

LAY ABSTRACT

Caregiver coaching is an evidence-based practice for young autistic children, but it is not widely used in community-based early intervention services. Previous research has explored why caregiver coaching is not widespread in early intervention, but only from the perspective of early intervention providers. Caregivers, providers, and administrators are all involved in the decision of whether to use caregiver coaching in early intervention. Therefore, it is important to include all perspectives in research regarding this practice. In this study we interviewed 20 caregivers of autistic children, 36 early intervention providers, and 6 administrators from early intervention agencies and asked questions about their perspectives regarding the use of caregiver coaching in early intervention. We did this to figure out what factors help and hinder the use of caregiver coaching in this setting and to see how caregivers, providers, and administrators agreed or disagreed on these factors. All participants agreed that caregivers' attitudes and expectations can influence whether caregiver coaching is used. In addition, all participants agreed that when caregivers and providers collaborate and have a strong working relationship, it can facilitate the use of caregiver coaching in early intervention. Other factors, such as caregiver stress and provider flexibility were also discussed. Based on these findings, we suggest strategies that can be used to possibly increase the use of caregiver coaching in early intervention for autistic children and their families.

Parents' and Teachers' Perspectives of Autism and Co-Morbidity Symptom Severity in Young Children with ASD Over One School Year

PURPOSE

Only a few studies examined the longitudinal pattern of parent-teacher reports on autism severity and comorbidities in autism spectrum disorder (ASD) and yielded conflicting results. The study's aims were to compare parents and teachers' perception of autism, attention deficit hyperactivity disorder (ADHD) and anxiety symptoms severity in children with ASD, at the start (T1) and end (T2) of the school year, to assess changes in their perception over time and to examine correlations between their reports.

METHODS

The study included 73 participants, (M = 61), aged 2:10 - 7:6 years (M = 4:10, SD = 1:0), who attended ASD special education classes and were receiving intensive interventions. Parents and teachers completed measures of autism severity and ADHD and anxiety symptoms at T1 and T2.

RESULTS

Teachers, in comparison to parents, rated more severe social-communication impairments and inattention symptoms at T1, but not at T2. A significant improvement in teachers' ratings of autism and inattention symptoms severity was documented at T2. At both time points, parents reported more severe anxiety symptoms. Significant correlations between parents' and teachers' reports were noted for autism severity at T1 and T2, but not for inattention and anxiety symptoms severity.

CONCLUSION

The study emphasizes the contribution of multiple perspectives for better collaboration between home and school environments. Obtaining accurate information from parents and teachers at the start of the school year may help to identify factors needed for better adjustment at school and to better address difficulties at home.

Neuroprotective effect of PPAR gamma agonist in rat model of autism spectrum disorder: Role of Wnt/β-catenin pathway

BACKGROUND

The clinical manifestation of autism spectrum disorder (ASD) is linked to the disruption of fundamental neurodevelopmental pathways. Emerging evidences claim to have an upregulation of canonical Wnt/β-catenin pathway while downregulation of PPARγ pathway in ASD. This study aims to investigate the therapeutic potential of pioglitazone, a PPARγ agonist, in rat model of ASD. The study further explores the possible role of PPARγ and Wnt/β-catenin pathway and their interaction in ASD by using their modulators.

MATERIAL AND METHODS

Pregnant female Wistar rats received 600 mg/kg of valproic acid (VPA) to induce autistic symptoms in pups. Pioglitazone (10 mg/kg) was used to evaluate neurobehaviors, relative mRNA expression of inflammatory (IL-1β, IL-6, IL-10, TNF-α), apoptotic markers (Bcl-2, Bax, & Caspase-3) and histopathology (H&E, Nissl stain, Immunohistochemistry). Effect of pioglitazone was evaluated on Wnt pathway and 4 μg/kg dose of 6-BIO (Wnt modulator) was used to study the PPARγ pathway.

