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Baloyi O, Jarvis MA, Chironda G, Mbeje P, Ngcobo SJ, Gqaleni T, Mhlongo EM, Ngcobo WB, Brysiewicz P. Experiences of families with children diagnosed with Autism Spectrum Disorder in World Health Organization Afro-Regions: A scoping review. Nurs Health Sci 2024; 26:e13123. [PMID: 38692580 DOI: 10.1111/nhs.13123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/13/2024] [Accepted: 04/09/2024] [Indexed: 05/03/2024]
Abstract
A scoping review on Autism Spectrum Disorder (ASD) and its impact on the families of affected children was undertaken due to insufficient information available on the diverse experiences impacting their lives. Using the Joanna Briggs Institute methodology, eligibility criteria were guided by Population (families), Concept (family experiences), and Context (African region). English-language articles were sought from a variety of databases and search engines. The publication date of the identified articles ranged from 2003 to 2021 with most published in 2020 (n = 10), and the majority using qualitative methodologies (n = 51). Most family members involved were parents (n = 51) and their ages ranged from 18 to 75 years. The families experienced various challenges related to their child with regard to education, healthcare, and the broader community including lack of support. Family coping strategies included believing in God, attending counseling sessions, adapting, and accepting the situation. Healthcare professionals should be prepared and positioned to educate families and siblings on various aspects of ASD. There is a need for active, continued research on families within most countries of World Health Organization Afro-region.
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Affiliation(s)
- Olivia Baloyi
- Department of Nursing, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Mary Ann Jarvis
- Department of Nursing, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Geldine Chironda
- Department of Nursing, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Pretty Mbeje
- Department of Nursing, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Silingene Joyce Ngcobo
- Department of Nursing, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Thusile Gqaleni
- Department of Nursing, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Euphemia Mbali Mhlongo
- Department of Nursing, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Winnie Baphumelele Ngcobo
- Department of Nursing, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Petra Brysiewicz
- Department of Nursing, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Lemay KR, Kogan CS, Rebello T, Keeley JW, Bhargava R, Buono S, Cooray S, Ginige P, Kishore MT, Kommu JVS, Recupero M, Roy A, Sharan P, Reed GM. Implementation of the International Classification of Diseases 11th revision behavioural indicators for disorders of intellectual development with co-occurring autism spectrum disorder. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024. [PMID: 38733333 DOI: 10.1111/jir.13146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND The classification of mental, behavioural and neurodevelopmental disorders in the World Health Organization's International Classification of Diseases 11th revision (ICD-11) includes a comprehensive set of behavioural indicators (BIs) within the neurodevelopmental disorders grouping. BIs can be used to assess the severity of disorders of intellectual development in situations in which standardised measures of intellectual functioning and adaptive behaviours are not available or feasible. This international study examines the implementation characteristics of the BIs and compares them to standardised measures for assessing the severity of intellectual impairment and adaptive behaviours in disorders of intellectual development and autism spectrum disorder (ASD). The clinical utility of the ICD-11 and the fidelity of its application in international clinical settings were also assessed. METHODS A total of 116 children and adolescents (5-18 years old) with a suspected or established diagnosis of disorders of intellectual development were included across four sites [Italy (n = 18), Sri Lanka (n = 19) and two sites in India (n = 79)]. A principal component analysis was conducted to evaluate the application of the ICD-11 guidance for combining severity levels. RESULTS Assessment using the BIs showed a higher proportion of individuals classified with mild severity, whereas the standardised measures indicated a higher proportion of severe ratings. Additionally, individuals with co-occurring ASD tended to have more severe impairments compared with those without ASD, as indicated by both BIs and standardised measures. Overall, the BIs were considered clinically useful, although more time and consideration were required when applying the guidelines for individuals with a co-occurring disorder of intellectual development and ASD. The principal component analysis revealed one principal component representing overall disorders of intellectual development severity levels. CONCLUSIONS The ICD-11 BIs can be implemented as intended in international clinical settings for a broad range of presentations of individuals with neurodevelopmental disorders. Use of the BIs results in similar severity diagnoses to those made using standardised measures. The BIs are expected to improve the reliability of severity assessments in settings where appropriate standardised measures for intellectual and adaptive behaviours are not available or feasible.
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Affiliation(s)
- K R Lemay
- School of Psychology, University of Ottawa, Ottawa, Canada
| | - C S Kogan
- School of Psychology, University of Ottawa, Ottawa, Canada
| | - T Rebello
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Department of Psychiatry, Research Foundation for Mental Hygiene, New York, NY, USA
| | - J W Keeley
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - R Bhargava
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - S Buono
- Department of Psychology, Oasi Research Institute-IRCCS, Troina, Italy
| | - S Cooray
- Faculty of Psychiatry of Learning Disability, Royal College of Psychiatrists, London, UK
| | - P Ginige
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - M T Kishore
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - J V S Kommu
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - M Recupero
- Department of Psychology, Oasi Research Institute-IRCCS, Troina, Italy
| | - A Roy
- Coventry and Warwickshire Partnership NHS Trust, Birmingham, UK
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
| | - P Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - G M Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Harrison AJ, Naqvi NC, Smit AK, Kumar PN, Muhammad NA, Saade S, Yu L, Cappe E, Low HM, Chan SJ, de Bildt A. Assessing Autism Knowledge Across the Global Landscape Using the ASK-Q. J Autism Dev Disord 2024; 54:1897-1911. [PMID: 36892718 DOI: 10.1007/s10803-023-05936-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/10/2023]
Abstract
Substantial variability exists with regard to autism service provision around the world. Service disparities observed in many low- and middle-income countries may be driven, in part, by limited autism knowledge; however, measurement limitations have made it difficult to quantify autism knowledge across countries. The current study uses the autism stigma and knowledge questionnaire (ASK-Q) to quantify autism knowledge and stigma between different countries and demographics. The current study compiled data from 6830 participants collected using adapted versions of the ASK-Q administered in 13 different countries, representing four different continents. Structural equation modeling was used to examine how autism knowledge varied across country and individual factors. Results reveal cross country variability with a large, 17-point difference between the countries with the highest knowledge (Canada) and the lowest knowledge (Lebanon). As expected, countries with higher economies had higher levels of knowledge. We also documented differences based on country worldview, participant occupation, gender, age, and education level. These results help to identify specific regions and populations that might most need greater information about autism.
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Affiliation(s)
- Ashley J Harrison
- Educational Psychology Department, University of Georgia, Athens, GA, 30606, USA.
- Department of Educational Psychology, University of Georgia, Aderhold Hall 110 Carlton Street, Athens, GA, 30602, USA.
| | - Nilofer C Naqvi
- Department of Psychology, Iona University, New Rochelle, NY, 10801, USA
| | - Anne K Smit
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Accare Child Study Center, Groningen, The Netherlands
| | - Prisha Nanda Kumar
- Educational Psychology Department, University of Georgia, Athens, GA, 30606, USA
| | - Noor Azimah Muhammad
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia. Jalan Yaacob Latiff, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Sabine Saade
- Psychology Department, American University of Beirut, Beirut, 1107 2020, Lebanon
| | - Luodi Yu
- Center for Autism Research, School of Education, Guangzhou University, Wenyi Bldg, Guangzhou, China
| | - Emilie Cappe
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, 92100, Boulogne-Billancourt, France
- Institut Universtaire de France (IUF), Paris, France
| | - Hui Min Low
- School of Education Studies, Universiti Sains Malaysia, Penang, Malaysia
| | - Sarah-Jane Chan
- Manggatal Health Clinic, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Annelies de Bildt
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Accare Child Study Center, Groningen, The Netherlands
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Dubey I, Bishain R, Dasgupta J, Bhavnani S, Belmonte MK, Gliga T, Mukherjee D, Lockwood Estrin G, Johnson MH, Chandran S, Patel V, Gulati S, Divan G, Chakrabarti B. Using mobile health technology to assess childhood autism in low-resource community settings in India: An innovation to address the detection gap. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:755-769. [PMID: 37458273 PMCID: PMC10913299 DOI: 10.1177/13623613231182801] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
LAY ABSTRACT Autism is diagnosed by highly trained professionals- but most autistic people live in parts of the world that harbour few or no such autism specialists and little autism awareness. So many autistic people go undiagnosed, misdiagnosed, and misunderstood. We designed an app (START) to identify autism and related conditions in such places, in an attempt to address this global gap in access to specialists. START uses computerised games and activities for children and a questionnaire for parents to measure social, sensory, and motor skills. To check whether START can flag undiagnosed children likely to have neurodevelopmental conditions, we tested START with children whose diagnoses already were known: Non-specialist health workers with just a high-school education took START to family homes in poor neighbourhoods of Delhi, India to work with 131 two-to-seven-year-olds. Differences between typically and atypically developing children were highlighted in all three types of skills that START assesses: children with neurodevelopmental conditions preferred looking at geometric patterns rather than social scenes, were fascinated by predictable, repetitive sensory stimuli, and had more trouble with precise hand movements. Parents' responses to surveys further distinguished autistic from non-autistic children. An artificial-intelligence technique combining all these measures demonstrated that START can fairly accurately flag atypically developing children. Health workers and families endorsed START as attractive to most children, understandable to health workers, and adaptable within sometimes chaotic home and family environments. This study provides a proof of principle for START in digital screening of autism and related conditions in community settings.
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Affiliation(s)
- Indu Dubey
- University of Reading, UK
- University of Nottingham, UK
| | | | | | | | - Matthew K Belmonte
- University of Reading, UK
- The Com DEALL Trust, India
- Nottingham Trent University, UK
| | - Teodora Gliga
- University of East Anglia, UK
- University of London, UK
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Genovesi E, Yao YI, Mitchell E, Arad M, Diamant V, Panju A, Hanlon C, Tekola B, Hoekstra RA. Mapping awareness-raising and capacity-building materials on developmental disabilities for non-specialists: a review of the academic and grey literature. Int J Ment Health Syst 2024; 18:10. [PMID: 38402178 PMCID: PMC10893740 DOI: 10.1186/s13033-024-00627-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 02/01/2024] [Indexed: 02/26/2024] Open
Abstract
Most children with developmental disabilities (DD), such as intellectual disabilities and autism, live in low- and middle-income countries (LMICs), where services are usually limited. Various governmental, non-governmental and research organisations in LMICs have developed awareness-raising campaigns and training and education resources on DD in childhood relevant to LMICs. This study aimed to comprehensively search and review freely available materials in the academic and grey literature, aimed at awareness raising, training and education on DD among non-specialist professionals and community members in LMICs. We consulted 183 experts, conducted key-word searches in five academic databases, four grey-literature databases and seventeen customised Google search engines. Following initial screening, we manually searched relevant systematic reviews and lists of resources and conducted forwards and backwards citation checks of included articles. We identified 7327 articles and resources after deduplication. We then used a rigorous multi-step screening process to select 78 training resources on DD relevant to LMICs, of which 43 aimed at informing and/or raising awareness DD, 16 highlighted specific strategies for staff in health settings and 19 in education settings. Our mapping analysis revealed that a wealth of materials is available for both global and local use, including comics, children's books, flyers, posters, fact sheets, blogs, videos, websites pages, social media channels, handbooks and self-education guides, and training programmes or sessions. Twelve resources were developed for cross-continental or global use in LMICs, 19 were developed for and/or used in Africa, 23 in Asia, 24 in Latin America. Most resources were developed within the context where they were intended to be used. Identified gaps included a limited range of resources on intellectual disabilities, manuals for actively delivering training to staff in education settings and resources targeted at eastern European LMICs: future intervention development and adaptation efforts should address such gaps, to ensure capacity building materials exist for a sufficient variety of DD, settings and geographical areas. Beyond identifying these gaps, the value of the review lies in the compilation of summary tables of information on all freely available resources found, to support their selection and use in wider contexts. Information on the resource content, country of original development and copyright is provided to facilitate resource sharing and uptake.
