Contributing factors to healthcare costs in individuals with autism spectrum disorder: a systematic review

Material hardship and sources of support for autistic adolescents and their families

This exploratory study used the Future of Families and Child Wellbeing Study (FFCWS) to compare the financial well-being of families of adolescents with and without autism. Recognizing the gap in autism research, which predominantly measures financial well-being through household income, this study employed a multidimensional approach, including indicators of assets, material hardships, and both formal and informal safety net access. We found that families with autistic adolescents experienced greater financial instability, including a higher likelihood of substantial income drops and bankruptcy. Despite similar access to food assistance programs, food insecurity was notably higher among these families, especially in the lowest income brackets where nearly all families utilized food assistance. Furthermore, material hardship prevalence (46.4%) exceeded income poverty (29.8%), among families with autistic adolescents. A substantial proportion of middle- to high-income families also experienced hardships, had no assets, and lacked connection to safety net programs, suggesting that income-based metrics may not fully capture the financial challenges families face. The findings highlight the need for policies that acknowledge the broader financial needs of families with autistic adolescents, underscoring the inadequacies of current support systems.Lay abstractOur study looks at how families with autistic teenagers manage financially compared with families with teenagers who do not have autism. We know that money matters are a big part of life's overall quality and that autistic individuals and their families often face more financial challenges. These challenges can affect their health, social connections, and access to needed services. What our research adds is a closer look at these financial difficulties by considering not just how much money a family has but also what they own, their struggles to meet basic needs, and the help they get from both government programs and their own social circles. We found that families with autistic teenagers often deal with more financial problems, including not having enough food, even though they might be using available support programs. This is important because it shows us that the current ways of helping may not be enough. Our findings suggest we need to think more broadly about how to support these families. This could mean making policies that better address their unique needs or coming up with new ways to help them that go beyond just looking at income. Understanding these challenges better can help us make life better for autistic individuals and their families.

Augmented Reality and Learning-Cognitive Outcomes in Autism Spectrum Disorder: A Systematic Review

BACKGROUND/OBJECTIVES

Augmented reality (AR) has emerged as a promising educational tool for individuals with autism spectrum disorder (ASD), offering interactive and engaging learning experiences. While AR interventions have been widely explored in educational contexts, their specific impact on learning outcomes in individuals with ASD remains unclear. This systematic review aimed to explore preliminary indications of the efficacy of augmented reality (AR)-based interventions in improving cognitive and academic skills in children, adolescents, and adults with ASD.

METHODS

A comprehensive literature search identified studies published between 2014 and 2024 that assessed AR interventions targeting learning outcomes in individuals with ASD.

RESULTS

A total of 12 studies (9 were single-subject studies), comprising 123 participants, met the inclusion criteria. The findings revealed that AR interventions contributed to improvements in multiple learning domains, including language acquisition, reading comprehension, mathematics, science education, executive functioning, and attention. AR-based applications were particularly effective in enhancing engagement, motivation, and interactive learning, addressing challenges commonly faced by individuals with ASD.

CONCLUSIONS

Findings suggest that AR can be a valuable tool for improving learning outcomes in individuals with ASD, and it could contribute to the inclusion and functional development of students with special needs.

A cross-sectional study of public knowledge and stigma towards autism spectrum disorder in Lebanon

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that requires public understanding to foster acceptance and reduce stigma. This study aimed to evaluate ASD knowledge and stigma among the Lebanese population and the factors influencing them. An online cross-sectional study was conducted between February and July 2022 among Lebanese adults. Participants completed a self-administered structured questionnaire that comprised a sociodemographic section and two validated scales serving the study's purpose (The Autism Stigma and Knowledge Questionnaire (ASK-Q) and The Autism Social Distance Scale). A total of 949 participants filled out the questionnaire. More than half of them had adequate knowledge of autism diagnosis and symptoms (57.9%), while only 6.6% and 9.6% showed adequate knowledge of its etiology and treatment, respectively. Additionally, 83.4% of the participants did not endorse stigma toward autism. The multivariate analysis taking the knowledge total score and subscales as the dependent variables showed that declaring prior knowledge of autism was significantly associated with better knowledge (Beta = 1.38) and higher stigma (Beta = 0.26). Furthermore, a higher knowledge score (Beta = - 0.06) and a declared prior knowledge of autism (Beta = - 0.62) were significantly associated with lower autism social distance. These findings highlight the need for targeted awareness campaigns to address knowledge gaps and further reduce stigma in Lebanon.