RESULTS

ASD model was established in pups as indicated by core autistic symptoms, increased neuroinflammation, apoptosis and histopathological neurodegeneration in cerebellum, hippocampus and amygdala. Pioglitazone significantly attenuated these alterations in VPA-exposed rats. The expression study results indicated an increase in key transcription factor, β-catenin in VPA-rats suggesting an upregulation of canonical Wnt pathway in them. Pioglitazone significantly downregulated the Wnt signaling by suppressing the expression of Wnt signaling-associated proteins. The inhibiting effect of Wnt pathway on PPARγ activity was indicated by downregulation of PPARγ-associated protein in VPA-exposed rats and those administered with 6-BIO.

CONCLUSION

In the present study, upregulation of canonical Wnt/β-catenin pathway was demonstrated in ASD rat model. Pioglitazone administration significantly ameliorated these symptoms potentially through its neuroprotective effect and its ability to downregulate the Wnt/β-catenin pathway. The antagonism between the PPARγ and Wnt pathway offers a promising therapeutic approach for addressing ASD.

Unveiling the influences of prenatal and maternal factors on the journey of an autistic child

Background

Autism Spectrum Disorder (ASD) is a complex lifelong neurodevelopmental disorder with a high and increasing global prevalence. Although the precise causes are unknown, both genetic and environmental factors, including maternal ones during pregnancy, significantly influence its development. Therefore, this study endeavors to explore the potential causes of autism, including maternal and paternal prenatal risk factors, as well as antenatal and natal maternal risk factors, and their associations with the severity of ASD in mothers of children with ASD, from February to May 2024.

Methods

At an autism center in Saudi Arabia, this cross-sectional study enrolled 168 mothers of children diagnosed with ASD. The web-based survey employs a structured questionnaire to gather comprehensive prenatal, natal, and demographic data. The collected data was coded and analyzed using suitable tests.

Results

The majority of the surveyed 168 mothers with autistic children reported having autism spectrum disorder (43.8%), moderate autism (31.9%), mild autism (15.6%), and severe autism (8.8%). Most autistic children had a history of one or both maternal and/or paternal antenatal exposures: 79.2% had soft drink consumption, 35.1% smoked, 24.4% had chronic physical diseases, and 20.8% had psychological disease. Regarding maternal antenatal conditions, 37% had a history of recurrent infection, 29.2% had anemia, 15.5% had a history of threatened abortion or bleeding, as well as exposure to air pollution, and 22 (13.1%) had a history of gestational diabetes. Significant (p <0.05) predictors of severe autism were gestational diabetes aOR 4.553 (95% CI: [1.518, 14.25], birth oxygen desaturation 4.142 (95% CI: [1.437, 12.45]. Furthermore, the likelihood of classifying a child's ASD as severe increases by 7.1% with each year of age1.071 (95% CI: [1.002, 1.15].

Conclusion

ASD is a prevalent health condition that has many interrelationships with prenatal, maternal (medical, environmental, and psychosocial factors), and natal conditions. Prospective studies are essential for understanding and addressing these ASD risk factors.

Effects of remote support courses on parental mental health and child development in autism: A randomized controlled trial

BACKGROUND

Sustaining the mental health of autistic children's parents can be demanding.

AIM

To determine the effect of remote support courses on the mental health of parents and the development of autistic children.

METHODS

Parents of 140 autistic children were randomly assigned to two groups receiving a 2-week intervention: The control group received caregiver-mediated intervention (CMI); the experimental group received CMI with remote family psychological support courses (R-FPSC). The Parenting Stress Index-Short Form, Parenting Sense of Competence Scale, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-9 were used to measure parents' mental health. The Childhood Autism Rating Scale and Gesell Developmental Schedules were used to evaluate children's development.

RESULTS

Improved parenting stress, sense of competence, depression, and anxiety were found in both groups, but improvements in parenting stress (81.10 ± 19.76 vs 92.10 ± 19.26, P < 0.01) and sense of competence (68.83 ± 11.23 vs 63.91 ± 10.86, P < 0.01) were greater in the experimental group, although the experimental group showed no significant reduction in depression or anxiety. Children's development did not differ significantly between the groups at follow-up; however, experimental group parents exhibited a short-term increase in training enthusiasm (12.78 ± 3.16 vs 11.57 ± 3.15, P < 0.05).