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Affiliation(s)
- Elisa Genovesi
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, Addison House, Guy's Campus, London, SE11UL, UK.
| | - Yuan Ishtar Yao
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, Addison House, Guy's Campus, London, SE11UL, UK
| | - Emily Mitchell
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, Addison House, Guy's Campus, London, SE11UL, UK
| | - Michal Arad
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, Addison House, Guy's Campus, London, SE11UL, UK
| | - Victoria Diamant
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, Addison House, Guy's Campus, London, SE11UL, UK
| | - Areej Panju
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, Addison House, Guy's Campus, London, SE11UL, UK
| | - Charlotte Hanlon
- Centre for Global Mental Health, Department of Health Services and Population Research and WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE58AB, UK
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bethlehem Tekola
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, Addison House, Guy's Campus, London, SE11UL, UK
| | - Rosa A Hoekstra
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, Addison House, Guy's Campus, London, SE11UL, UK
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Zakirova-Engstrand R, Yakubova G. A scoping review of autism research conducted in Central Asia: Knowledge gaps and research priorities. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:342-354. [PMID: 37161788 PMCID: PMC10851649 DOI: 10.1177/13623613231170553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
LAY ABSTRACT Very little is known about the status of autism research in Central Asia. Through the library databases, we identified and reviewed 11 scientific studies conducted with autistic people and their families in five Central Asian countries-Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. Of the 11 studies, 10 were conducted in Kazakhstan and 1 in Uzbekistan. Within these limited number of research studies, different topics such as diagnosis, risk factors of autism, biology, and various service and intervention areas were addressed. We identified several knowledge gaps and research priorities to address the needs of autistic people, their families, and professionals in Central Asia.
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Lee JD, Terol AK, Yoon CD, Meadan H. Parent-to-parent support among parents of children with autism: A review of the literature. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:263-275. [PMID: 36588317 DOI: 10.1177/13623613221146444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
LAY ABSTRACT Parents of autistic children have long reported feelings of isolation and increased stress during and after receiving their child's diagnosis. Increasing global prevalence of autism also calls for increased services and supports to meet the needs of these families, but most parents who live in low-resource settings still report exacerbated barriers. This may indicate the need for diversifying intervention delivery models to increase contextual fit and enhance implementation effects for different populations. For example, many parents have reported parent-to-parent (P2P) model to be a source of emotional support, advocacy, and knowledge related to their child's diagnosis, and practical advice. However, little is known about this topic due to the lack of synthesis of relevant autism literature. To address this gap, we conducted a literature review to gain a deeper understanding of how P2P support is used. We identified 25 studies based on our inclusion and exclusion criteria, which we coded to extract variables such as demographic information of participants, types of P2P, dosage, target outcomes, and social validity. About half of studies focused on providing support groups for parents, and the other half focused on individual matching and mentoring for skill acquisition of parents. Across the included 25 studies, a total of 141 parents participated as parent mentors and 747 parents as parent mentees. We also present implications for future research.
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Montiel-Nava C, Vargas I, Gonzalez-Avila Z, Montenegro MC, Ramírez AC. Pilgrimage for an autism diagnosis: A study of Venezuelan parents' experiences. Transcult Psychiatry 2024; 61:95-106. [PMID: 37964582 DOI: 10.1177/13634615231211482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
It cannot be assumed that the experience of having an autistic child is the same across countries since demographic and systemic factors are as diverse as the manifestation of ASD symptomatology. This study explores the lived experiences of 20 Venezuelan parents after receiving an autism diagnosis for their child. Applied thematic analysis was used to analyze parental attitudes, challenges in identifying their child's delay, access to diagnostic services, beliefs towards autism, professional evaluations, family support, and perceptions toward health and educational services for autistic children. Venezuelan parents reported a generalized lack of autism awareness, an unsupportive school system, and judgment from their extended family. Despite the universal health coverage in the country, Venezuelan parents commented on the scarcity of services, as well as the lengthy and costly processes to receive an ASD diagnosis. The results support previous research findings showing that socioeconomic factors influence how parents experience the process of obtaining an autism diagnosis for their children. For most Venezuelan parents, it might imply a long journey in which limited resources and knowledge about autism will determine its route and length. For parents, cultural values and spiritual and religious beliefs will serve as both coping mechanisms and barriers to accessing services.
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Affiliation(s)
- Cecilia Montiel-Nava
- Department of Psychological Sciences, Universidad de Texas Rio Grande Valley, Edinburg, TX, USA
| | - Irina Vargas
- Escuela de Psicología, Universidad Rafael Urdaneta, Maracaibo, Venezuela
| | - Zoila Gonzalez-Avila
- Department of Child and Youth Mental Health, Vancouver Coastal Health, BC, Canada
| | | | - Ana C Ramírez
- Department of Psychological Sciences, Universidad de Texas Rio Grande Valley, Edinburg, TX, USA
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Clarke EB, McCauley JB, Lutz A, Gotelli M, Sheinkopf SJ, Lord C. Understanding profound autism: implications for stigma and supports. Front Psychiatry 2024; 15:1287096. [PMID: 38317766 PMCID: PMC10839016 DOI: 10.3389/fpsyt.2024.1287096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024] Open
Abstract
Introduction Societal perceptions and lack of understanding of autism spectrum disorder can be stigmatizing for autistic individuals and their families. This may be particularly the case for individuals who meet criteria for profound autism. Despite the considerable service needs of this marginalized group, there is little data on the prevalence of profound autism, nor on the experiences of those with profound autism and their families. Methods The current study leveraged a mixed-methods approach to address these gaps. First, the prevalence of profound autism was examined in six samples-three from the United States and three from Western Europe. Second, inductive thematic analysis was used to code interviews from 20 caregivers of profoundly autistic adults. Results The prevalence of profound autism varied widely across the six samples-from 11% to 48%. There were also notable differences between samples in prevalence by gender, race, and ethnicity. Two overarching themes were identified via inductive thematic analysis: Community Perceptions of Autism and Family Support Needs and Advocacy Challenges. Though caregivers were not directly asked about stigmatization during interviews, 85% of caregivers reported at least one instance of perceived stigma. Discussion Future research should continue to examine the unique needs and stigmatization experiences of profoundly autistic individuals and their families across the life course.
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Affiliation(s)
- Elaine B. Clarke
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - James B. McCauley
- Department of Psychology, St. Mary’s College of California, Moraga, CA, United States
| | - Amy Lutz
- Department of History and Sociology of Science, University of Pennsylvania, Philadelphia, PA, United States
| | - Marina Gotelli
- Fundación Brincar por un Autismo Feliz, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas Y Técnicas, Buenos Aires, Argentina
| | - Stephen J. Sheinkopf
- Thompson Center for Autism and Neurodevelopment, University of Missouri, Columbia, MO, United States
| | - Catherine Lord
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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Pillay S, Duncan M, de Vries PJ. 'We are doing damage control': Government stakeholder perspectives of educational and other services for children with autism spectrum disorder in South Africa. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:73-83. [PMID: 36510832 PMCID: PMC10771016 DOI: 10.1177/13623613221142111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
LAY ABSTRACT Autism spectrum disorder is a growing public health concern in low- and middle-income countries like South Africa where there are no plans or policies in place for autism spectrum disorder management. Many children with autism spectrum disorder in South Africa are out of schools and waiting for school placement to become available. This study explored the perspectives of key government stakeholders on educational and other services for children with autism spectrum disorder in the Western Cape Province of South Africa and their suggestion for improving services for these children and their families. Semi-structured interviews were conducted with government stakeholders from the Western Cape Department of Education, Department of Health and the Department of Social development. The main theme that emerged was 'We are doing damage control'. Government stakeholders acknowledged that autism spectrum disorder services were being overlooked because of other demands on government resources. Finding from this study highlighted the need for government departments to work together to develop a strategy for autism spectrum disorder management. Engagement between government and civil society to break down barriers, strengthen systems and develop solutions to improving access to services for children with autism spectrum disorder and their families is recommended.
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Dey I, Chakrabarty S, Nandi R, Shekhar R, Singhi S, Nayar S, Ram JR, Mukerji S, Chakrabarti B. Autism community priorities in diverse low-resource settings: A country-wide scoping exercise in India. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:187-198. [PMID: 36999343 PMCID: PMC10771024 DOI: 10.1177/13623613231154067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
LAY ABSTRACT It is vital to directly engage with the autism community in order to develop better services and drive the research agenda. While some studies in high-income countries have mapped the priorities of the autism community, there is a severe dearth of such efforts in the global south. Five million autistic individuals are estimated to live in India alone, and there has been little effort to map their priorities. Moreover, studies in high-income countries focused largely on research priorities, and not so much on skills training and interventions. Keeping these needs in mind, we conducted an online survey followed by an in-depth conversation with parents of autistic children and autistic adults drawn from across India. We found that the respondents reported self-help skills to be the most important for training, as they considered it fundamental for every other aspect of life. Speech and language therapy was considered to be the highest intervention priority for this group, highlighting the importance of social communication. Mental health counselling was also considered to be a high priority, but several parents identified it as being more relevant for themselves rather than for their children. Within research, the topmost priority was to understand ways in which the community can better support autistic people. We hope that these findings will help researchers, policymakers and service providers to be able to make well-informed decisions, develop relevant services and shape future research.