Critical Appraisal of Systematic Reviews Assessing Gut Microbiota and Effect of Probiotic Supplementation in Children with ASD-An Umbrella Review

Given the significance of gut microbiota in autism spectrum disorder (ASD), we aimed to assess the quality of systematic reviews (SRs) of studies assessing gut microbiota and effects of probiotic supplementation in children with ASD. PubMed, EMBASE, PsycINFO, Medline, and Cochrane databases were searched from inception to November 2024. We included SRs of randomised or non-randomized studies reporting on gut microbiota or effects of probiotics in children with ASD. A total of 48 SRs (probiotics: 21, gut microbiota: 27) were included. The median (IQR) number of studies and participants was 7 (5) and 328 (362), respectively, for SRs of probiotic intervention studies and 18 (18) and 1083 (1201), respectively, for SRs of gut microbiota studies in children with ASD. The quality of included SRs was low (probiotics: 12, gut microbiota: 14) to critically low (probiotics: 9, gut microbiota: 13) due to lack of reporting of critical items including prior registration, deviation from protocol, and risk of bias assessment of included studies. Assuring robust methodology and reporting of future studies is important for generating robust evidence in this field.

Family Intensive Behavioral Intervention for Children with Autism Spectrum Disorder: A Half-Year Comparison-Controlled Study

Objective

Family intervention is a crucial component of treatment for children with autism spectrum disorder (ASD), yet the impact of parent-mediated family-intensive behavioral intervention on the language abilities of children with ASD has been barely studied. The purpose is to investigate the effectiveness of the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP)-based family-intensive behavioral intervention in enhancing the language abilities of children with ASD. This study provides insights to help ASD children better cope with daily life.

Methods

From September 2020 to September 2022, a total of 85 clinically diagnosed children with ASD and 30 age- and sex-matched children without ASD were recruited. Applied Behavior Analysis (ABA) and VB-MAPP were used for evaluating and determining individualized intervention programs for children with ASD. The intervention lasted 6 months.

Results

There were no significant differences in demographic characteristics between children with ASD and children without ASD (all p > 0.05), except for the mother's age. After the intervention, there was a significant increase in all VB-MAPP scores among children with ASD (all p < 0.001), compared with the baseline VB-MAPP total score and 16 domain scores. Tests of noninferiority showed that children with ASD at post-intervention were non-inferior to children without ASD in the Visual Perceptual Skills and Matching-to-Sample (VP/MTS) score (p = 0.001), play score (p = 0.034), reading score (p < 0.001), and writing score (p < 0.001).

Conclusions

Family-intensive behavioral intervention significantly improved the skills of children with ASD, as assessed by the VB-MAPP. These findings emphasize the importance of family intervention and provide further support for proposing a family intervention program for children with ASD that is suitable for China's national conditions.

Unveiling autism spectrum disorder in South East Asia through a public health Lens

Autism spectrum disorder (ASD) is a multifaceted developmental condition characterized by persistent challenges in social communication, restricted interests, and repetitive behaviors. Though there is no cure, early and intensive interventions can significantly improve the quality of life for those affected. The aim of this paper is to examine the complexities of autism spectrum disorder (ASD) from a public health perspective in South East Asian region, highlighting the global rise in prevalence and the compounded challenges posed by the COVID-19 pandemic. The rise in ASD prevalence from 4 to 5 cases per 10,000 children in the 1980s to 11.3 per 1,000 children in 2012 highlights the need for effective interventions. The pandemic exacerbated behavioral issues, anxiety, and screen time-related health problems, underscoring the importance of adjusting strategies for early identification and support. Diagnostic tools like the Modified Checklist for Autism in Toddlers (M-CHAT) and the Social Communication Questionnaire (SCQ) play a critical role in community-based screening. Effective prevention strategies include primary measures such as public awareness campaigns and genetic counseling, secondary measures focusing on early identification and intervention, and tertiary measures involving ongoing support and therapy. Addressing implementation challenges, particularly in low-income countries, requires enhanced public awareness, training of community health workers, and integration of ASD services into primary healthcare systems. Future research should aim to develop and evaluate scalable, culturally relevant interventions and explore the impact of environmental factors on ASD. Comprehensive strategies at the community level, combined with robust public health policies, are crucial for improving outcomes for individuals with ASD and their families.

Machine Learning Differentiation of Autism Spectrum Sub-Classifications

PURPOSE

Disorders on the autism spectrum have characteristics that can manifest as difficulties with communication, executive functioning, daily living, and more. These challenges can be mitigated with early identification. However, diagnostic criteria has changed from DSM-IV to DSM-5, which can make diagnosing a disorder on the autism spectrum complex. We evaluated machine learning to classify individuals as having one of three disorders of the autism spectrum under DSM-IV, or as non-spectrum.

METHODS

We employed machine learning to analyze retrospective data from 38,560 individuals. Inputs encompassed clinical, demographic, and assessment data.