CONCLUSION

Integrating R-FPSC with CMI may be effective in reducing parenting stress, enhancing parents' sense of competence, and increasing parents' training enthusiasm.

Association between adherence to behavioral intervention and capability well-being among parents of autistic children: a cross-sectional study from China

BACKGROUND

High adherence to behavioral interventions among parents of autistic children contribute to improvement in children's behaviors and parental outcomes. However, most of previous studies focused on the effects of intervention adherence on health-related well-being among parents, which is inadequate to capture the multi-dimensional parental burden of caring for autistic children. The aim of this study is to assess the association between parents' adherence to behavioral intervention and their capability well-being.

METHODS

A cross-sectional study was conducted among caregivers of autistic children aged 1-17 years with a confirmed diagnosis in China. A total of 213 parents of autistic children who were currently receiving behavioral intervention were considered in this study. Parental adherence to behavioral intervention was evaluated by the 5-item General Adherence subscale of the Medical Outcome Study. Capability well-being was assessed using the Investigating Choice Experiments Capability Measures for Adults (ICECAP-A), including the domains of stability, attachment, autonomy, achievement, and enjoyment. The index scores for each domain were computed based on the preference-based value set in the United Kingdom, ranging from 0 to 1. Multivariate linear regression analyses were conducted to assess the relationship between intervention adherence and parental well-being. Intervention adherence as well as the variables with p < 0.1 in the univariate analyses were included in multivariate linear regression analyses.

RESULTS

The mean overall score of ICECAP-A was 0.681 (0.205). In the univariate analyses, intervention adherence was positively associated with stability, autonomy, achievement, and enjoyment (p < 0.05), while the relationship between intervention adherence and attachment was not significant (p = 0.07). After controlling for the confounders in the multivariate linear regression analyses, intervention adherence was positively associated with achievement (β = 0.0004) and enjoyment (β = 0.0004).

CONCLUSIONS

The overall capability well-being among parents of autistic children was worse than that of the general population and caregivers of adult patients with chronic diseases. Adherence to behavioral interventions was positively associated with parental well-being in terms of achievement and enjoyment. Health professionals should involve parents in behavioral interventions and encourage them to implement therapeutic strategies on a routine basis. Customized interventions are warranted to improve capability well-being targeting at vulnerable groups.

Parental Distress and Parenting Behavior in Families of Preschool Children with and Without ASD: Spillover and Buffering

Parents of children with autism spectrum disorder (ASD) report increased distress relative to parents of children with neurotypical development. Parent well-being is generally considered a key determinant of parenting behavior, thus increased distress may spill over into less optimal parenting in families of children with ASD. However, evidence is mixed regarding the degree to which parenting is actually compromised in this population, suggesting the possibility of buffering, wherein the parenting of children with ASD may be robust against spillover from increased parental distress. The current study tested competing spillover and buffering models with regard to relations among child ASD status, parental distress, and parenting behavior. Parents of preschoolers with (n = 73) and without (n = 55) ASD completed self-report measures of parenting stress, depressive symptoms, and emotion dysregulation, as well as of positive and negative parenting behaviors. Families of preschoolers with ASD reported higher distress and negative parenting, and lower positive parenting than did their counterparts. Findings supported the spillover model for negative parenting such that increased parental distress accounted for status-group differences in negative parenting. In contrast, potential buffering was observed for positive parenting in that an inverse association between distress and parenting was observed for parents of children with neurotypical development only. Findings highlight the potential benefit of intervention to reduce parental distress in families of children with ASD, but also suggest some existing ability of these families to buffer certain parenting behaviors from deleterious effects of parent distress.

