ASD Diagnosis and Treatment Experiences Among Mexican Heritage Families

Latine Caregivers' Perspectives of Autism-Related Services: A Scoping Review

PURPOSE

Minoritized cultural groups in the United States experience disparities in diagnostic and intervention services for autistic children. Listening to the experiences of minoritized caregivers when accessing these services can identify areas for structural and individual improvement in cultural responsiveness.

METHOD

We conducted a scoping review to map the experiences of Latine caregivers of autistic children in navigating autism-related services. Included studies were published between 2015 and 2024 and employed a qualitative design.

RESULTS

Twenty-six studies were included in the review. The caregivers interviewed in these studies were primarily mothers; few studies included fathers or extended family members. Services reviewed included both assessment and intervention. Factors related to assessment and intervention uptake included communication, provider support, logistics, immigration, cultural beliefs, caregivers' knowledge about autism, and social systems.

CONCLUSIONS

Public education on the signs of autism and how to access services may address some of the barriers identified by caregivers in this review. Clinicians can provide education and support to empower caregivers to advocate for their children.

Experiences and Needs of Leaders Supporting Multilingual ABA Staff: A Qualitative Exploration

Heritage-language-speaking caregivers of autistic children in the United States (U.S.) have encountered barriers when attempting to access multilingual support for their children. Multilingual autism providers, such as professionals in Applied Behavior Analysis (ABA), have also reported challenges in providing multilingual care, such as a lack of training opportunities. Little is known about the experiences and needs of leaders in ABA who support multilingual direct care staff. Therefore, the current study aimed to answer the research question: What are the experiences and needs of ABA leaders in autism care related to supporting multilingual ABA staff who work with multilingual autistic children and their families? This exploratory qualitative study used semi-structured focus groups and interviews with monolingual and multilingual behavior analysts who had experience supporting multilingual ABA staff. Transcripts were analyzed using reflexive thematic analysis. The 14 participants were a diverse sample of U.S.-based monolingual, multilingual, autistic, and non-autistic leaders in ABA with experience supervising multilingual ABA staff. Two major themes were generated from the data set: (1) Diverse Experiences: Organizational Policies and Actions Impacting Multilingual Staff, and (2) Building Community and Creating Solutions. Participants shared experiences and challenges supervising multilingual ABA staff. Implications highlight the need to closely examine organizational policies to prevent discrimination and spotlight the need for more research to be conducted in this area.

Sacrifice, uncertainty, and resilience: Qualitative study of U.S./Mexico border mothers of autistic children

The purpose of this study was to explore and document the migratory motivations and reasonings of Mexican mothers of autistic children pursuing autism services in the United States. The study was guided by the overarching research question, "What are the experiences of mothers living in the U.S./Mexico border while seeking services for their autistic children, and what social and financial resources influence their decisions?". Following a Community-Based Participatory Research approach, we collaborated with organizations and stakeholders in the development of qualitative research materials while also supporting the purposeful recruitment of caregivers who: (1) had lived in the U.S./Mexico border and moved to the United States to pursue autism services, or (2) were currently living in the U.S./Mexico border and were looking to pursue autism services in the United States. Eleven mothers participated in a two-part semi-structured interview protocol alongside a demographic form. Findings outline three global themes that describe the dynamic process of pursuing autism services and migrating to the United States: (1) stage of constant contrast between Mexico and the United States, (2) active pursuit of autism services in the United States, and (3) potential pathways to immigration. The global themes provide a systemic analysis and reflection of the current autism service system in Mexico while also highlighting the gaps in service coordination for first-generation immigrant families.Lay abstractThis study aimed to understand why Mexican mothers of autistic children move to the United States to seek autism services. Using a method that involved the community, we worked with local partners to create research materials and find caregivers for the study. We focused on mothers who had either moved from the U.S./Mexico border to the United States for autism services or were planning to do so. Eleven mothers participated by completing a two-part interview and a demographic form. The results highlight three main themes that explain the complex reasons and motivations behind their decision to seek autism services in the United States: (1) stage of constant contrast between Mexico and the United States, (2) active pursuit of autism services in the United States, and (3) potential pathways to immigration. These findings also highlight the differences in autism services between the United States and Mexico and the challenges faced by immigrant families trying to get the care their children need.

Barriers and Facilitators of Access to Healthcare Among Immigrants with Disabilities: A Qualitative Meta-Synthesis

BACKGROUND

Immigrants with disabilities (IWDs) are disproportionately affected by a lack of access to healthcare services and face unique challenges compared to the general population. This qualitative meta-synthesis examines the barriers, facilitators, and lived experiences of IWDs accessing healthcare in the U.S. and Canada.

