Supporting and hindering environments for participation of adolescents diagnosed with autism spectrum disorder: A scoping review

A systematic review: Which psycho-social-environmental factors do autistic students identify as being important for positive experiences in mainstream secondary school?

Mainstream secondary school can be a challenging environment for autistic students, in part due to social and sensory factors. Research to date has focussed on identifying the negative aspects of school experience; however, few studies have identified factors that promote positive experiences. We take a neuro-affirmative approach when exploring how schools can support autistic students, informed by both the social and the human rights models of disability. We conducted a systematic review of qualitative studies in which autistic adolescents and adults identified factors that related to positive experiences in mainstream secondary school. We identified 117 relevant studies and 36 met inclusion criteria. Through thematic synthesis, we developed overarching themes: 'Understanding and Acceptance', 'Environments that suit me' and 'Agency to meet my needs', with additional subthemes. This study identified that agency, understanding and acceptance by both staff and peers, as well as access to engaging activities, were key factors in creating a positive and supportive environment for autistic students. Adaptation to both the social and sensory contexts were important to meet the needs of autistic students. The findings suggest that policy and practice should focus on creating a positive environment in schools for autistic students, in addition to addressing current challenges.Lay abstractResearch has shown that many autistic students do not thrive in mainstream secondary schools. Often studies focus on the challenges autistic people face rather than what supports thriving. We reviewed published articles, exploring what factors helped autistic people create a positive experience in school from their own perspective. We identified 36 studies and analysed the direct quotes made by autistic adolescents and adults in these studies. Factors important for positive experience included the autistic student feeling understood and accepted by adults and peers in school, being able to shape sensory and social environments in ways that suited them and accessing engaging activities. This review highlighted ways in which schools can become more inclusive and positive environments for autistic students.

Application of the international classification of functioning, disability, and health in autism and attention-deficit hyperactivity disorder: A scoping review

LAY ABSTRACT

The International Classification of Functioning, Disability, and Health (ICF) is a framework designed by the World Health Organization (WHO) to help different sectors, such as healthcare, social services, education, and policy, understand how people with health-related issues function (do the things they want to and need to do) in their daily lives. This framework has also been used to guide clinical practice and research in autism and attention-deficit hyperactivity disorder (ADHD). To make it more practical, shorter versions of the ICF called Core Sets have been developed. We wanted to explore how the ICF and the ICF Core Sets have been used in research relating to autism and ADHD. We looked at the research that had been previously published on this topic by conducting a systematic search and review. Seventy-eight studies meeting our criteria were included in our review. Results show that the ICF has been applied in many ways across various contexts. However, most of the research has focused on autism, mainly involving children. The review highlights that although the ICF was used in some studies, the underlying philosophies of the framework were not always followed. The medical perspective still influenced the way research was done and interpreted. Nevertheless, using the ICF in the right way can help shift research on neurodevelopmental conditions like autism and ADHD toward a more holistic approach, moving away from solely focusing on medical aspects.

The Feasibility of Occupation-Based Coaching for Autistic Children and Primary Caregivers

Autistic children participate less and have fewer opportunities to develop participation skills than nonautistic peers. The extent to which occupation-based coaching (OBC), a metacognitive strategy training intervention, affects participation in school-age autistic children is unknown. We conducted a single-group pretest-posttest design to evaluate the feasibility and preliminary effect of telehealth OBC for autistic children (n = 13) and primary caregivers (n = 12). Participants completed eight telehealth OBC sessions to address activity-based goals; they completed child, caregiver, and family outcomes pre- and post-intervention. Recruitment, retention, caregiver measure completion, and intervention adherence rates exceeded feasibility benchmarks. OBC had large effects on child performance (Hedge's g = 1.65) and satisfaction (Hedge's g = 1.89), a moderate effect on child sleep disturbance (Hedge's g = 0.60), and small effects on child participation (Hedge's g = 0.23) and family quality of life (Hedge's g = 0.26). Further research in a large-scale study is warranted with changes to better support child measure completion and enhance the study protocol.

Factors that inhibit the social involvement of children with autism: perspectives of parents in the Cape Coast metropolis

BACKGROUND

Many countries, including Ghana, continue to face challenges concerning the social involvement of persons with disabilities such as autism. This study investigated the factors that inhibit the social involvement of children with autism in the Cape Coast Metropolis.