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Affiliation(s)
| | | | | | | | | | - Shoba Nayar
- Auckland University of Technology, New Zealand
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Zerihun T, Kinfe M, Koly KN, Abdurahman R, Girma F, Hanlon C, de Vries PJ, Hoekstra RA. Non-specialist delivery of the WHO Caregiver Skills Training Programme for children with developmental disabilities: Stakeholder perspectives about acceptability and feasibility in rural Ethiopia. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:95-106. [PMID: 37194191 PMCID: PMC10771020 DOI: 10.1177/13623613231162155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
LAY ABSTRACT Children with developmental disabilities including autism who live in low- and middle-income countries have very limited access to care and intervention. The World Health Organization initiated the caregiver skills training programme to support families with children with developmental disabilities. In Ethiopia, contextual factors such as poverty, low literacy and stigma may affect the success of the programme. In this study, we aimed to find out if the caregiver skills training programme is feasible to deliver in rural Ethiopia and acceptable to caregivers and programme facilitators. We trained non-specialist providers to facilitate the programme. Caregivers and non-specialist facilitators were asked about their experiences in interviews and group discussions. Caregivers found the programme relevant to their lives and reported benefits of participation. Facilitators highlighted the skills they had acquired but also emphasised the importance of support from supervisors during the programme. They described that some caregiver skills training programme topics were difficult to teach caregivers. In particular, the idea of play between caregiver and child was unfamiliar to many caregivers. Lack of available toys made it difficult to practise some of the caregiver skills training programme exercises. Participants indicated that the home visits and group training programme components of the caregiver skills training were acceptable and feasible, but there were some practical barriers, such as transportation issues and lack of time for homework practice. These findings may have importance to non-specialist delivery of the caregiver skills training programme in other low-income countries.
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Affiliation(s)
- Tigist Zerihun
- University of Cape Town, South Africa
- Saint Paul's Hospital Millennium Medical College, Ethiopia
| | | | - Kamrun Nahar Koly
- King's College London, UK
- International Centre for Diarrhoeal Disease Research, Bangladesh
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13
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Montiel-Nava C, Montenegro MC, Ramirez AC, Valdez D, Rosoli A, Garcia R, Garrido G, Cukier S, Rattazzi A, Paula CS. Age of autism diagnosis in Latin American and Caribbean countries. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:58-72. [PMID: 36602228 DOI: 10.1177/13623613221147345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
LAY ABSTRACT An earlier diagnosis of autism spectrum disorder might lead to earlier intervention. However, people living in Latin American and Caribbean countries do not have much knowledge about autism spectrum disorder symptoms. It has been suggested that the older a child is when diagnosed, the fewer opportunities he or she will have to receive services. We asked 2520 caregivers of autistic children in six different Latin America and Caribbean Countries, the child's age when they noticed some developmental delays and their child's age when they received their first autism spectrum disorder diagnosis. Results indicate that, on average, caregivers were concerned about their child's development by 22 months of age; however, the diagnosis was received when the child was 46 months of age. In addition, older children with better language abilities and public health coverage (opposed to private health coverage) were diagnosed later. On the contrary, children with other medical problems and more severe behaviors received an earlier diagnosis. In our study, children were diagnosed around the time they entered formal schooling, delaying the access to early intervention programs. In summary, the characteristics of the autistic person and the type of health coverage influence the age of diagnosis in children living in Latin America and Caribbean Countries.
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Affiliation(s)
| | | | | | - Daniel Valdez
- FLACSO, Argentina
- Universidad de Buenos Aires, Argentina
| | - Analia Rosoli
- Organización Estados Iberoamericanos para la Educación, la Ciencia y la Cultura (OEI), Dominican Republic
| | | | | | - Sebastian Cukier
- Programa Argentino para Niños, Adolescentes y Adultos con Condiciones del Espectro Autista (PANAACEA), Argentina
| | - Alexia Rattazzi
- Programa Argentino para Niños, Adolescentes y Adultos con Condiciones del Espectro Autista (PANAACEA), Argentina
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14
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Wanniachchi PM, Sumanasena SP. A short report on a preliminary interventional study to evaluate play-mediated interaction skills in caregivers of children with autism spectrum disorder from Sri Lanka. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:155-161. [PMID: 37942514 DOI: 10.1177/13623613231211370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
LAY ABSTRACT Most children with autism spectrum disorder live in low- and middle-income countries. Most of them do not have access to timely and culturally acceptable interventions. Research from high-income countries and low- and middle-income countries, such as Sri Lanka, show that parent-mediated intervention programmes improve functional outcomes, highlighting the importance of parents as partners. We undertook a preliminary study to evaluate how play-based parent coaching will enhance the parent interaction skills to promote social-emotional, cognitive and language skills in children with autism spectrum disorder aged 2-4 years. We evaluated how parents acquire interaction skills to engage with children using a caregiver skills assessment checklist adapted from freely accessible resources. Before and after training, all parent-child dyads participated in a 10-min video-recorded play session with a set of toys of their choice. Over the course of 2 weeks, all parents spent 2 h/day playing and interacting with the child to harness the desired skills. The results showed that the parental training had a positive effect on all 30 caregivers in gaining skills, with a significant improvement in all three domains with the highest impact on skills for social-emotional development. Overall, parents reported high levels of satisfaction on the training. The significant improvement in parent interaction skills was promising. However, further studies to look at the sustainability of the skills and the impact on children's overall development need to be looked into using larger and more generalised studies.
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Chee ZJ, Scheeren AM, De Vries M. The factor structure and measurement invariance of the Autism Spectrum Quotient-28: A cross-cultural comparison between Malaysia and the Netherlands. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:32-42. [PMID: 36632803 PMCID: PMC10771022 DOI: 10.1177/13623613221147395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
LAY ABSTRACT The AQ-28 is a questionnaire measuring autistic traits, that is, traits that are related to Autism Spectrum Conditions, but its reliability in other cultures has not been thoroughly evaluated. We, therefore, tested whether the properties of the AQ-28 are comparable between two countries with different cultures, Malaysia and the Netherlands. A total of 437 Malaysian and 818 Dutch participants completed the AQ-28 online. We measured whether the AQ-28 measures autistic traits similarly in Malaysia and the Netherlands. The AQ-28 measures autistic traits similarly, and the reliability was acceptable and good in the general population of Malaysia and the Netherlands, respectively. However, Malaysians scored higher than Dutch participants. Moreover, 11 AQ-28 items showed cultural bias, indicating that these items are answered/interpreted differently in Malaysia and the Netherlands. Cross-cultural differences in interpreting, reporting, and/or expressing autistic traits highlighted in this study could potentially explain why some items are culturally biased and why Malaysians score higher on these items. The findings of this work imply that cutoff scores derived from one culture should not be generalised to another culture. Moreover, the findings are informative for future development of culturally neutral or appropriate screening and diagnostic tools for autism.
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Mukherjee D, Bhavnani S, Lockwood Estrin G, Rao V, Dasgupta J, Irfan H, Chakrabarti B, Patel V, Belmonte MK. Digital tools for direct assessment of autism risk during early childhood: A systematic review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:6-31. [PMID: 36336996 PMCID: PMC10771029 DOI: 10.1177/13623613221133176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
LAY ABSTRACT The challenge of finding autistic children, and finding them early enough to make a difference for them and their families, becomes all the greater in parts of the world where human and material resources are in short supply. Poverty of resources delays interventions, translating into a poverty of outcomes. Digital tools carry potential to lessen this delay because they can be administered by non-specialists in children's homes, schools or other everyday environments, they can measure a wide range of autistic behaviours objectively and they can automate analysis without requiring an expert in computers or statistics. This literature review aimed to identify and describe digital tools for screening children who may be at risk for autism. These tools are predominantly at the 'proof-of-concept' stage. Both portable (laptops, mobile phones, smart toys) and fixed (desktop computers, virtual-reality platforms) technologies are used to present computerised games, or to record children's behaviours or speech. Computerised analysis of children's interactions with these technologies differentiates children with and without autism, with promising results. Tasks assessing social responses and hand and body movements are the most reliable in distinguishing autistic from typically developing children. Such digital tools hold immense potential for early identification of autism spectrum disorder risk at a large scale. Next steps should be to further validate these tools and to evaluate their applicability in a variety of settings. Crucially, stakeholders from underserved communities globally must be involved in this research, lest it fail to capture the issues that these stakeholders are facing.
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Affiliation(s)
- Debarati Mukherjee
- Indian Institute of Public Health - Bengaluru, Public Health Foundation of India, India
| | | | | | - Vaisnavi Rao
- Institute for Democracy and Economic Affairs (IDEAS), Malaysia
| | | | | | | | - Vikram Patel
- Child Development Group, Sangath, India
- Harvard Medical School, USA
- Harvard T.H. Chan School of Public Health, USA
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17
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de Jonge M, Boutjdir M, El-Korchi T, Torres H, Karpur A, Shih A, Elidrissi A. Urban and rural differences in needs, service use and satisfaction among caregivers of autistic children in Morocco. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:107-122. [PMID: 36800902 PMCID: PMC10771028 DOI: 10.1177/13623613221150086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
LAY ABSTRACT It is very important to understand the needs of caregivers to be able to empower caregivers and to develop or improve services around the world. Therefore, research in different regions is needed to understand differences in caregivers needs between countries, but also between areas within countries. This study investigated differences in needs and service use between caregivers of autistic children in Morocco, living in urban and rural areas. A total of 131 Moroccan caregivers of autistic children took part in the study and responded to an interview survey. The results showed both similarities and differences between urban and rural living caregivers' challenges and needs. Autistic children from urban communities were much more likely to receive intervention and attend school than children from rural communities, even though age and verbal skills of the two groups of children were comparable. Caregivers expressed similar needs for improved care and education, but different challenges in caring. Limited autonomy skills in children were more challenging to rural caregivers, while limited social-communicational skills were more challenging to urban caregivers. These differences may inform healthcare policy-makers and program developers. Adaptive interventions are important to respond to regional needs, resources, and practices. In addition, the results showed the importance of addressing challenges as experienced by caregivers such as costs related to care, barriers in access to information, or stigma. Addressing these issues may help reduce both global and within-country differences in autism care.
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Affiliation(s)
| | - Mohamed Boutjdir
- VA New York Harbor Healthcare System, USA
- State University of New York Downstate Health Sciences University, USA
- NYU Grossman School of Medicine, USA
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18
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Lee JD, Meadan H, Oyunbaatar E, Amar A. Strategies for capacity building in a low-resource setting: Stakeholders' voices. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:162-173. [PMID: 36165578 DOI: 10.1177/13623613221127077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Prevalence of autism is increasing all around the globe, but there is still great inequity in accessing evidence-based interventions. Although the field of autism research has made great strides in identifying and establishing evidence-based interventions, dissemination and implementation of these interventions have been reported as inequitable. This inequity is especially highlighted in many low-resource settings, such as Mongolia. As a field, there is still much to be learned about what strategies are used by stakeholders in low-resource settings to build capacity and to mitigate the hardships. To gain a deeper understanding of strategies for capacity building within a low-resource setting, we conducted five focus groups with 30 Mongolian caregivers of children with autism and 15 individual interviews with various professionals who work in Mongolia. These stakeholders reported three main strategies, including (a) partnership, (b) advocacy, and (c) empowerment, which included several strategies and implications on capacity-building practices. Furthermore, the findings from this study may suggest important implications for future intervention research.