Comparison of effects of interventions to promote the mental health of parents of children with autism: A systematic review and network meta-analysis

Individuals diagnosed with autism spectrum disorders often face persistent challenges in social interaction and engage in repetitive and stereotyped behaviors. Parenting a child with autism can profoundly affect parents both physically and psychologically, potentially leading to negative impacts on their mental health. This study employs a network meta-analysis methodology to evaluate the comparative effectiveness of mental health interventions specifically designed for parents of autistic children. A total of 69 empirical intervention studies involving 4213 parents of autistic children were included in the analysis. Employing the frequency framework model and utilizing Stata 16.0 software, we quantitatively analyzed the impact of various interventions on anxiety, depression, parenting stress, and parenting self-efficacy. Our findings indicate that mindfulness-based interventions demonstrate the highest efficacy in reducing parenting stress, while cognitive behavioral therapy is effective in alleviating anxiety and depression in parents of children with autism. Psychoeducational interventions have shown significant benefits in mitigating parental anxiety, depression, and parenting stress, and acceptance and commitment (ACT) displays promising outcomes in reducing depression. We also elaborate on the underlying mechanisms that contribute to the effectiveness of these interventions. This network meta-analysis presents valuable insights for the development of targeted interventions to provide support to parents of children with autism.

Efficacy of a Parent-Implemented Pivotal Response Treatment for Children with Autism Spectrum Disorder

PURPOSE

Pivotal response treatment (PRT) is a well-established intervention addressing core symptoms of autism spectrum disorder (ASD), with parent involvement as a key component. The current study aimed to examine the effects of PRT parent training on parent fidelity and provide descriptive analyses of parent-child interactions before and after parent training. It also probed parental acceptance and satisfaction with the program.

METHODS

A concurrent multiple baseline design across participants was used to evaluate the effectiveness of the parent training program. Four parents (range 32-47 years old) and their children with ASD participated in the study. The intervention comprised 12 one-on-one parent training sessions over six consecutive weeks. The visual analysis and effect size calculation (Tau-U) were used to evaluate functional relationship between independent and dependent variables. The descriptive analysis was used to analyze parent-child interaction data.

RESULTS

The findings reveal that all parents learned and maintained PRT with a high level of fidelity, they also enhanced awareness to create more opportunities for interactions during free play, and the parents were very satisfied with the program. The results also indicate that the six-week parent training program is effective in teaching parents to implement PRT with their children.

CONCLUSION

These results suggest that the parent training program may be a promising treatment model that is effective, efficient, and cost-effective. Implications for future research and practice are then discussed.

The Effect of Autism Spectrum Disorder on Family Mental Health: Challenges, Emotional Impact, and Coping Strategies

BACKGROUND

Autism Spectrum Disorder (ASD) impacts not only diagnosed individuals, but also significantly affects the quality of life of both primary and secondary caregivers. These effects are particularly pronounced when compared to caregivers of individuals with other neurodevelopmental disorders. The emotional and physical demands of caring for someone with ASD can profoundly alter family dynamics and interpersonal relationships, creating challenges that require a comprehensive approach to be understood and addressed.

METHODS

The methodological design is a narrative review study, based on a search conducted during May, June, July, and August 2024 in the Scopus, Dialnet, and WoS databases concerning the object of study. As a result, a total of 197 articles were qualitatively analyzed. Of these, 36 articles were selected for a more detailed qualitative analysis, leading to a final sample of 14 documents. The selected studies were examined through qualitative content analysis. The inclusion criteria for this selection were as follows: empirical studies or research published in English or Spanish; open access via the Internet; categories limited to "education/educational research" relevant to the proposed objectives; and specific documents related to students with Autism Spectrum Disorder (ASD).

RESULTS

The care of individuals with Autism Spectrum Disorder (ASD) has a significant and multifaceted impact on family life, deeply affecting the mental health of caregivers. These effects manifest in the form of chronic stress, anxiety, and interpersonal difficulties, altering family dynamics. The quality of life of caregivers varies depending on the coping strategies they employ, which are crucial for their emotional well-being.

CONCLUSIONS

Understanding and optimizing these strategies is essential to mitigate the negative effects of caregiving and improving the overall well-being of families living with ASD.