METHODS

The study was conducted in the Cape Coast metropolis. A qualitative interpretivism approach was used. Twenty-three participants were recruited for the study using purposive sampling. An in-depth interview guide was employed for data collection, and thematic analysis was used.

RESULTS

We found that most autistic children do not get the opportunity to be involved in social activities due to their autistic features, socio-cultural and their parents' financial status. The findings also showed that the inability of children with autism to speak fluently and sit for long without being aggressive prevents their inclusion in social activities. However, older children with autism were considered more for activities in the metropolis than those within the younger ages. Financial constraint was a common challenge that prevented some parents from bringing up their children with autism in ways that would make them considerable for social roles.

CONCLUSION

Factors such as autistic features, sociocultural and financial constraints inhibited the social involvement of children with autism. Underlining these barriers is the issue of inadequate knowledge of autism and financial barriers for parents of children with autism. We, therefore, recommended that the Ghana Health Service and the Ministry of Health to intensify advocacy programs targeted at educating the public on autism to reduce discrimination.

Being able to be myself: Understanding autonomy and autonomy-support from the perspectives of autistic adults with intellectual disabilities

LAY ABSTRACT

Autistic young adults with intellectual disabilities want to be autonomous but are less autonomous than other people. However, they can be autonomous with appropriate support. We wanted to learn how we can support autistic adults with intellectual disabilities to be more autonomous. We designed our study with help from five autistic community partners to make sure the research was relevant to autistic people and would improve their lives. We talked with eight autistic young adults with intellectual disabilities about autonomy. We defined "talk" as verbal language, as well as non-verbal cues such as body language, facial expressions, vocalizations, and laughter. We did art projects and played games while we talked. We met in small groups over multiple sessions. Our participants told us that being autonomous meant being able to be themselves. They told us three main ways to support their autonomy: (1) having choice and control, (2) being able to communicate in their own way, and (3) being in a safe environment. Families, support staff, and caregivers can use this information to help autistic young adults with intellectual disabilities to be autonomous.

Barriers and Facilitators for Physical Activity Among Children and Youth With Autism-A Scoping Review

BACKGROUND

The purpose of this scoping review was to systematically synthesize barriers and facilitators for physical activity (PA) among children and youth with autism spectrum disorders (ASD) across the socioecological model.

METHODS

Five electronic databases were searched in March 2022 for studies examining barriers and facilitators for PA among children and youth with ASD. An updated search was performed in April 2024. The framework synthesis method was utilized, and the socioecological model was the chosen framework.

RESULTS

Fifty-four studies published from 2008 to 2024 were included. Among the included studies, 57% included the perspectives of children and youth with ASD alone or together with proxies (eg, parents, teachers, and coaches), while 43% included only the perspectives of proxies. Barriers and facilitators on the intrapersonal and interpersonal levels were most substantial. The analysis led to 2 main categories of barriers and facilitators, those unique to children and youth with ASD, and those similar to what had been identified through research on children and youth, both typically developing and with other disabilities.

CONCLUSIONS

This comprehensive scoping review shows the complexity of factors contributing to barriers and facilitators for PA among children and youth with ASD, and highlights both the factors unique to this population and more general factors affecting PA participation. The findings from this synthesis might be used to guide the development of inclusive PA in physical education, organized sports, and other community PA arenas.

The Autism Program Environment Rating Scale in Swedish Primary School: Cultural Adaptation and Content Validation

There is a recognized need to improve inclusive learning environments for autistic children in primary school settings in Sweden. This study aimed to translate, cross-culturally adapt, and assess the content validity of the Swedish primary school version of the Autism Program Environment Scale (APERS), originally developed to evaluate autism program quality in educational settings in the United States. Following the translation into Swedish and the first cultural adaptation of the APERS, a content panel group of 14 professionals rated its content validity. Four of the content panel members also participated in individual interviews that provided a qualitative evaluation of the instrument's content validity. Finally, the authors piloted the APERS in 10 Swedish primary school classrooms to assess its feasibility. The ratings and qualitative information from the content panel members indicated a substantial need for the Swedish APERS in primary school, resulting in the culturally adapted APERS-Primary-Sweden (SE). The instrument demonstrated a high level of cross-cultural content validity for assessing the quality of the learning environment for students with autism in Swedish primary school settings. The pilot testing of the instrument resulted in further cultural adaptations. In conclusion, APERS-Primary-SE is a comprehensive scale that can be used to assess the quality of primary school learning environments for children with autism in Sweden. Further research is needed to evaluate the adapted instrument's effectiveness in improving the learning environment in Swedish primary school classrooms.