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Buffle P, Armijos C, Naranjo A, Gentaz E. Feasibility of an observational procedure to enhance early identification of autism spectrum disorder in paediatric settings: A mixed-methods study on an Ecuadorian sample. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:84-94. [PMID: 37313623 PMCID: PMC10771021 DOI: 10.1177/13623613231175587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
LAY ABSTRACT In Ecuador, the low official estimate of the number of persons with autism spectrum disorder suggest that many children are not identified and are not receiving support. Screening tools are short parent-addressed questionnaires used to identify children that may be developing with autism. Their use is recommended, but their application can be perceived as challenging in paediatric routines. Some professionals prefer looking for autism-related behaviours in a child rather than using screening questionnaires. Although a short observation does not replace the use of validated screening questionnaires, tasks to guide the observation of autistic early signs can help professionals decide to screen or refer the family for assessment and early intervention. In this study, we tested observational tasks that could be adapted to the Ecuadorian paediatric contexts.
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Affiliation(s)
- Paulina Buffle
- University of Geneva, Switzerland
- Pontificia Universidad Católica del Ecuador, Ecuador
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20
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Ponzo S, May M, Tamayo-Elizalde M, Bailey K, Shand AJ, Bamford R, Multmeier J, Griessel I, Szulyovszky B, Blakey W, Valentine S, Plans D. App Characteristics and Accuracy Metrics of Available Digital Biomarkers for Autism: Scoping Review. JMIR Mhealth Uhealth 2023; 11:e52377. [PMID: 37976084 PMCID: PMC10692878 DOI: 10.2196/52377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Diagnostic delays in autism are common, with the time to diagnosis being up to 3 years from the onset of symptoms. Such delays have a proven detrimental effect on individuals and families going through the process. Digital health products, such as mobile apps, can help close this gap due to their scalability and ease of access. Further, mobile apps offer the opportunity to make the diagnostic process faster and more accurate by providing additional and timely information to clinicians undergoing autism assessments. OBJECTIVE The aim of this scoping review was to synthesize the available evidence about digital biomarker tools to aid clinicians, researchers in the autism field, and end users in making decisions as to their adoption within clinical and research settings. METHODS We conducted a structured literature search on databases and search engines to identify peer-reviewed studies and regulatory submissions that describe app characteristics, validation study details, and accuracy and validity metrics of commercial and research digital biomarker apps aimed at aiding the diagnosis of autism. RESULTS We identified 4 studies evaluating 4 products: 1 commercial and 3 research apps. The accuracy of the identified apps varied between 28% and 80.6%. Sensitivity and specificity also varied, ranging from 51.6% to 81.6% and 18.5% to 80.5%, respectively. Positive predictive value ranged from 20.3% to 76.6%, and negative predictive value fluctuated between 48.7% and 97.4%. Further, we found a lack of details around participants' demographics and, where these were reported, important imbalances in sex and ethnicity in the studies evaluating such products. Finally, evaluation methods as well as accuracy and validity metrics of available tools were not clearly reported in some cases and varied greatly across studies. Different comparators were also used, with some studies validating their tools against the Diagnostic and Statistical Manual of Mental Disorders criteria and others through self-reported measures. Further, while in most cases, 2 classes were used for algorithm validation purposes, 1 of the studies reported a third category (indeterminate). These discrepancies substantially impact the comparability and generalizability of the results, thus highlighting the need for standardized validation processes and the reporting of findings. CONCLUSIONS Despite their popularity, systematic evaluations and syntheses of the current state of the art of digital health products are lacking. Standardized and transparent evaluations of digital health tools in diverse populations are needed to assess their real-world usability and validity, as well as help researchers, clinicians, and end users safely adopt novel tools within clinical and research practices.
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Affiliation(s)
- Sonia Ponzo
- Healios Limited, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Merle May
- Healios Limited, London, United Kingdom
| | | | | | - Alanna J Shand
- Healios Limited, London, United Kingdom
- Institute of Epidemiology and Healthcare, University College London, London, United Kingdom
| | | | | | | | | | - William Blakey
- Healios Limited, London, United Kingdom
- School of Computing, Engineering and Physical Sciences, University of the West of Scotland, Paisley, United Kingdom
| | | | - David Plans
- Healios Limited, London, United Kingdom
- Department of Psychology, Royal Holloway, University of London, London, United Kingdom
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21
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Szatmari P. Editorial: The Importance of Screening for Developmental Disorders and Demonstrating Improved Health Outcomes. J Am Acad Child Adolesc Psychiatry 2023; 62:1086-1088. [PMID: 36958406 DOI: 10.1016/j.jaac.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/14/2023] [Indexed: 03/25/2023]
Abstract
Screening for emotional, behavioral, and developmental disorders is generally considered to be a valuable activity in the child and youth developmental and mental health service sectors. The premise is that screening allows for early identification, which in turn allows for early intervention, which in turn leads to better long-term outcomes. While the hypothesized causal chain from screening to outcomes may seem long, the evidence base to support this aspiration is growing. In this issue of the Journal, the article by Rah et al.1 provides an important piece of the puzzle to support screening for developmental disorders in early childhood in particular and has a number of important lessons for the field.
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Affiliation(s)
- Peter Szatmari
- Centre for Addiction and Mental Health, University of Toronto, Toronto Ontario, Canada.
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22
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Male I, Farr W, Bremner S, Gage H, Williams P, Gowling E, Honey E, Gain A, Parr J. An observational study of individual child journeys through autism diagnostic pathways, and associated costs, in the UK National Health Service. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1119288. [PMID: 37350848 PMCID: PMC10283036 DOI: 10.3389/fresc.2023.1119288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/02/2023] [Indexed: 06/24/2023]
Abstract
Background Demand for diagnostic assessment in children with possible autism has recently increased significantly. Services are under pressure to deliver timely and high-quality diagnosis, following National Institute and Care Excellence multidisciplinary assessment guidelines. This UK National Health Service study aimed to answer: how many hours of health professional time are required to deliver autism diagnostic assessment, and how much does this cost?. Method Case notes of 20 children (1-16 yrs.) from 27 NHS trusts, assessed through an autism diagnostic pathway in the previous year, were examined retrospectively. Data included: hours of professional time, diagnostic outcome. Assessment costs calculated using standardised NHS tariffs. Results 488 children (aged 21-195 months, mean 82.9 months, SD 39.36) from 22 Child Development Services (CDS), four Child and Adolescent Mental Health Services (CAMHS) and one tertiary centre; 87% were either under 5 (36%) or 5 to 11 years (51%). Children seen by CDS were younger than CAMHS (mean (SD) 6.10 (2.72) vs. 10.39 (2.97) years, p < 0.001). Mean days to diagnosis were 375 (SD 235), with large variation (range 41-1553 days). Mean hours of professional time per child was 11.50 (SD 7.03) and varied substantially between services and individuals. Mean cost of assessment was £846.00 (SD 536.31). 339 (70.0%) children received autism diagnosis with or without comorbidity; 54 (11%) received no neurodevelopmental diagnosis; 91 (19%) received alternative neurodevelopmental diagnoses. Children with one or more coexisting conditions took longer to diagnose, and assessment was more costly, on average 117 days longer, costing £180 more than a child with no neurodevelopmental diagnosis. Age did not predict days to diagnosis or assessment costs. Conclusion Typical assessment took 11 h of professional time and over 12-months to complete, costing GB£850 per child. Variation between centres and children reflect differences in practice and complexity of diagnostic presentation. These results give information to those delivering/planning autism assessments using multi-disciplinary team approach, in publicly funded health systems. Planning of future diagnostic services needs to consider growing demand, the need for streamlining, enabling context appropriate services, and child/family complexity.
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Affiliation(s)
- Ian Male
- Research Department, Sussex Community NHS Foundation Trust, West Sussex, United Kingdom
- Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - William Farr
- Research Department, Sussex Community NHS Foundation Trust, West Sussex, United Kingdom
- Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
- Faculty of Education, University of Cambridge, Cambridge, United Kingdom
| | - Stephen Bremner
- Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Heather Gage
- School of Biosciences and Medicine, University of Surrey, Guildford, United Kingdom
| | - Peter Williams
- School of Mathematics, University of Surrey, Guildford, United Kingdom
| | - Emma Gowling
- Geriatrics, Queen Alexandra Hospital, Cosham, United Kingdom
| | - Emma Honey
- Paediatrics, Northumberland Tyne and Wear National Health Service, Newcastle Upon Tyne, United Kingdom
| | - Aaron Gain
- Public Health, University of Brighton, Brighton, UK
| | - Jeremy Parr
- Paediatrics, Northumberland Tyne and Wear National Health Service, Newcastle Upon Tyne, United Kingdom
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
- Faculty of Medical Sciences, Great North Children's Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
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23
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Mahajan R, Sagar R. Adequate Management of Autism Spectrum Disorder in Children in India. Indian J Pediatr 2023; 90:387-392. [PMID: 36173539 DOI: 10.1007/s12098-022-04352-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 08/04/2022] [Indexed: 11/05/2022]
Abstract
Despite the significant burden of neurodevelopmental disorders such as autism spectrum disorder (ASD) in India, there are areas of unmet needs at every level of the health care system. This includes screening and recognition, reliable and valid tools to evaluate, and to adequately manage ASD. There are also gaps in education and training of medical professionals, paraprofessionals, special education teachers and the related services. Lack of public awareness and cultural factors contribute to delays in early recognition and interventions. A framework is suggested to address these unmet needs at various levels to improve the care of these children with ASD. These include a) a focus on education of medical professionals, paraprofessionals, and teachers; b) setting up infrastructure at community, regional, and statewide levels, with adequate funding; and c) use of audiovisual technology and collaboration with international expertise.