RESULTS

The algorithm achieved AUROCs ranging from 0.863 to 0.980. The model correctly classified 80.5% individuals; 12.6% of individuals from this dataset were misclassified with another disorder on the autism spectrum.

CONCLUSION

Machine learning can classify individuals as having a disorder on the autism spectrum or as non-spectrum using minimal data inputs.

Multikingdom and functional gut microbiota markers for autism spectrum disorder

Associations between the gut microbiome and autism spectrum disorder (ASD) have been investigated although most studies have focused on the bacterial component of the microbiome. Whether gut archaea, fungi and viruses, or function of the gut microbiome, is altered in ASD is unclear. Here we performed metagenomic sequencing on faecal samples from 1,627 children (aged 1-13 years, 24.4% female) with or without ASD, with extensive phenotype data. Integrated analyses revealed that 14 archaea, 51 bacteria, 7 fungi, 18 viruses, 27 microbial genes and 12 metabolic pathways were altered in children with ASD. Machine learning using single-kingdom panels showed area under the curve (AUC) of 0.68 to 0.87 in differentiating children with ASD from those that are neurotypical. A panel of 31 multikingdom and functional markers showed a superior diagnostic accuracy with an AUC of 0.91, with comparable performance for males and females. Accuracy of the model was predominantly driven by the biosynthesis pathways of ubiquinol-7 or thiamine diphosphate, which were less abundant in children with ASD. Collectively, our findings highlight the potential application of multikingdom and functional gut microbiota markers as non-invasive diagnostic tools in ASD.

Exploration of radiographers' knowledge, attitudes, and practices in delivering healthcare to children with autism spectrum disorder

INTRODUCTION

Autism Spectrum Disorder (ASD) poses unique challenges in healthcare settings, including radiographic examinations. This study aimed to assess the knowledge, attitudes, and practices (KAP) of radiographers in the United Arab Emirates (UAE) towards ASD children, a population with increased healthcare needs.

METHODS

A cross-sectional survey was conducted online, targeting radiographers across the UAE. The instrument utilized was a comprehensive and validated self-administered questionnaire developed based on relevant literature. The questionnaire incorporated sections to gauge radiographers' knowledge about ASD, their attitudes towards working with ASD children, and their adherence to recommended practices during radiographic examinations. Descriptive and inferential statistics were employed to describe KAP and identify any influencing factors.

RESULTS

Radiographers demonstrated a moderate level of knowledge regarding ASD. Despite the knowledge, misconceptions about ASD nature were common. The radiographers generally acknowledged the need for special care for ASD children during radiographic procedures. High confidence in working with ASD children was noted, particularly among older participants, despite a clear interest in further training. Good adherence to recommended practices was observed, with physical restraints not being a common practice. However, areas for improvement were identified, such as the use of visual aids.

CONCLUSION

Despite a moderate level of knowledge and good practices, there is a need to improve UAE radiographers' understanding and handling of ASD children.

IMPLICATIONS FOR PRACTICE

This study highlights the need for enhancing ASD-specific knowledge and training and integrating supportive tools in radiographic procedures. This comprehensive approach could significantly improve the radiographic service quality for ASD children in the UAE.

Exploring the varied manifestations of structural violence in the lives of children on the autism spectrum and their families: a qualitative longitudinal study in Kurdistan, Iran

BACKGROUND

There are many dimensions regarding autism that are closely connected to social structures, policies, and power dynamics, silently impacting the well-being of individuals within the autism spectrum. This research aims to explore these overlooked aspects using a theoretical framework called "structural violence."

METHODS

The study was conducted in Kurdistan, Iran, and a qualitative longitudinal approach was chosen. A purposive sampling method was employed to select the participants, with 11 parents taking part. The study data comprised 29 interviews using a topic guide conducted over a span of 2 years. Thematic analysis and a matrix-based approach were utilized for data analysis. To enhance the scientific rigor of this research, four criteria, including Guba and Lincoln's principles, were implemented to ensure methodological accuracy.

RESULTS

The research findings highlight four primary forms through which structural violence impacts children on the autism spectrum and their families: access to healthcare, geographic disparities, awareness and stigma, and poverty and financial burden. Additionally, the study identified 11 subthemes related to structural violence in the context of autism and families.

CONCLUSIONS

We illustrated how structural forces create barriers to accessing adequate healthcare services, exacerbate discrimination based on ethnicity and geography, perpetuate stigma, and contribute to poverty and the inability to meet basic needs. These factors not only worsen health issues but also deepen existing disparities in healthcare access and outcomes for children on the autism spectrum and families. We emphasize the urgent need for systemic changes to address these issues. It is essential to promote public awareness, provide better access to health and support services, and address economic and political factors that contribute to these inequalities.