Parent-reported environmental factors and strategies to support home and community participation in children on the autism spectrum

PURPOSE

Participating in home and community activities can be influenced by environmental factors and parent strategies. Children on the autism spectrum are reported to participate less in home and community activities than their neurotypical peers. Little is known about environmental factors that may influence their participation, and ways parents support their child's participation.

MATERIALS AND METHODS

Parents of children on the autism spectrum aged 5-6 years (n = 72) and 10-11 years (n = 94) completed the Participation and Environment Measure for Children and Youth. This study reports on the perceived support, barriers, and resources in the home and the community environment. Parents reported strategies they used to support their child's participation in home and the community.

RESULTS

Home environmental factors were identified as more supportive by the parents of younger children. The sensory quality of activities and social demands were factors identified as making community participation harder for both groups. Parents used a range of different strategies in the home and the community to support their child's participation.

CONCLUSIONS

Identifying environmental barriers and supports to participation can assist in developing interventions to support meaningful participation in activities for children on the autism spectrum.Implications for rehabilitationSkills required for the activity and preferences of children on the autism spectrum are important considerations when supporting their participation in activities.When exploring a child's level of participation, it may be helpful to ask parents about what their child can do with or without their support.The sensory quality of the environment is a consideration when supporting the participation of children on the autism spectrum in community activities.As sensory processing is an individual experience, the impact of sensory elements of the environment may differ for individuals.

Made to feel different: Families perspectives on external responses to autism and the impacts on family well-being and relationships

LAY ABSTRACT

The influence of the environment on different groups of people with disabilities has rarely been studied in the context of neurodevelopmental disabilities, such as autism, in adolescence. This study explored how external responses to autism affect the experiences, outcomes and family relationships of autistic adolescents and their family members, including siblings and parents. This study adds to the knowledge of factors that contribute to the social disadvantage and exclusion autistic adolescents and their families face in their communities. Interviews with 30 participants from families with an autistic adolescent show that external factors greatly impact the well-being of autistic adolescents and their families. The school environment, including sensory overload, bullying and negative interactions with teachers, was found to be a key factor that negatively influenced mental health and family relationships. The study also revealed that isolation and stigma are major concerns for families, indicating the importance of public awareness campaigns to increase understanding of autism. In addition, the lack of adequate support and services presented significant challenges for families. The study emphasises the importance of person-centred approaches to providing services, which involve including autistic individuals and their families in designing and delivering support.

'We are all bringing, like a unique sort of perspective': The core elements of a strengths-based digital arts mentoring program for autistic adolescents from the perspective of their mentors

INTRODUCTION

While the adoption of strengths-based approaches to supporting autistic adolescents is growing in popularity, the application of this approach to a digital arts mentoring program has yet to be explored. This study reports on the core elements contributing to the success of a community digital arts mentoring program for autistic adolescents from the mentors' perspective. This paper presents an in-depth exploration of mentors' experiences, comprising a component of a broader line of research investigating a digital arts mentoring program for autistic adolescents emphasising positive youth development.

METHODS

The digital arts mentoring program spanned 20 weeks across two Australian school terms and was attended by two groups of autistic adolescents (N = 18) aged between 11 and 17 years. A qualitative approach was utilised in exploring the perspective of their mentors (N = 6). Qualitative data were collected at the end of each school term for each group with the mentors using an interpretive phenomenological approach and Colaizzi's seven-step analysis method. Thirteen individual interviews were conducted with six mentors.

CONSUMER AND COMMUNITY INVOLVEMENT

This research was conducted with a disability arts provider to provide a digital arts mentoring program to autistic adolescents. The mentors employed have lived experience with disorders such as attention deficit hyperactivity disorder (ADHD) and anxiety.

RESULTS

Five primary themes emerged from the data: positive connections, mentor knowledge and experience, mentoring approaches, autism education, program organisation, resources and environment. Subthemes underpinned the primary themes related to positive connections (three subthemes), mentoring approaches (four subthemes) and program organisation, resources and environment (three subthemes).