Moderating effects of general self-efficacy on courtesy stigma and anxiety and depressive symptoms of parents of children with autism spectrum disorder

Background

Stigma, anxiety and depressive symptoms are highly prevalent in parents of children with autism spectrum disorder (ASD) and may have a detrimental impact on the rehabilitation and treatment of children with ASD, ultimately leading to more behavioral issues and higher rates of disability. Therefore, the purpose of this study was to identify the association between general self-efficacy, courtesy stigma, and anxiety and depressive symptoms, and to further discuss whether general self-efficacy moderated the association between courtesy stigma and anxiety and depressive symptoms in parents of children with ASD.

Methods

A total of 409 parents of children with ASD from Lianyungang, Jiangsu Province, Eastern China participated in a cross-sectional survey. A structured questionnaire was used to collect sociodemographic characteristics, courtesy stigma, general self-efficacy, anxiety symptoms, and depressive symptoms. Hierarchical multiple regression was used to assess the associations of courtesy stigma, general self-efficacy and courtesy stigma × general self-efficacy interaction with anxiety and depressive symptoms. Simple slope analysis was used to visualize the interaction.

Results

The courtesy stigma of parents of children with ASD was positively correlated with anxiety (B = 0.374, P < 0.001) and depressive symptoms (B = 0.366, P < 0.001). General self-efficacy was negatively correlated with anxiety (B = -0.200, P < 0.001) and depressive symptoms (B = -0.210, P < 0.001). The association between courtesy stigma and anxiety symptoms was different in the high (1 standard deviation (SD) above the mean, b = 0.258, standard error (SE) = 0.056, t = 4.567, P < 0.001) and low (1 SD below the mean, b = 0.470, SE = 0.053, t = 8.870, P < 0.001) groups of general self-efficacy. In addition, the association between courtesy stigma and depressive symptoms was also different in the high (1 SD above the mean, b = 0.241, SE = 0.056, t = 4.268, P < 0.001) and low (1 SD below the mean, b = 0.469, SE = 0.053, t = 8.844, P < 0.001) groups of general self-efficacy.

Conclusions

General self-efficacy could moderate the impact of courtesy stigma on anxiety and depressive symptoms. Therefore, among parents of children with ASD who experienced high courtesy stigma, enhancing general self-efficacy could be an effective strategy to reduce anxiety and depressive symptoms in this population.

Analyzing the influence of physical exercise interventions on social skills in children with autism spectrum disorder: insights from meta-analysis

Introduction

Children diagnosed with autism spectrum disorder (ASD) commonly encounter difficulties in social interactions and communication, significantly affecting their overall wellbeing. One proposed strategy to address these challenges is through physical exercise interventions. This study aims to conduct a meta-analysis to assess the impact of physical exercise interventions on the social skills of children with ASD.

Methods

To perform this meta-analysis, we followed the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) Statement and the practical guide for transparent reporting of systematic reviews. Eligible studies included randomized controlled trials or quasi-experimental studies investigating the effects of physical exercise interventions on social skills among children with ASD. We used the standardized mean difference (SMD) to measure effect size.

Results

Sixteen studies were included in the meta-analysis. The results indicated a significant improvement in social skills among children with ASD following physical exercise interventions (SMD = -0.54, 95% CI = [-0.63; -0.44]). The moderator analysis underscored the crucial role of age in explaining the intervention outcomes for enhancing social skills, with interventions lasting more than 12 weeks recommended for better social skills improvement.

Discussion

The findings of this meta-analysis provide robust evidence supporting the efficacy of physical exercise interventions in enhancing the social skills of children with ASD. The moderator analysis underscores the importance of considering both the mean age and duration of interventions when implementing such programs. These results underscore the significance of physical exercise as a viable option for improving social skills in this population.

Family Resilience in Primary Caregivers of Children Who Are Deaf and Hard of Hearing

PURPOSE

This study aimed to investigate family resilience-defined as the capacity of a family to harness its collective strengths and resources to recover from and adapt to significant adversities or crises effectively-in primary caregivers of children who are deaf and hard of hearing (cDHH) and its association with quality of life, life satisfaction, perceived social support, and loneliness.

METHOD

The study involved 108 primary caregivers of cDHH and 139 primary caregivers of children with normal hearing. Participants underwent psychometric evaluations including the Family Resilience Scale, World Health Organization Quality of Life Assessment-Brief Form, Satisfaction with Life Scale, UCLA Loneliness Scale, and Multidimensional Scale of Perceived Social Support.