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Affiliation(s)
- Rajneesh Mahajan
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA. .,Department of Psychiatry, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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Kang L, Liu J, Liu Y, Liang W, Yang F, Liu M. Global, regional, and national disease burden of autism spectrum disorder among children under 5 years from 1990 to 2019: An analysis for the Global Burden of Disease 2019 Study. Asian J Psychiatr 2023; 79:103359. [PMID: 36462389 DOI: 10.1016/j.ajp.2022.103359] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/15/2022] [Accepted: 11/25/2022] [Indexed: 11/28/2022]
Abstract
AIM To estimate the trend in burden of autism spectrum disorder (ASD) at global, regional, and national levels from 1990 to 2019. METHODS Annual incident cases, incidence rates, prevalent cases, prevalence rates, disability-adjusted life years (DALYs), and DALY rates of ASD among children under 5 years from 1990 to 2019 were collected from the Global Burden of Diseases Study 2019. The percentage of relative changes in cases and the estimated annual percentage changes (EAPCs) of rates were calculated to reflect the temporal trends of ASD burden. Pearson correlation analysis was used to explore the influential factors for EAPC. RESULTS Globally, the incidence rate, prevalence rate, and DALY rate of ASD among children under 5 years were 91.09 per 100,000, 439.39 per 100,000, and 68.67 per 100,000 in 2019, respectively. From 1990-2019, the incidence rate decreased (EAPC = -0.09, 95% confidence interval [CI] -0.12 to -0.06), whereas the prevalence rate (EAPC=0.08, 95%CI 0.06-0.09) and DALY rate (EAPC=0.08, 95%CI 0.07-0.10) increased. The largest increases in prevalent cases (80.26%) and DALYs (81.24%) were found in low SDI regions, while High-income North America experienced the fastest increase in incidence rate, prevalence rate, and DALY rate. Moreover, the burden of ASD among male children under 5 years was approximately three times that among female children, despite the slight narrowing of gender disparity. The EAPC of incidence rate was positively correlated with SDI and UHCI in 2019 (P < 0.001). CONCLUSION ASD is a noticeable child neurodevelopmental syndrome. More attention should be given to early screening, diagnosis, and intervention, particularly in resource-limited areas.
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Affiliation(s)
- Liangyu Kang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yan Liu
- School of Mental Health, Jining Medical University, Jining, China
| | - Wannian Liang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Fude Yang
- Beijing Huilongguan Hospital, Peking University Huilonguan Clinical Medical School, Beijing, China.
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
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25
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Talantseva OI, Romanova RS, Shurdova EM, Dolgorukova TA, Sologub PS, Titova OS, Kleeva DF, Grigorenko EL. The global prevalence of autism spectrum disorder: A three-level meta-analysis. Front Psychiatry 2023; 14:1071181. [PMID: 36846240 PMCID: PMC9947250 DOI: 10.3389/fpsyt.2023.1071181] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
UNLABELLED Autism spectrum disorder (ASD) is one the most disabling developmental disorders, imposing an extremely high economic burden. Obtaining as accurate prevalence estimates as possible is crucial to guide governments in planning policies for identification and intervention for individuals with ASD and their relatives. The precision of prevalence estimates can be heightened by summative analyses of the data collected around the world. To that end, we conducted a three-level mixed-effects meta-analysis. A systematic search of the Web of Science, PubMed, EMBASE, and PsycINFO databases from 2000 up to 13 July 2020 was performed, and reference lists of previous reviews and existing databases of prevalence studies were screened. Overall, 79 studies were included in the analysis of ASD and 59-in the analysis of previously existing relevant diagnoses: 30 for Autistic Disorder (AD), 15 for Asperger Syndrome (AS), and 14 for Atypical Autism (AA) and Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS); these research reports covered the period from 1994 to 2019. Pooled prevalence estimates were 0.72% (95% CI = 0.61-0.85) for ASD, 0.25% (95% CI = 0.18-0.33) for AD, 0.13% (95% CI = 0.07-0.20) for AS, and 0.18% (95% CI = 0.10-0.28) for the combined group of AA and PDD-NOS. Estimates were higher (1) for the studies that used records-review surveillance rather than other designs; (2) in North America compared with other geographical regions; and (3) in high-income compared with lower-income countries. The highest prevalence estimates were registered in the USA. There was an increase in autism prevalence estimates over time. The prevalence was also significantly higher for children aged between 6 and 12 years compared to children under the age of 5 and over the age of 13 years. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019131525, identifier CRD42019131525.
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Affiliation(s)
- Oksana I Talantseva
- Center for Cognitive Sciences, Sirius University of Science and Technology, Sirius, Russia.,Laboratory of Translational Developmental Sciences, Department of Psychology, Saint Petersburg State University, Saint Petersburg, Russia
| | - Raisa S Romanova
- Center for Cognitive Sciences, Sirius University of Science and Technology, Sirius, Russia
| | - Ekaterina M Shurdova
- Laboratory of Translational Developmental Sciences, Department of Psychology, Saint Petersburg State University, Saint Petersburg, Russia
| | - Tatiana A Dolgorukova
- Laboratory of Translational Developmental Sciences, Department of Psychology, Saint Petersburg State University, Saint Petersburg, Russia
| | - Polina S Sologub
- Laboratory of Translational Developmental Sciences, Department of Psychology, Saint Petersburg State University, Saint Petersburg, Russia
| | - Olga S Titova
- Laboratory of Translational Developmental Sciences, Department of Psychology, Saint Petersburg State University, Saint Petersburg, Russia
| | - Daria F Kleeva
- Center for Bioelectric Interfaces, National Research University Higher School of Economics, Moscow, Russia
| | - Elena L Grigorenko
- Center for Cognitive Sciences, Sirius University of Science and Technology, Sirius, Russia.,Laboratory of Translational Developmental Sciences, Department of Psychology, Saint Petersburg State University, Saint Petersburg, Russia.,Department of Psychology, University of Houston, Houston, TX, United States.,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, United States.,Child Study Center, Yale University, New Haven, CT, United States
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Overview of Services for Autism Spectrum Disorders (ASD) in Low- and Middle-Income Countries (LMICs) and among Immigrants and Minority Groups in High-Income Countries (HICs). Brain Sci 2022; 12:brainsci12121682. [PMID: 36552142 PMCID: PMC9775866 DOI: 10.3390/brainsci12121682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Autism spectrum disorder (ASD) prevalence is rising [...].
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Mahony C, O'Ryan C. A molecular framework for autistic experiences: Mitochondrial allostatic load as a mediator between autism and psychopathology. Front Psychiatry 2022; 13:985713. [PMID: 36506457 PMCID: PMC9732262 DOI: 10.3389/fpsyt.2022.985713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022] Open
Abstract
Molecular autism research is evolving toward a biopsychosocial framework that is more informed by autistic experiences. In this context, research aims are moving away from correcting external autistic behaviors and toward alleviating internal distress. Autism Spectrum Conditions (ASCs) are associated with high rates of depression, suicidality and other comorbid psychopathologies, but this relationship is poorly understood. Here, we integrate emerging characterizations of internal autistic experiences within a molecular framework to yield insight into the prevalence of psychopathology in ASC. We demonstrate that descriptions of social camouflaging and autistic burnout resonate closely with the accepted definitions for early life stress (ELS) and chronic adolescent stress (CAS). We propose that social camouflaging could be considered a distinct form of CAS that contributes to allostatic overload, culminating in a pathophysiological state that is experienced as autistic burnout. Autistic burnout is thought to contribute to psychopathology via psychological and physiological mechanisms, but these remain largely unexplored by molecular researchers. Building on converging fields in molecular neuroscience, we discuss the substantial evidence implicating mitochondrial dysfunction in ASC to propose a novel role for mitochondrial allostatic load in the relationship between autism and psychopathology. An interplay between mitochondrial, neuroimmune and neuroendocrine signaling is increasingly implicated in stress-related psychopathologies, and these molecular players are also associated with neurodevelopmental, neurophysiological and neurochemical aspects of ASC. Together, this suggests an increased exposure and underlying molecular susceptibility to ELS that increases the risk of psychopathology in ASC. This article describes an integrative framework shaped by autistic experiences that highlights novel avenues for molecular research into mechanisms that directly affect the quality of life and wellbeing of autistic individuals. Moreover, this framework emphasizes the need for increased access to diagnoses, accommodations, and resources to improve mental health outcomes in autism.
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Affiliation(s)
| | - Colleen O'Ryan
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
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28
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Genovesi E, Jakobsson C, Nugent L, Hanlon C, Hoekstra RA. Stakeholder experiences, attitudes and perspectives on inclusive education for children with developmental disabilities in sub-Saharan Africa: A systematic review of qualitative studies. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1606-1625. [PMID: 35635316 PMCID: PMC9483198 DOI: 10.1177/13623613221096208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT In sub-Saharan Africa, there are few services for children with developmental disabilities such as autism and intellectual disability. One way to support these children is to include them in mainstream schools. However, currently, African children with developmental disabilities are often excluded from mainstream education opportunities. People involved (e.g. teachers, families and children) can offer information on factors that could ease or interfere with inclusion. This article discusses the findings of published studies that explored the views of relevant groups on including children with developmental disabilities in mainstream schools in sub-Saharan Africa. We systematically searched the literature and identified 32 relevant articles from seven countries in sub-Saharan Africa. We found that unclear policies and insufficient training, resources and support for teachers often blocked the implementation of inclusive education. Factors in favour of inclusive education were the commitment of many teachers to include pupils with developmental disabilities and the work of non-governmental organisations (NGOs), which provided resources and training. This review suggests that motivated teachers should be provided with appropriate training, resources and support for inclusive education, directly and by promoting the work of NGOs.
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Affiliation(s)
| | | | - Lena Nugent
- University Medical Center Hamburg-Eppendorf, Germany
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Szlamka Z, Hanlon C, Tekola B, Pacione L, Salomone E, Servili C, Hoekstra RA. Exploring contextual adaptations in caregiver interventions for families raising children with developmental disabilities. PLoS One 2022; 17:e0272077. [PMID: 36170237 PMCID: PMC9518887 DOI: 10.1371/journal.pone.0272077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 07/12/2022] [Indexed: 11/30/2022] Open
Abstract
There are increasing efforts to scale up services globally for families raising children with developmental disabilities (DDs). Existing interventions, often developed in high income, Western settings, need substantial adaptation before they can be implemented in different contexts. The aim of this study was to explore perspectives on the role that context plays in the adaptation and implementation of interventions targeting caregivers of children with DDs across settings. The study question was applied to the Caregiver Skills Training (CST) programme of the World Health Organization specifically, as well as to stakeholder experiences with caregiver interventions more broadly. Two focus group discussions (FGDs; n = 15 participants) and 25 individual semi-structured interviews were conducted. Participants were caregivers of children with DDs and professionals involved in adapting or implementing the CST across five continents and different income settings. Data were analysed thematically. Four main themes were developed: 1) Setting the scene for adaptations; 2) Integrating an intervention into local public services; 3) Understanding the reality of caregivers; 4) Challenges of sustaining an intervention. Informants thought that contextual adaptations were key for the intervention to fit in locally, even more so than cultural factors. The socio-economic context of caregivers, including poverty, was highlighted as heavily affecting service access and engagement with the intervention. Competing health priorities other than DDs, financial constraints, and management of long-term collaborations were identified as barriers. This study validates the notion that attention to contextual factors is an essential part of the adaptation of caregiver interventions for children with DDs, by providing perspectives from different geographical regions. We recommend a stronger policy and research focus on contextual adaptations of interventions and addressing unmet socio-economic needs of caregivers.