CONCLUSION

The findings suggest that prior experience, sufficient training, a supportive environment and a flexible and adaptable approach were essential for success. Understanding the core elements of a strengths-based digital arts program in occupational therapy provides a comprehensive framework for utilising clients' inherent strengths and creativity as therapeutic tool, creating an empowering environment, fostering meaningful outcomes for clients.

A psychometric investigation of health-related quality of life measures for paediatric neurodevelopment assessment: Reliability and concurrent validity of the PEDS-QL, CHU-9D, and the EQ-5D-Y

There is a need for tools that can provide a brief assessment of functioning for children with neurodevelopmental conditions, including health-related quality of life (HR-QoL). This study evaluated the psychometric properties of three commonly used and well known HR-QoL measures in a cohort of children presenting to clinical developmental assessment services. The most common diagnoses received in these assessment services were autism spectrum disorders. Findings showed good internal consistency for the PedsQL and the CHU-9D, but not the EQ-5D-Y. This research also found that the CHU-9D, EQ-5D-Y, and PedsQL correlated with relevant functioning domains assessed by the VABS-III. Overall, the measures showed that children with neurodevelopmental conditions experienced poor HR-QoL. The majority of children (>86%) met cut-off criteria for significant health concerns on the PedsQL. On the EQ-5D-Y and CHU-9D, they showed reduced HR-QoL particularly on domains relating to school and homework, being able to join in activities, looking after self, and doing usual activities. This study supports the use of the CHU-9D and PedsQL in this population to assess and potentially track HR-QoL in a broad neurodevelopment paediatric population.

Parents' Perceptions: Environments and the Contextual Strategies of Parents to Support the Participation of Children and Adolescents with Autism Spectrum Disorder-A Descriptive Population-Based Study from Switzerland

Environments have a modifying effect on the participation of children and adolescents with autism spectrum disorder (ASD) in all areas of life. This cross-sectional study investigated parental perspectives on supportive or hindering environments and the daily contextual strategies parents used to enhance their children's participation. Qualitative and quantitative data gathered from 115 parents from German-speaking Switzerland using the participation and environment measure-child and youth (PEM-CY) were analyzed. Results revealed 45 environmental supports and barriers at home, at school, and in the community. Contextual strategies were identified in combination with people, activities, time, objects, and places. Parental perspectives on participation and their contextual strategies should be considered in environmental-based interventions to support the participation of children and adolescents with ASD.

Fatigue among Greek Parents of Children with Autistic Spectrum Disorder: The Roles of Spirituality and Social Support

The high demands of caring for and raising a child with autism spectrum disorder on a daily basis may lead parents to physical and mental fatigue. This study aimed to assess the effect of social support and spirituality on the fatigue of parents with children with autistic spectrum disorder. A cross-sectional study with a convenience sample was conducted in Schools of Special Education in Attica (Greece). The sample consisted of 123 parents who completed The Fatigue Assessment Scale (FAS), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale (FACIT Sp-12) to measure the levels of fatigue, social support, and spirituality, respectively. The Pearson correlation coefficient was used to investigate the relationship between the quantitative variables. To study the effect of social support and spirituality on fatigue, multivariable linear regression was applied. The mean age was 47.3 years old, 81.3% were women, and 38.9% stated "Close/Very close faith toward God". Higher levels of total MSPSS and FACIT Sp-12 were associated with lower total FAS (r = -0.50, p < 0.001 and r = -0.49, p < 0.001, respectively). Social support and spirituality were significant predictors of fatigue.

Development and validation of School Resilience Questionnaire (SRQ) in Iranian adolescents

BACKGROUND

School resilience, encompassing factors like teacher involvement and school supportiveness, is crucial for positive educational outcomes in adolescents. However, few validated scales measure school resilience. This study aimed to develop and validate the School Resilience Questionnaire (SRQ) for Iranian adolescents.

METHODS

The study used a cross-sectional design. The SRQ was developed through expert reviews, interviews with students, and evaluation of existing resilience measures. After expert feedback, the final 55-item questionnaire was used. Participants were high school adolescents from Tehran, Iran (2021-2022). A multi-stage cluster random sampling approach was used. Exploratory Factor Analysis (EFA) involved 200 students, and Confirmatory Factor Analysis (CFA) included 310 students to validate the factor structure. Convergent validity was assessed by examining correlations with academic support, while divergent validity was evaluated using academic burnout measures. Construct validity and reliability were also assessed.