METHODS

A theory-generating qualitative meta-synthesis approach was used to analyze and synthesize raw qualitative data. Using eight databases, 752 studies were retrieved, and 10 were selected and synthesized after a three-stage review. The final articles were assessed using the Critical Appraisal Skills Program (CASP) checklist, and a PRISMA flow chart was used to report on the selection process.

RESULTS

The analysis identified structural barriers, including the bureaucracy and complexity of the system, healthcare costs, transportation, communication, long wait times, and a lack of integrated services. Cultural barriers included denial and trust, stigma and discrimination, awareness and language gaps, and lack of social support. Facilitators of access included support from immediate family members, community health centers, and social workers.

CONCLUSIONS

The findings highlight the need for policy reforms to reduce bureaucratic hurdles, improve communication within healthcare systems, and enhance cultural competence among healthcare providers. Addressing these issues through integrated service models and targeted support can significantly improve the quality of life as a result of improved healthcare access for IWDs.

Parent-Mediated Autism Intervention Through a Culturally Informed Lens: Parents Taking Action and Pivotal Response Training with Latine Families

Background/Objectives: The prevalence of autism has increased substantially among Latine children; however, few service systems are prepared to provide culturally relevant services. Parents Taking Action (PTA) is a culturally informed parent-mediated psychoeducation program designed to meet the informational needs of Latine families with children with autism. The purpose of this study was to pilot a hybrid model of intervention by including direct parent coaching through pivotal response training (PRT) along with PTA among Latina mothers of children with autism. Methods: Ten Latina mothers of children eight years of age with autism participated in this study. The mothers received PTA from two bilingual trained promotoras (community health workers). PTA provided 14 2 h psychoeducation sessions. The mothers also received four one-hour sessions of PRT from bilingual/bicultural coaches. Results: Paired samples t-tests indicated significant increases in the families' outcomes, their self-efficacy in using the intervention strategies, and their frequency of using strategies, from pre- to post-test. Conclusions: This study suggests that culturally informed parent-mediated autism intervention coupled with parent coaching positively affects family outcomes among Latine families of children with autism.

It's our job to bridge the gap: Perspectives of bilingual autism providers on heritage language care

LAY ABSTRACT

In the United States, many people have heritage languages they speak in their homes other than English, such as Chinese or Spanish. Autistic children whose families speak different languages could benefit from support and teaching in their heritage languages. Still, caregivers have reported that it is challenging to do so. Many autism professionals make suggestions that are not based on research. To date, researchers have not examined the perspectives of the small group of bilingual professionals in the United States who provide bilingual support for autistic children. Therefore, this study explored how bilingual autism providers in the United States talked about their work, bilingualism, and the impacts their bilingual work has on autistic children and families. The bilingual providers in this study reported many positive outcomes for autistic children when they can learn and use their heritage languages and some negative outcomes when providers cannot communicate in the same language. Recommendations from this study highlight the need to recruit more bilingual providers in the field of autism.

Diagnostic Evaluation of Autism Spectrum Disorder in Pediatric Primary Care

BACKGROUND AND OBJECTIVES

Children with autism spectrum disorder (ASD) continue to experience significant delays in diagnosis and interventions. One of the main factors contributing to this delay is a shortage of developmental-behavioral specialists. Diagnostic evaluation of ASD by primary care pediatricians (PCPs) has been shown to be reliable and to decrease the interval from first concern to diagnosis. In this paper, we present the results of a primary care ASD diagnosis program in which the PCP serves as the primary diagnostician and leverages the infrastructure of the primary care medical home to support the child and family during the pre- and post-diagnostic periods, along with data on parental satisfaction with this model.

METHODS

Retrospective data from a cohort of patients evaluated through this program were analyzed to determine the mean age at diagnosis and interval from referral for evaluation to diagnosis. We used survey methodology to obtain data from parents regarding their satisfaction with the process.

RESULTS

Data from 8 of 20 children evaluated from April 2021 through May 2022 showed a median age of diagnosis of 34.5 months compared to the national average of 49 months. Mean interval from referral for evaluation to diagnosis was 3.5 months. Parental survey responses indicated high satisfaction.

CONCLUSIONS

This model was successful in shortening the interval from referral to diagnosis resulting in significant decrease of age at diagnosis compared with the national average. Widespread implementation could improve access to timely diagnostic services and improve outcomes for children with ASD.