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Affiliation(s)
- Zsofia Szlamka
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- * E-mail:
| | - Charlotte Hanlon
- Centre for Global Mental Health, Department of Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bethlehem Tekola
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Laura Pacione
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
- Department of Psychiatry, Division of Child and Youth Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Erica Salomone
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - WHO CST Team
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Rosa A. Hoekstra
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
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Dursun OB, Turan B, Öğütlü H, Binici NC, Örengül AC, Alataş E, Özdemir RM, Taşlıbeyaz E, Karaman S, Mukaddes NM, on behalf of Turkish Autism Workgroup, Alkaşi A, Bozkurt A, Güneş A, Çevikaslan A, Erol A, Kiliçoğlu AG, Karayağmurlu A, Beşenek AM, Aral A, Adanir AS, Birdir A, Mustan AT, Karaboğa AEÇ, Çiçek AU, Arman A, Ayaz AB, Büyükaslan A, Ay B, Ayik B, Karabucak B, Şahin B, Kalayci BM, Ocakoğlu BK, Özgür BG, Özcan BG, Karakpici B, Tumba C, İnce C, Tanıdır C, Mutlu C, Ceylan C, Kaya C, Achmet CCC, Aslan C, Yalvaç ÇT, Yektaş Ç, Bilginer Ç, Çildir DA, Yıldız D, Sapmaz D, Ayyıldız D, Varmış DA, Güntepe D, Yılmaz D, Kaba D, Karagöz D, Kınay D, Türe ES, Topçu E, Şentürk E, İşeri E, Özen E, Taşyürek E, Atabay E, Çöp E, Güney E, Güzel E, Aşıkhasanoglu EÖ, Demirdöğen EŞ, Çelebi F, Özbek F, Durmuş FB, Ari F, Yıldırım F, Gümüştaş F, Güven G, Yücel Gİ, Coşun GN, Ulaş G, Bulut GÇ, Ayaz G, Karaçetin G, Dinç GŞ, Kara H, Harmancı H, Toz Hİ, Aykutlu HC, Kandemir H, Güneş H, Genç HA, Gül H, Doğru H, Adaletli H, Kılıç HT, Aktaş H, Esin İS, Erdoğan İ, Kaya İ, Çimen İD, Kirtil İY, Nalbant K, Tarakçıoğlu MC, Çakır M, Kara MZ, Kinik MF, Karadağ M, Sertçelik M, Şahin M, Keleş M, Topal M, Terzioğlu MA, Çolpan M, Demirtaş ME, Onat M, Usta MB, Coşkun M, Gülşen M, Erkan MC, Bahalı MK, Demir N, Çetin NK, Kilit N, Ayaz N, Çetin NY, Nilüfer, Aliyev O, Demir N, Şimşek NE, Ünaldi N, Soylu N, Bilgin N, Fındık OTP, Yüzügüldü O, Demir O, Kocaman O, Tuncer ÖF, Küçük Ö, Üneri Ö, Çoban ÖG, Yalçin Ö, Hekim Ö, Keskiner Ö, Uzun Ö, Algedik P, Yılmaz R, Bostan R, Sanberk S, Gün SE, Yilmaz S, Aksu S, Özkan S, Hesapçioğlu ST, Erden S, Arslan SC, Çelenay S, Kala S, Nasiroğlu S, Karakoç S, Çiçek S, Hocaoğlu S, Avcil S, Derin S, Yilmaz SS, Fırat S, Eray Ş, Kilinçel Ş, Coşkun Ş, Uysal T, Kadak T, Karaosman T, Mutluer T, Soylemez TE, Kalyoncu T, Fidan T, Kaytanli U, Gündoğdu Ü, Gündüz Y, Torun YT, Yulaf Y, Güleş Z, Babadaği Z. A new model for recognition, referral, and follow‐up of autism spectrum disorder: A nationwide program. Autism Res 2022. [DOI: 10.1002/aur.2813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Onur Burak Dursun
- General Directorate of Health Services, Autism, Mental Special Needs and Rare Diseases Department Turkish Ministry of Health Ankara Turkey
| | - Bahadır Turan
- Department of Child and Adolescent Psychiatry Karadeniz Technical University Trabzon Turkey
| | - Hakan Öğütlü
- Department of Child and Adolescent Psychiatry Ankara City Hospital Ankara Turkey
| | - Nagihan Cevher Binici
- Department of Child and Adolescent Psychiatry Dr. Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital Izmır Turkey
| | | | - Esra Alataş
- General Directorate of Public Health Turkish Ministry of Health Ankara Turkey
| | - Rabia Madan Özdemir
- General Directorate of Health Services, Autism, Mental Special Needs and Rare Diseases Department Turkish Ministry of Health Ankara Turkey
| | - Elif Taşlıbeyaz
- Faculty of Computer and Instructional Technologies Education Erzincan University Erzincan Turkey
| | - Selçuk Karaman
- Department of Management and Information Systems Hacı Bayram Veli University Ankara Turkey
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Naithani L, Goldie C, Kaur A, Butter C, Lakhera S, Leadbitter K, Divan G. Early Autism Intervention Components Deliverable by Non-specialists in Low- and Middle-Income Countries: A Scoping Review. Front Psychiatry 2022; 13:914750. [PMID: 35845443 PMCID: PMC9277121 DOI: 10.3389/fpsyt.2022.914750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/23/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction The past decade has seen key advances in early intervention for autistic children in high-income countries, with most evidence based on specialist delivery of interventions. The care gap seen in low- and middle-income countries (LMIC) remains close to 100%. A key challenge in addressing this care gap concerns the paucity of specialists available to deliver services. Task-sharing provides an important potential solution; there is a need to identify interventions that are suitable for scaled-up delivery through task-sharing in low-resourced settings. We aimed to conduct a scoping review to identify studies which reported autism intervention delivered by non-specialists within LMIC and, using established frameworks, specify intervention components with evidence of successful non-specialist delivery. Methods A scoping literature search, conducted within four databases, generated 2,535 articles. Duplicates were removed, followed by screening of titles and abstracts, with 10% double-rated for reliability. 50 full text articles were then screened independently by two raters. Articles were included if studies: (a) were conducted in LMIC; (b) included samples of autistic children (age < 10); (c) evaluated psycho-social interventions delivered by non-specialists; (d) reported child outcomes; and (e) were peer-reviewed full-texts in English. Two established frameworks - @Practicewise and NDBI-Fi framework - were then used to ascertain the commonly delivered components of these interventions. Results Two studies met the inclusion criteria. Both studies evaluated parent-mediated interventions delivered by non-specialists in South Asia. Through the two frameworks, we identified elements and techniques that had been delivered successfully by non-specialists. Conclusion There is evidence from two acceptability and feasibility trials that non-specialists can be trained to deliver some intervention elements and techniques within parent-mediated interventions, with good fidelity and acceptability and evidence of effectiveness. The review points up the lack of a widespread evidence base in this area and need for further research in low resourced settings, including well-powered trials and mechanistic analyses to identify active ingredients. A focus on the pre-requisites for non-specialist delivery is critical to reduce inequity and provide universal health coverage within resource-constrained health systems.
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Affiliation(s)
| | - Caitlin Goldie
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, United Kingdom
| | | | - Charlotte Butter
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, United Kingdom
| | | | - Kathy Leadbitter
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, United Kingdom
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Hoekstra RA. Serving the underserved: How can we reach autism families who systemically miss out on support? AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1315-1319. [PMID: 35757982 DOI: 10.1177/13623613221105389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Totsika V, Liew A, Absoud M, Adnams C, Emerson E. Mental health problems in children with intellectual disability. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:432-444. [PMID: 35421380 DOI: 10.1016/s2352-4642(22)00067-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 12/16/2022]
Abstract
Intellectual disability ranks in the top ten causes of disease burden globally and is the top cause in children younger than 5 years. 2-3% of children have an intellectual disability, and about 15% of children present with differences consistent with an intellectual disability (ie, global developmental delay and borderline intellectual functioning). In this Review, we discuss the prevalence of mental health problems, interventions to address these, and issues of access to treatment and services. Where possible, we take a global perspective, given most children with intellectual disability live in low-income and middle-income countries. Approximately 40% of children with intellectual disability present with a diagnosable mental disorder, a rate that is at least double that in children without intellectual disability. Most risk factors for poor mental health and barriers to accessing support are not unique to people with intellectual disability. With proportionate universalism as the guiding principle for reducing poor mental health at scale, we discuss four directions for addressing the mental health inequity in intellectual disability.
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Affiliation(s)
- Vasiliki Totsika
- Division of Psychiatry, University College London, London, UK; Department of Psychiatry, Centre for Developmental Psychiatry and Psychology, Monash University, Melbourne, VIC, Australia; Centre for Educational Development Appraisal and Research (CEDAR), University of Warwick, Coventry, UK; Tavistock & Portman NHS Foundation Trust, London, UK.
| | - Ashley Liew
- Centre for Educational Development Appraisal and Research (CEDAR), University of Warwick, Coventry, UK; National & Specialist CAMHS, South London and Maudsley NHS Foundation Trust, London, UK; Department of Children's Neurosciences, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK; Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Michael Absoud
- Department of Children's Neurosciences, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK; Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Colleen Adnams
- Division of Intellectual Disability, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Eric Emerson
- Centre for Disability Research, Faculty of Health & Medicine, Lancaster University, Lancaster, UK; Centre for Disability Research & Policy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Green J, Leadbitter K, Ainsworth J, Bucci S. An integrated early care pathway for autism. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:335-344. [PMID: 35303486 DOI: 10.1016/s2352-4642(22)00037-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 01/17/2023]
Abstract
In this Viewpoint, we argue for the need to reconceptualise an integrated early-care provision for autistic children in the light of their enduring support needs and relevant new findings from developmental and intervention research. This model goes beyond short-term reactive care to outline an early proactive, evidenced, developmentally phased, and scalable programme of support for autistic children and their families from the earliest opportunity, with timely access to later step-up care when needed. We also integrate this model with emerging opportunities from data science and digital health technologies as a potential facilitator of such a pathway. Building on this work, we argue that the best current autism intervention evidence can be integrated with concepts and evidence gained in the management of other enduring health conditions to support an autistic child and their family through their early development. The aim is to improve those children's social communication abilities, expand their range and flexibility of interests, and mitigate any negative impacts of sensory difficulties and restricted, repetitive behaviours on the child and their family wellbeing. The pathway solutions described could also be adapted for older adolescents and adults and could be used within the health systems of different countries, including within low-income and middle-income contexts.