RESULTS

EFA revealed six consistent factors across the sample. CFA confirmed significant and acceptable factor loadings for all SRQ items. Fit indices were RMSEA = 0.076; SRMR = 0.070, CFI = 0.94, NFI = 0.93, IFI = 0.94, RFI = 0.93. Convergent validity showed positive correlations between SRQ subscales and academic support. Divergent validity showed negative correlations between SRQ subscales and academic burnout (p < 0.05).

CONCLUSION

The study successfully developed and validated the 55-item SRQ for Iranian adolescents. The questionnaire demonstrates satisfactory psychometric properties, making it a valuable tool for research and evaluation purposes in this context.

Translation and cross-cultural adaptation of the young children participation and environment measure for its use in Austria, Germany, and Switzerland

Background

Concepts such as participation and environment may differ across cultures. Consequently, cultural equivalence must be assured when using a measure like the Young Children Participation and Environment Measure (YC-PEM) in other settings than the original English-speaking contexts. This study aimed to cross-culturally translate and adapt the YC-PEM into German as it is used in Germany, Austria, and Switzerland.

Methods

Following international guidelines, two translations were compared, and the research and expert team made the first adaptations. Twelve caregivers of children with and without disabilities from three German-speaking countries participated in two rounds of think-aloud interviews. Data were analyzed by content analysis to look for item, semantic, operational, conceptual, and measurement equivalence to reach a cultural equivalence version in German.

Results

Adaptations were needed in all fields but prominently in item, operational, and conceptual equivalence. Operational equivalence resulted in graphical adaptations in the instructions and questions to make the German version of YC-PEM, YC-PEM (G), more user-friendly.

Conclusion

This study presents a cross-cultural translation and adaptation process to develop a German version of the YC-PEM suitable for Germany, Austria, and Switzerland. A culturally adapted YC-PEM (G) is now available for research, practice, and further validation.

Social skills interventions for Thai adolescents with Autism Spectrum Disorder (ASD): a qualitative study of the perceptions and experiences of Thai adolescents, their caregivers and healthcare professionals

BACKGROUND

Social skills interventions (SSIs) are effective for enhancing social skills and decreasing mental health problems in adolescents with autism spectrum disorder (ASD). However, these interventions have been designed and their effectiveness has been established in Western countries. Lack of culturally acceptable SSIs for Asian nations is a possible barrier to implementing effective and tailored interventions that address the unique requirements of ASD individuals across countries and cultures. This study aims to explore the needs and preferences of adolescents with ASD, their caregivers, and healthcare professionals (HPs) in Thailand regarding the components, delivery formats, and cultural adaptation required for an outpatient-based social skills intervention.

METHODS

Qualitative data was collected via three focus groups of HPs (n = 20) and 24 paired interviews with adolescents with ASD and their caregivers from a child psychiatric hospital in Thailand. Purposive sampling was employed, and thematic analysis was used to analyse the data.

RESULTS

Nine themes emerged from the data generated by HPs, and seven from adolescents with ASD and their caregivers. SSIs for Thai adolescents with ASD and their caregivers should emphasise specific social skills training and assess the abilities of adolescents as required. Incorporating various learning strategies is important. Parental involvement is essential and provides knowledge of an adolescent's symptoms and coaching skills, which are best used to support their adolescents. Cultural considerations include the need for social knowledge of Thai culture, promoting assertiveness and praising parents' abilities, implementing a programme in time to not interrupt academic achievement, and renaming a programme from social skills intervention to social communication intervention. Barriers to implementing a programme included HPs' need for specialised training and education and decreased workload. Also, the caregivers' and adolescents' stigma reduced attendance in a programme. Increased extra compensation and relocation days off are provided as policy support for staff who deliver the intervention.

CONCLUSION

The results suggest that SSIs for Thai adolescents with ASD should be tailored to meet the needs for specific knowledge, skills, and parental collaboration as coaches for their adolescents. Additionally, it should incorporate Thai culture. It is necessary to consider staff knowledge, workload, and stigma in order to reduce barriers to implementation in practice.