RESULTS

Significant differences were found in almost every scale and its subdimension between the two groups (p < .05). Correlation analysis revealed significant correlations between all scale total scores for both groups (p < .05, .153 < | r | < .737). Quality of life was found to be a significant predictor of family resilience, F(1, 139) = 41.824, R2 = .279, B = 0.495, t = 6.467, p < .001.

CONCLUSIONS

Our study highlights the significant impact of having cDHH on caregivers' family resilience, quality of life, life satisfaction, feelings of loneliness, and perceived social support. The results underscore the importance of enhancing caregivers' quality of life as a potential strategy to improve their family resilience. Further research is needed to understand the complex interplay of factors influencing these outcomes.

High threshold of total developmental quotient at 3 years for follow-up in extremely preterm infants

AIM

To investigate the relationship between the developmental quotient (DQ) at age 3 years and the need for educational support at school age in extremely preterm infants.

METHODS

A total of 176 infants with a gestational age of <28 weeks were analyzed. The total DQ and subscales were evaluated using the Kyoto Scale of Psychological Development (KSPD) test. Neurodevelopment at age 3 years was stratified using total DQ in a conventional (DQ < 70 as developmental delay, DQ 70- <85 as subnormal, DQ ≥85 as normal) and a modified way (subdividing normal into DQ 85- <93 as low-normal and DQ ≥93 as high-normal). The prevalence of future educational support was compared for each stratum. Additionally, subscales were compared between those with and without educational support in each total DQ stratum.

RESULTS

In conventional stratification, the prevalence of educational support was 32 (63 %) for developmental delay, 14 (24 %) for subnormal, and 10 (15 %) for normal. In modified stratification, the prevalence was 8 (26 %) for low-normal and 2 (5 %) for high-normal. While there was no significant difference in the odds of educational support between the normal and subnormal, the low-normal had significantly higher odds compared to the high-normal (OR 6.00; 95 % CI, 1.16-30.95, p = 0.03). Among the low-normal stratum, the language-social subscale was significantly lower in those with educational support.

CONCLUSION

Setting high thresholds for total DQ and evaluating detailed subscales at age 3 years may be useful for developmental follow-up in extremely preterm infants.

Using network analysis to identify factors influencing the heath-related quality of life of parents caring for an autistic child

BACKGROUND

Raising an autistic child is associated with increased parenting stress relative to raising typically developing children. Increased parenting stress is associated with lower parent wellbeing, which in turn can negatively impact child wellbeing.

AIMS

The current study sought to quantify parenting stress and parent health-related quality of life (HRQOL) in the autism context, and further understand the relationship between them by employing a relatively novel statistical method, Network Analysis.

METHODS AND PROCEDURES

This cross-sectional study involved 476 parents of an autistic child. Parents completed an online survey requesting information on parent and child characteristics, parent's perceptions of their autistic child's symptoms and problem behaviours, and assessed their parenting stress and HRQOL.

OUTCOMES AND RESULTS

Relative to normative data, parent HRQOL was significantly lower in terms of physical health and mental wellbeing. The structure extracted by the Network Analysis indicated that child age and externalising behaviours were the main contributors to parenting stress, and that externalising behaviours, ASD core behavioural symptoms, and parenting stress predicted HRQOL.

CONCLUSIONS AND IMPLICATIONS

Parental responses to child-related factors likely determine parent HRQOL. Findings are discussed in relation to the transactional model, emphasising the importance of both parent and child wellbeing.