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Affiliation(s)
- Jonathan Green
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Manchester, UK; Department of Child and Adolescent Mental Health, Manchester Royal Children's Hospital, Manchester, UK.
| | - Kathy Leadbitter
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Manchester, UK
| | - John Ainsworth
- Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine, and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine, and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK; Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Autism Children and English Vocabulary Learning: A Qualitative Inquiry of the Challenges They Face in Their English Vocabulary Learning Journey. CHILDREN 2022; 9:children9050628. [PMID: 35626806 PMCID: PMC9140079 DOI: 10.3390/children9050628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022]
Abstract
Language learning is one of the most important aspects of an individual’s life development and growth. Normal learners’ English language acquisition differs depending on their preferences and learning styles. Children with autism, on the other hand, appear to have different learning methods and routines. There has been a lot of previous work on the language learning styles of normal learners, but not much on the language learning path of children with autism. Due to that, this study aims at investigating the challenges children with autism face in their English vocabulary learning. Observations and focus group discussions were conducted with 45 children with autism, 4 autism education teachers, 2 occupational therapists and a parent of children with mild autism children to investigate the challenges autism children face in their vocabulary learning. The findings have gathered that autistic children encounter a few challenges occasionally in their English vocabulary learning journey. The data were gathered and arranged thematically. Further recommendations and suggestions are discussed in this study.
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‘AReal-Vocab’: An Augmented Reality English Vocabulary Mobile Application to Cater to Mild Autism Children in Response towards Sustainable Education for Children with Disabilities. SUSTAINABILITY 2022. [DOI: 10.3390/su14084831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The American Psychiatric Association defines autism spectrum disorder as a neurological illness, in which children with the disorder have trouble communicating socially or have a set of behaviours that are recurrent or restricted. Autism learners are mostly visual method learners who learn best through pictures and visuals. Most learners with autism struggle to learn new terminology due to their cognitive difficulties, and with the advent of the Fourth Industrial Revolution, technology is no longer a foreign concept in the educational sphere. The usage of augmented reality technology has proven to be beneficial in offering more relevant learning sessions for autism learners. As a result, underpinned by the learning theories of behaviourism, constructivism, connectives and cognitivism, altogether with the theory of mind and Frame model, an augmented reality smartphone application, called ‘AReal-Vocab’, was created to assist children with mild autism in acquiring English vocabulary. The design and development research approach was employed in this study, in which later, the developed mobile augmented reality application was then tested on six mildly autistic youngsters to see how well the designed and developed augmented reality mobile application aided them in acquiring the English language. The AReal-Vocab mobile application, which was planned and built, has had an impact on the English-vocabulary learning of children with moderate autism, according to the findings. Not only has AReal-Vocab helped mildly autistic children learn English vocabulary in a more engaging and meaningful way, sparking their interest in the language learning process, but it also serves as a platform for instilling leisure learning at home, as well as stimulating pronunciation skills and language articulation. The findings of this study are expected to benefit all parties involved, particularly children with autism, autism educators, and parents of children with autism.
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Samadi SA, McConkey R, Nuri H, Abdullah A, Ahmad L, Abdalla B, Biçak CA. Screening Children for Autism Spectrum Disorders in Low- and Middle-Income Countries: Experiences from the Kurdistan Region of Iraq. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084581. [PMID: 35457465 PMCID: PMC9032855 DOI: 10.3390/ijerph19084581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/29/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023]
Abstract
Screening tools for the early identification of developmental disabilities are strongly advised, yet culturally valid tools are not readily available for use in low- and middle-income countries. The present study describes the context and the processes used to develop a suitable screening procedure for use in the Kurdistan region of Iraq. This was based on an autism rating scale—GARS-3—developed in the USA for use primarily with children’s parents. It was administered to three groups of children: those with a pre-existing diagnosis of ASD; those with a confirmed diagnosis of a developmental disability; and those who were typically developing—735 participants in all. The 10 items from the 58 items in the full GARS-3 scale that best discriminated the three groups of children were identified. Subsequent analysis confirmed that the ten-item summary scores had reasonable internal reliabilities, with a good specificity and sensitivity in distinguishing children with ASD from those that were typically developing but less so for children with other developmental disabilities. The study confirms the universality of autism symptoms but also the different emphasis Kurdish parents may place on them. Nevertheless, screening procedures need to be developed in the context of support services that can undertake follow-up diagnostic assessments and provide suitable interventions for use by parents to promote their child’s development. The study provides an example of how this can be possible in low- and middle-income countries.
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Affiliation(s)
- Sayyed Ali Samadi
- Institute of Nursing Research, Ulster University, Newtownabbey BT37 0QB, Northern Ireland, UK;
- Bahoz Centre for Children with Developmental Disabilities, Erbil 44000, The Kurdistan Region of Iraq, Iraq
| | - Roy McConkey
- Institute of Nursing Research, Ulster University, Newtownabbey BT37 0QB, Northern Ireland, UK;
- Correspondence: ; Tel.: +44-73-9440-1227
| | - Hana Nuri
- Evaluation Unit, Bahoz Center for Children with Developmental Disabilities, Erbil 44000, The Kurdistan Region of Iraq, Iraq; (H.N.); (A.A.); (L.A.); (B.A.); (C.A.B.)
| | - Amir Abdullah
- Evaluation Unit, Bahoz Center for Children with Developmental Disabilities, Erbil 44000, The Kurdistan Region of Iraq, Iraq; (H.N.); (A.A.); (L.A.); (B.A.); (C.A.B.)
| | - Lizan Ahmad
- Evaluation Unit, Bahoz Center for Children with Developmental Disabilities, Erbil 44000, The Kurdistan Region of Iraq, Iraq; (H.N.); (A.A.); (L.A.); (B.A.); (C.A.B.)
| | - Barez Abdalla
- Evaluation Unit, Bahoz Center for Children with Developmental Disabilities, Erbil 44000, The Kurdistan Region of Iraq, Iraq; (H.N.); (A.A.); (L.A.); (B.A.); (C.A.B.)
| | - Cemal A. Biçak
- Evaluation Unit, Bahoz Center for Children with Developmental Disabilities, Erbil 44000, The Kurdistan Region of Iraq, Iraq; (H.N.); (A.A.); (L.A.); (B.A.); (C.A.B.)
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Bhavnani S, Lockwood Estrin G, Arora R, Kumar D, Kakra M, Vajaratkar V, Juneja M, Gulati S, Patel V, Green J, Divan G. "I was Confused … and Still am" Barriers Impacting the Help-Seeking Pathway for an Autism Diagnosis in Urban North India: A Mixed Methods Study. J Autism Dev Disord 2022; 52:1778-1788. [PMID: 34014464 PMCID: PMC8938390 DOI: 10.1007/s10803-021-05047-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2021] [Indexed: 12/27/2022]
Abstract
Timely recognition of autism in children is integral to improve developmental outcomes. This study used mixed-methods (84 case-registers and 20 in-depth interviews with caregivers of children with a diagnosis of autism) to explore the extent to which the nature of parental concerns and prior knowledge of developmental disorders impact the time between symptom recognition and autism diagnosis, and the contextual family, societal and health-system related factors that impede the autism help-seeking pathway. Lack of awareness of age-appropriate child developmental milestones, apparent amongst the community and health professionals, contributed to a 1.5-year delay between parental concerns and autism diagnosis. Recommendations to shorten this help-seeking pathway include harnessing the potential of non-specialist workers to increase awareness and enable developmental monitoring of young children through scalable tools.
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Affiliation(s)
- Supriya Bhavnani
- Child Development Group, Sangath, House 451 Bhatkar Waddo, Succor, Bardez, Goa, 403501, India.
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurgaon, 122002, India.
| | - Georgia Lockwood Estrin
- Centre for Brain and Cognitive Development, Birkbeck, University of London, Malet Street, WC1E 7HX, London, UK
| | - Rashi Arora
- Child Development Group, Sangath, House 451 Bhatkar Waddo, Succor, Bardez, Goa, 403501, India
| | - Divya Kumar
- Child Development Group, Sangath, House 451 Bhatkar Waddo, Succor, Bardez, Goa, 403501, India
| | - Minal Kakra
- Child Development Group, Sangath, House 451 Bhatkar Waddo, Succor, Bardez, Goa, 403501, India
| | - Vivek Vajaratkar
- Department of Orthopaedic Surgery, Goa Medical College, Bambolim, Goa, 403202, India
| | - Monica Juneja
- Maulana Azad Medical College, Balmiki Basti, New Delhi, India, 110002
| | - Sheffali Gulati
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Vikram Patel
- Child Development Group, Sangath, House 451 Bhatkar Waddo, Succor, Bardez, Goa, 403501, India
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA
- Department of Global Health and Population, Harvard T H Chan School of Public Health, 655 Huntington Ave, Boston, MA, 02115, USA
| | - Jonathan Green
- Royal Manchester Children's Hospital, University of Manchester and Manchester Academic Health Sciences Centre, Oxford Rd, Manchester, M13 9PL, UK
| | - Gauri Divan
- Child Development Group, Sangath, House 451 Bhatkar Waddo, Succor, Bardez, Goa, 403501, India
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Abubakar A, Gona JK, Kipkemoi P, Rimba K, Amukambwa D, Newton CR. Perspectives of key stakeholders on educational experiences of children with autism spectrum disorders at the Kenyan Coast. Afr J Disabil 2022; 11:847. [PMID: 35280969 PMCID: PMC8905404 DOI: 10.4102/ajod.v11i0.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 10/21/2021] [Indexed: 11/02/2022] Open
Abstract
Background Objectives Methods Results Conclusion
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Affiliation(s)
- Amina Abubakar
- Neurosciences Research Group, Centre for Geographic Medicine Research-Coast, KEMRI-Welcome Trust Research Programme, Kilifi, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Joseph K. Gona
- Neurosciences Research Group, Centre for Geographic Medicine Research-Coast, KEMRI-Welcome Trust Research Programme, Kilifi, Kenya
| | - Patricia Kipkemoi
- Neurosciences Research Group, Centre for Geographic Medicine Research-Coast, KEMRI-Welcome Trust Research Programme, Kilifi, Kenya
| | - Kenneth Rimba
- Neurosciences Research Group, Centre for Geographic Medicine Research-Coast, KEMRI-Welcome Trust Research Programme, Kilifi, Kenya
| | - Dennis Amukambwa
- Neurosciences Research Group, Centre for Geographic Medicine Research-Coast, KEMRI-Welcome Trust Research Programme, Kilifi, Kenya
| | - Charles R.J.C. Newton
- Neurosciences Research Group, Centre for Geographic Medicine Research-Coast, KEMRI-Welcome Trust Research Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Lee JD, Meadan H, Oyunbaatar E. Parent peer coaching program: A cascading intervention for parents of children with autism in Mongolia. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1999-2014. [PMID: 35083932 DOI: 10.1177/13623613211070636] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT Parents of children with autism are known to experience severe hardships related to raising their children. These hardships are exacerbated in low-resource settings internationally where there is very little resource for children and their families, including professionals who provide evidence-based treatment. Mongolia was chosen as an example of such low-resource settings in this single-case research, and four parent mentors and five parent peers and their children with autism participated and completed the study. A local parent group, the Autism Association of Mongolia, was actively involved in this study and helped with recruitment, development, adaptation, and implementation of the intervention to increase acceptability and feasibility. In addition, a local bilingual research assistant was also utilized as the purpose of this study was to build capacity of diverse stakeholders of children with autism in Mongolia. The research assistant was trained and coached by the research team on both content (communication teaching strategies and behavior management) and delivery (coaching adults), who then provided coaching to parent mentors via live videoconferencing in Mongolian. Parent mentors then similarly provided coaching to parent peers after observing the interactions with their children with autism. The findings suggest that parents can effectively deliver high-fidelity coaching to disseminate evidence-based treatment in low-resource settings when given proper training and coaching. Further examination on scalability and sustainment of effects is suggested.