Do children with disabilities have the same opportunities to play as children without disabilities? Evidence from the multiple indicator cluster surveys in 38 low and middle-income countries

Background

Play is essential for the cognitive, social, and emotional development of all children. Disparities potentially exist in access to play for children with disabilities, and the extent of this inequity is unknown.

Methods

Data from 212,194 children aged 2-4 years in 38 Low and Middle-Income Countries were collected in the UNICEF supported Multiple Indicator Cluster Survey (2017-2020). Disability was assessed by the Washington Group-Child Functioning Module. Logistic regression models were applied to investigate the relationship between disability and play opportunities, controlling for age, sex, and wealth status. Meta-analysis was used to pool the estimates (overall, and disaggregated by sex), with heterogeneity assessed by Cochran's Q test.

Findings

Children with disabilities have approximately 9% fewer play opportunities than those without disabilities (adjusted RR [aRR] = 0.88, 95% CI = 0.82-0.93), and this varied across countries. Mongolia and Democratic Republic of São Tomé and Príncipe had the lowest likelihood of play opportunities for children with disabilities ((aRR = 0.26, 95% CI = 0.09-0.75; aRR = 0.46, 95% CI = 0.23-0.93, respectively). Moreover, children with disabilities are 17% less likely to be provided with opportunities to play with their mothers (aRR = 0.83, 95% CI: 0.73-0.93), which is further reduced for girls with disabilities (aRR = 0.74, 95% CI: 0.60-0.90) compared to their peers without disabilities. The associations varied by impairment type, and children with communication and learning impairments are less likely to have opportunities for play with aRR of 0.69 (95% CI: 0.60-0.79) and 0.78 (95% CI: 0.71-0.86), compared to those without disabilities, respectively.

Interpretation

Children with disabilities are being left behind in their access to play and this is likely to have negative impacts on their overall development and well-being.

Funding

HK and TS are funded by HK's NIHR Global Research Professorship (NIHR301621). SR is funded by a Rhodes Scholarship. This study was funded by the Programme for Evidence to Inform Disability Action (PENDA) grant from the UK Foreign, Commonwealth and Development Office.

Parents' perceptions: Participation patterns and desires for change for children and adolescents with autism spectrum disorder-A descriptive population-based study from Switzerland

BACKGROUND

Low participation in youth with autism spectrum disorder (ASD) has been reported, but age-related and contextual information is rare.

OBJECTIVE

This study aimed to describe, from parental perspectives, two patterns of participation and parental desires for change of children (age: 5-11) and adolescents (age: 12-17) with ASD in Switzerland.

METHOD

A cross-sectional design used the German version of the Participation and Environment Measure-Child and Youth to describe and juxtapose the participation results of 60 children and 55 adolescents with ASD in 45 activities at home, school and in the community and parental desires for change.

RESULTS

Participation patterns differed between settings and age groups. Both groups were found to participate most at home, followed by school, whereas community participation was either low or nonexistent. Children were more involved at home than adolescents, while school involvement was higher than participation frequency in both age groups. Community participation frequency was generally low but higher in children than in adolescents, while involvement was similarly low in both groups. Half the parents expressed desire for change with three tendencies: (1) widespread desire for change at home due to high support needs, (2) parents of adolescents expressed more desire for change in all settings than those of children and (3) all parents mainly desired to increase participation frequency and involvement.

CONCLUSIONS

This study informs research and social, health and community service providers to further reshape their programmes to meet parental needs and increase the participation of youth with ASD.

Participation of Children With Autism During COVID-19: The Role of Maternal Participation

BACKGROUND

Little is known about participation during adverse times.

OBJECTIVES

This study described participation of children with autism aged 6 to 13 during COVID-19 pandemic and examined the extent to which child factors, mother's own participation, and environmental barriers/supports explain child participation in home and community.

METHOD

A total of 130 mothers completed the Participation and Environment Measure for Children and Youth, the Health Promoting Activities Scale, functional issues checklist, and sociodemographic questionnaire.

RESULTS

Children's participation frequency and involvement were significantly higher at home than in the community. In both settings, mothers desired change in 71% of activities. Multiple regression models indicated that child's age and mother's participation frequency significantly explained child's home involvement (R2 = 21%), where mother's participation (frequency) had a unique contribution (ΔR2 = 10.4%) at home but not in the community.

CONCLUSION

Findings imply the importance of maternal participation to child's participation at home and suggest redirecting attention for enhancing family participation as a whole.