A Systematic Review of Parental Self-Efficacy in Parents of Autistic Children

Parental self-efficacy (PSE) assesses a parent's expectations and beliefs about their ability to effectively parent their child. PSE has implications for a parent's well-being, parenting practices, mental health, the parent-child relationship, and child adjustment. While PSE has been extensively examined within the broader parenting literature, the examination of PSE specifically for parents of autistic children has gained increasing attention in recent years. The following systematic review aimed to investigate the role of PSE for parents of autistic children by examining variables that predict PSE or are predicted by PSE in relation to how they align with the broader parenting literature and are unique to autism. Utilizing PRISMA guidelines, peer-reviewed articles were included if (a) participants included caregivers of autistic children, (b) at least one quantitative outcome measure of PSE was utilized, and (c) the role of PSE was examined as an outcome, predictor, or variable in an explanatory model. A total of 53 studies were included in the review and the role of PSE was examined regarding family (e.g., parental characteristics, parent stress, well-being, and support) and child factors (e.g., autism symptomology, problem behaviors, interventions). Several themes emerged including a positive relationship between PSE and support, and a negative relationship between PSE and parenting stress, parent mental health outcomes (e.g., anxiety, depression), and autism symptomology. Findings were compared to the broader parenting and PSE literature to examine how increased considerations and challenges (e.g., child problem behaviors, social impairment, and caregiver strain) associated with raising an autistic child might impact PSE.

Do Naturalistic Developmental Behavioral Interventions improve family quality of life? A systematic review and meta-analysis

LAY ABSTRACT

Naturalistic Developmental Behavioral Interventions have been described as culturally responsive and family-friendly interventions, with research demonstrating improvements in children's development following the receipt of these interventions. Given the child-directed nature of Naturalistic Developmental Behavioral Interventions and the intervention's integration within families' daily routines, many studies have examined the impact of Naturalistic Developmental Behavioral Interventions on family and family member quality of life. We conducted a systematic review and meta-analysis to explore the relationship between Naturalistic Developmental Behavioral Interventions and family quality of life. Results suggest that the provision of a Naturalistic Developmental Behavioral Intervention neither improved nor worsened family or family member quality of life. For those involved in delivering Naturalistic Developmental Behavioral Intervention services, there is an immediate need to convey to families that children's improvements will likely not translate into improvements in family quality of life.

The mediator role of parenting stress in the effect of stigmatization on burnout in parents of children with autism: A structural equality model

PURPOSE

The purpose of this study was to report on the mediator role of parenting stress in the effect of stigmatization on burnout in parents of children with autism.

DESIGN AND METHODS

A descriptive and correlational research design was used in this study. The sample consisted of 146 parents who had children diagnosed with autism spectrum disorder and volunteered to participate in the study. A "Personal Information Form", the "Parents' Internalized Stigma of Mental Illness Scale", the "Parenting Stress Scale", and the "Parental Burnout Assessment" were used for data collection.

RESULTS

In the study, it was observed that the feeling of stigmatization increased as the education level increased and that variables such as the ages of the parent and the child and an increase in the number of children requiring care also affected the feeling of stigmatization. Parenting stress was found to have a "partial mediator" role in the effect of stigmatization on parental burnout.

CONCLUSION

Our findings emphasized the heterogeneous correlation between stigmatization, burnout, and stress levels of parents of children with autism.

PRACTICE IMPLICATIONS

This study has key implications for pediatric nursing practices. Pediatric nurses can educate the community about autism, what issues should be considered, and how to support parents. Furthermore, nurses can introduce parents who have children with autism to each other and direct them to parent-child activities that can regulate their moods.

School participation of autistic youths: The influence of youth, family and school factors

LAY ABSTRACT

School-aged youths have a basic human right to participate in educational and recreational activities at school. Yet, autistic youths are at high risk of being excluded from school and from school-based activities. It is important to understand how this occurs, to ensure that all autistic youths have opportunities to participate in school activities that are equal to the opportunities of their non-autistic peers. The present study investigated multiple influences on the school participation of autistic youths, including youth factors (age and autistic traits), family factors (parent education level and parental self-efficacy for supporting their child's schoolwork) and school factors (the impact of problems autistic youths experienced with the physical and social environments of school). Using an online survey, we gathered the views and experiences of the parents of 200 autistic youths aged between 4 and 16 years, in the Netherlands. We found that among the factors, only the impact of problems that autistic youths experienced with the physical environment of school was associated with their school participation. In particular, autistic youths who experienced greater difficulties with the physical environment of school had lower levels of school participation. Our findings highlight the pressing need to modify school environments to better accommodate the needs of autistic youths so that they can participate easily and comfortably.