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Pillay S, Duncan M, de Vries PJ. Who’s waiting for a school? Rates, socio-demographics, disability and referral profile of children with autism spectrum disorder awaiting school placement in the Western Cape Province of South Africa. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1849-1863. [DOI: 10.1177/13623613211067324] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this study, we examined the demographic, disability, referral and service needs profile of children with autism spectrum disorder waiting for school placement in the Western Cape Province of South Africa and combined our findings with those of a previous study on children with autism spectrum disorder attending schools in the province over the same period of time. In June 2016, there were 744 children with autism spectrum disorder or suspected autism spectrum disorder waiting for an appropriate school placement, 478 children were pre-school age and 266 children were school-going age. Fifty-three percent (53%) of pre-school age children and 38% of school-going age children were reported to be at home and receiving no educational or other intervention while they waited for a school. More than half the children on the waiting list had been waiting for services for more than a year. The combined data on children with autism spectrum disorder in school and waiting for schools showed a total of 1684 known children with autism spectrum disorder in the Western Cape in June 2016, representing less than 0.1% of the childhood population in the province. The results highlight the need for education systems strengthening to accommodate all children with autism spectrum disorder in appropriate educational settings from as early as possible. We propose multi-stakeholder engagement to develop contextually appropriate policies, best practice guidelines and actions for the education of children with autism spectrum disorder in South Africa. Lay abstract In South Africa, there are limited educational opportunities for children with autism spectrum disorder and many children with autism spectrum disorder have to wait for school placement. This study examined the education waiting list for children with autism spectrum disorder in the Western Cape Province of South Africa and reported on the demographic, disability, referral and service provision characteristics of these children. In June 2016, there were 744 children with definite autism spectrum disorder or possible autism spectrum disorder between the ages of 1 and 17 years waiting for school placement. There were children of compulsory school-going age who were reported to be at home and not receiving any intervention while they waited. More than half the children on the waiting list had been waiting for more than a year. We then combined the findings of this study with the findings of a previous study on children with autism spectrum disorder already attending schools in the province over the same period of time. We found a total of 1684 children known to have autism spectrum disorder – this was less than 0.1% of all young people in the province at the time. Between 2012 and 2016, there was a 276% increase in the number of children with autism spectrum disorder waiting for schools in the Western Cape. The results show that education systems in the Western Cape need to be strengthened to accommodate all children with autism spectrum disorder in appropriate education settings from as early as possible. We recommend engaging with different stakeholders to develop policies, best practice guidelines and actions for autism spectrum disorder education in South Africa.
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Affiliation(s)
- Sarosha Pillay
- Department of Health and Rehabilitation Sciences, University of Cape Town, South Africa
- Centre for Autism Research in Africa, Division of Child & Adolescent Psychiatry, University of Cape Town, South Africa
| | - Madeleine Duncan
- Department of Health and Rehabilitation Sciences, University of Cape Town, South Africa
| | - Petrus J de Vries
- Centre for Autism Research in Africa, Division of Child & Adolescent Psychiatry, University of Cape Town, South Africa
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Lord C, Charman T, Havdahl A, Carbone P, Anagnostou E, Boyd B, Carr T, de Vries PJ, Dissanayake C, Divan G, Freitag CM, Gotelli MM, Kasari C, Knapp M, Mundy P, Plank A, Scahill L, Servili C, Shattuck P, Simonoff E, Singer AT, Slonims V, Wang PP, Ysrraelit MC, Jellett R, Pickles A, Cusack J, Howlin P, Szatmari P, Holbrook A, Toolan C, McCauley JB. The Lancet Commission on the future of care and clinical research in autism. Lancet 2022; 399:271-334. [PMID: 34883054 DOI: 10.1016/s0140-6736(21)01541-5] [Citation(s) in RCA: 243] [Impact Index Per Article: 121.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022]
Affiliation(s)
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alexandra Havdahl
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway; Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Paul Carbone
- Department of Pediatrics at University of Utah, Salt Lake City, UT, USA
| | - Evdokia Anagnostou
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Themba Carr
- Rady Children's Hospital San Diego, Encinitas, CA, USA
| | - Petrus J de Vries
- Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | | | | | | | | | | | - Peter Mundy
- University of California, Davis, Davis, CA, USA
| | | | | | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Emily Simonoff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Vicky Slonims
- Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul P Wang
- Simons Foundation Autism Research Initiative, Simons Foundation, New York, NY, USA; Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Rachel Jellett
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Patricia Howlin
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Peter Szatmari
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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Nair AS, Priya RS, Rajagopal P, Pradeepa C, Senthil R, Dhanalakshmi S, Lai KW, Wu X, Zuo X. A case study on the effect of light and colors in the built environment on autistic children's behavior. Front Psychiatry 2022; 13:1042641. [PMID: 36532166 PMCID: PMC9748440 DOI: 10.3389/fpsyt.2022.1042641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The importance of strategies and services by caregivers and family members substantially impact the psychological and emotional wellbeing of autistic children. The rapid research developments in clinical and non-clinical methods benefit the features of autistic children. Among various internal and external factors, the influence of the built environment also impacts the characteristics of autistic children. This study investigates primarily the psychological effect of light and colors on the mood and behavior of autistic children to identify the most favorable and preferred indoor lights and color shades. METHODS A questionnaire survey was conducted at an autism center among autistic children and their parents. This study included autistic children aged between 6 and 16 (45 males, 42 females, mean age 8.7 years, standard deviation 2.3). Eighty-seven participants were involved in the survey to determine the sensory perceptions, intolerance, preferences, and sensitivities of children with an autism spectrum disorder toward colors and lighting. The margin of error at the statistical analysis's 95% confidence level is ± 0.481. RESULTS As per this case report, the children have various color preferences and respond differently to different shades. Different hues have varying effects on autistic children, with many neutral tones and mellow shades proven to be autistic-friendly with their calming and soothing effect, while bright, bold, and intense colors are refreshing and stimulating. The stimulus of bright-lighting causes behavioral changes in autistic children prone to light sensitivity. CONCLUSION The insights gained from this interaction with parents and caretakers of autistic children could be helpful for designers to incorporate specific autistic-friendly design elements that make productive interior spaces. A complete understanding of the effect of factors like color and lighting on the learning ability and engagement of autistic children in an indoor environment is essential for designers and clinicians. The main findings of this study could be helpful for a designer and clinicians to address designing an autism-friendly built environment with a color palette and lighting scheme conducive to their wellbeing and to maximize their cognitive functioning.
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Affiliation(s)
- Ashwini Sunil Nair
- School of Architecture and Interior Design, SRM Institute of Science and Technology, Chennai, India
| | | | - Prashanthini Rajagopal
- School of Architecture and Interior Design, SRM Institute of Science and Technology, Chennai, India
| | - Chandramouli Pradeepa
- School of Architecture and Interior Design, SRM Institute of Science and Technology, Chennai, India
| | - Ramalingam Senthil
- Department of Mechanical Engineering, SRM Institute of Science and Technology, Chennai, India
| | - Samiappan Dhanalakshmi
- Department of Electronics and Communication Engineering, SRM Institute of Science and Technology, Chennai, India
| | - Khin Wee Lai
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Xiang Wu
- School of Medical Information and Engineering, Xuzhou Medical University, Xuzhou, China
| | - Xiaowei Zuo
- Department of Psychiatry, The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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Trembath D, Waddington H, Sulek R, Varcin K, Bent C, Ashburner J, Eapen V, Goodall E, Hudry K, Silove N, Whitehouse A. An evidence-based framework for determining the optimal amount of intervention for autistic children. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:896-904. [PMID: 34672993 DOI: 10.1016/s2352-4642(21)00285-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 12/28/2022]
Abstract
The provision of timely, effective, and socially valid non-pharmacological intervention is at the core of efforts to support the development of young autistic children. These efforts are intended to support children to develop skills, empower their caregivers, and lay the foundation for optimal choice, independence, and quality of life into adulthood. But what is the optimal amount of intervention? In this Viewpoint, we review current guidelines and consider evidence from an umbrella review of non-pharmacological interventions for autistic children aged up to 12 years. We show the lack of consensus on the issue, identify factors that might be relevant to consider, and present an evidence-based framework for determining the optimal amount of intervention for each child, along with recommendations for future research.
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Affiliation(s)
- David Trembath
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Hannah Waddington
- Faculty of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Rhylee Sulek
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Kandice Varcin
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Catherine Bent
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC, Australia
| | | | - Valsamma Eapen
- Academic Unit of Child Psychiatry South West Sydney Local Health District and Ingham Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Kristelle Hudry
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC, Australia
| | - Natalie Silove
- School of Medicine, University of Sydney, NSW, Australia
| | - Andrew Whitehouse
- Telethon Kids Institute, Northern Entrance, Perth Children's Hospital, Nedlands, WA, Australia.
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Jaffee SR. Editorial: 'In our time': Has the pandemic changed the way we write and read mental health and neurodevelopmental disorder research reviews? J Child Psychol Psychiatry 2021; 62:481-483. [PMID: 33905121 DOI: 10.1111/jcpp.13424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The past year was marked by upheaval, as countries across the globe shut down in the face of the COVID-19 pandemic. Although the topics for this year's Annual Research Review were decided long before most of had heard of the coronavirus, many readers may find themselves reading the papers in this issue through a pandemic lens. For some authors, the COVID-19 pandemic and the social unrest that characterized parts of the world where these authors live are likely to have shaped the way they ultimately framed the topics of their reviews. This issue serves as a reminder that it is critical to read science in social and historical context. Our preoccupations as psychologists and psychiatrists reflect our cultural values and societal experiences at a particular time and place.
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