Probiotics, prebiotics, and synbiotics for patients with autism spectrum disorder: a meta-analysis and umbrella review

Background and objective

The potential impact of gut health on general physical and mental well-being, particularly in relation to brain function, has led to a growing interest in the potential health advantages of prebiotics, probiotics, and synbiotics for the management of ASD. A comprehensive meta-analysis and systematic review was conducted in order to evaluate the effectiveness and protection of many drugs targeted at manipulating the microbiota in the treatment of ASD.

Methods

The present study employed a comprehensive examination of various electronic databases yielded a total of 3,393 records that were deemed possibly pertinent to the study. RCTs encompassed a total of 720 individuals between the ages of 2 and 17, as well as 112 adults and participants ranging from 5 to 55 years old, all of whom had received a diagnosis of ASD.

Results

Overall, 10 studies reported Autism-Related Behavioral Symptoms (ARBS). Regarding the enhancement of autism-related behavioral symptoms, there wasn't a statistically significant difference between the intervention groups (combined standardized mean difference = -0.07, 95% confidence interval: -0.39 to 0.24, Z = 0.46, p = 0.65). We observed that in the patients with ASD treated with probiotic frontopolar's power decreased significantly from baseline to endpoints in beta band (Baseline: 13.09 ± 3.46, vs. endpoint: 10.75 ± 2.42, p = 0.043, respectively) and gamma band (Baseline: 5.80 ± 2.42, vs. endpoint: 4.63 ± 1.39, p = 0.033, respectively). Among all tested biochemical measures, a significant negative correlation was found between frontopolar coherence in the gamma band and TNF-α (r = -0.30, p = 0.04).

Conclusion

The existing body of research provides a comprehensive analysis of the developing evidence that indicates the potential of probiotics, prebiotics, and synbiotics as therapeutic therapies for ASD. Our findings revealed that those there was no significant effect of such therapy on autism-related behavioral symptoms, it has significant effect on the brain connectivity through frontopolar power in beta and gamma bands mediated by chemicals and cytokines, such as TNF-α. The psychobiotics showed no serious side-effects.

Home environment design theories and models related to the occupational performance, participation and well-being of people with intellectual disabilities: A scoping review

Background

Access to housing for people with intellectual disabilities is often constrained by lack of choice, control and can often be inappropriate or unsafe. To enable people to remain at home and participate in their occupations, a collation and review of theories and models supporting good home environment design offers a view from which practice could be advanced.

Method

A scoping review was used to map the literature on theories and models on home environmental designing, which can have influence on the occupational performance and participation of people with intellectual disabilities. The theories and models found were analysed using the lens of the Person-Environment-Occupation-Performance model.

Results

Four themes supporting the understanding of environmental home design that can influence participation and well-being were found. These were offering safety and comfort; providing control and choice to manage stress; offering skill acquisition for continued learning and interest; and the person-environment interaction for function and participation. The themes are discussed in relation to participation in occupation and well-being for people with intellectual disabilities.

Conclusion

The study contributes knowledge to practitioners and stakeholders on theories and models of home environment design which could support the occupational performance, participation and well-being of people with intellectual disabilities.

Participation Patterns of Israeli Children with and without Autism, and the Impact of Environment

AIMS

Participation is vital to children's quality of life, yet it is often limited for those with autism spectrum disorder (ASD). An improved understanding of the factors that may support or hinder their participation is important. This study aims to explore the participation patterns of children with and without ASD in the home, school, and community settings, as well as to explore the impact of environmental factors on the participation of children with ASD.

METHODS

78 parents of children aged 6-12, attending mainstream educational settings (30 with ASD; 48 without ASD) completed the Participation and Environment Measure for Children and Youth and a demographic questionnaire.

RESULTS

Children with ASD were rated significantly lower than children without ASD in participation, and their parents expressed a greater desire to change their participation while reporting lower overall environmental support. Among the ASD group, significant differences in participation were found across the three settings, with the highest participation scores at home. Environmental factors that support or limit children's participation were identified.

CONCLUSIONS

The results highlight the importance of environmental factors in children's participation. It is essential to evaluate different environmental settings; identifying the supportive and limiting environmental factors will enhance interventions for children with ASD.