Psychometric Properties of the Caregiver Strain Questionnaire in a Chinese Sample of Caregivers of Children with Autism Spectrum Disorder

The Caregiver Strain Questionnaire assesses the three dimensions of caregiver strain, namely the objective, subjective externalized and subjective internalized strain. It was validated among caregivers of children with Autism Spectrum Disorder (ASD) in the United States and Mainland China with promising psychometric properties.This study aimed to develop and validate the Chinese (traditional script) version of the Caregiver Strain Questionnaire (C-CGSQ) among 198 caregivers of children with ASD in Hong Kong. The C-CGSQ showed excellent internal consistency (α = 0.958) and test-retest reliability (Spearman's r = 0.966). Concurrent, convergent, divergent validity and a three-factor structure (consistent with previous studies) were established. The C-CGSQ demonstrated promising psychometric properties in measuring caregiver strain among caregivers of Chinese ASD children in Hong Kong.

A Prospective Study of the Family Quality of Life, Illness Perceptions, and Coping in Mothers of Children Newly Diagnosed with Autism Spectrum Disorder and Communication Difficulties

(1) Background: This study assesses the impact of mothers' illness perceptions about autism spectrum disorder and their coping strategies on the family's quality of life during the initial period following diagnosis and one year afterward. (2) Method: The sample consisted of 53 mothers of children newly diagnosed with autism spectrum disorder and having communication difficulties who completed the following: the Beach Center Family Quality of Life Scale, the Brief Illness Perception Questionnaire, and the Brief-COPE. (3) Results: The findings revealed a moderate family quality of life in the initial assessment and a lack of a statistically significant change one year later. Notably, statistically significant changes were observed in coping strategies, as in the second assessment, and the score in denial and self-blame decreased. Pearson and Eta analyses indicated several correlations between socio-demographic characteristics, illness perceptions, coping strategies, and family quality of life. Multiple regression analysis showed that positive reframing was positively associated with total family quality of life in the initial period following diagnosis and one year afterward, while self-blame was associated with poorer quality of life in the time after diagnosis. Furthermore, the belief about the controllability of the disorder was correlated with better family quality of life one year after the diagnosis. (4) Conclusions: Illness perceptions and coping can be considered as predictors of family quality of life outcomes one year after the diagnosis of autism spectrum disorder. The focus of interventions, apart from controlling the disorder's symptoms, should aim to strengthen specific strategies and weaken others.

The effects of a web-based 24-hour movement behavior lifestyle education program on mental health and psychological well-being in parents of children with autism spectrum disorder: A randomized controlled trial

BACKGROUND AND PURPOSE

Compared with parents of neurotypical children or children diagnosed with other disabilities, parents of children with autism spectrum disorder (ASD) often experience poorer mental health, greater stress, and more depression and anxiety symptoms. This study aimed to assess the effects of a web-based 24-h movement behavior lifestyle education program on mental health and psychological well-being in parents of children with ASD.

METHODS

This study employed a randomized controlled trial utilizing the Health Action Process Approach (HAPA) as a theoretical framework. A total of 318 parents of children with ASD were enrolled and randomly assigned to the experimental or control group. The experimental group received an 8-week web-based 24-h movement behavior lifestyle education program, while the control group followed their usual routine. Two instruments, the Depression Anxiety and Stress Scale (DASS-21) and the Satisfaction With Life Scale (SWLS), were used to measure mental health and psychological well-being, respectively. The data were collected at two time points-at the beginning and the end of the intervention.

RESULTS

Compared with the baseline and control groups, the experimental group demonstrated significant improvements in all outcome measures (p < 0.01). There were significant differences in the DASS-21 and SWLS scores between the two groups before and after the intervention (p ≤ 0.01).

CONCLUSION

This study represents the first randomized controlled trial involving a web-based 24-h movement behavior lifestyle education program specifically designed to address the mental health and psychological well-being of parents of children with ASD. The findings confirm the potential impact of 24-h movement behavior lifestyle education as a functional and effective strategy for parents of children with ASD.