Disabled Students' perception of the sensory aspects of the learning and social environments within one Higher Education Institution

Introduction

The environment, both natural and man-made, can influence how we learn and socialise. For some, the environment can be a challenge to overcome. The purpose of this study was to establish a student's perspective on the sensory aspects of the learning and social environments of a university.

Methods

A survey design based upon Winnie Dunn's Adult/Adolescent Sensory Profile was developed specifically for this study; 150 disabled students responded to the survey, which was analysed using descriptive statistics and template analysis.

Results

The final template analysis identified 3 main themes with 10 sub-themes, with each sub-theme relating to the research question as well as to the level of explanation: (a) Theme one: Barriers in the environment described noise, poor lighting, crowding and lack of visual cues that created difficulties for the respondents to this survey. The sub-themes were obstacles to learning in the library, obstacles to learning in lectures, obstacles to learning in exams and ventilation in learning spaces. (b) Theme two: Reactions to barriers, included how respondents react to sensory overload and uncertainty in the environment. The sub-themes encompassed problems when schedules change regularly, and reactions when overwhelmed in college. (c) Theme three: Improving the environment refers to suggestions that respondents made to improving the environment for all students to enable engagement and participation within college. The sub-themes compromised of developing a safe space for managing sensory needs, seeking natural elements across campus, seeking awareness, as well as adaptions and strategies for transitions.

Conclusion

Respondents identified how individuals have varied responses to sensory stimuli thereby increasing our understanding. They pointed to a way forward for institutes of higher education to design spaces that are more inclusive by putting forward suggestions for greater use of green space, better furnishings and minimisation of distractions, thereby increasing the health and welfare for all.

Assessment of home environment for autistic individuals: a literature review of the existing tools

Background

Autism Spectrum Disorder is a neurodevelopmental disorder, and its prevalence is estimated at 1% worldwide. The home environment can influence activities and roles for autistic individuals, however there are limited assessments that focus on the home environment for this population.

Purpose

To identify existing assessment tools of home environment for autistic individuals in the literature.

Methods

We explored five databases. Initial search on databases was made in 2019 and updated in 2022. Documents selection was made in two phases: 1) title and abstract screening, 2) full-text reading of selected publications. The included studies were analyzed.

Results

We identified seven home environment-related assessment tools that can be used with the autistic population. Most of the tools included few items related to the non-human environment and do not include specific elements of the environment (e.g.: details about sensory stimuli or assessment of the layout). Six of them are design for children or youths and only one out seven is specific to autistic people.

Conclusions

The identified tools do not allow for a detailed assessment of the non-human environment of autistic individuals only the identification of environment-related difficulties. More research and the development of new tools are needed to improve it.

Variable patterns of daily activity participation across settings in autistic youth: A latent profile transition analysis

LAY ABSTRACT

What people do or engage in in their daily lives, or daily life participation, is often linked to their state of being happy and healthy, as well as potential for living independently. To date, little research has been conducted on daily activity participation by autistic youth at home, at school or in the community. Learning more about individual differences in participation levels and what might influence them can help to create custom supports for autistic youth and their families. In this study, 158 caregivers of autistic youth were asked how often their children took part in 25 common activities at two assessments, about one year apart. The analysis showed three profiles for each of the home and school settings and two profiles for the community setting. These profiles reflected distinct patterns in how often autistic youth took part in various daily activities, particularly in doing homework, school club activities and community gatherings. Most autistic youth were in profiles marked by often taking part at home but less often at school and in the community, and about three-fourths of them tended to stay in the same profile over time. Autistic youth with limited participation profiles were more likely to have lower scores on measures of cognitive ability and daily life skills and more challenging behaviour, and faced more barriers in their environment. These findings show how important it is to think about each autistic person's strengths and weaknesses, and changing needs, to better support their daily life participation.

Strength-based technology clubs for autistic adolescents: A feasibility study

Strength-based technology clubs are thought to help autistic adolescents transition to adulthood by developing positive traits, enhancing technical skills, and creating supportive networks. A newly developed strength-based technology club was delivered to 25 autistic adolescents, with the feasibility tested via qualitative and quantitative methods. Autistic adolescents, their parents, and club facilitators participated in separate focus groups, with audio data transcribed and thematically analyzed. Quantitative data was collected via adolescent and parent-reported pretest-posttest measures following the 15-week program. Autistic adolescents were highly satisfied with the club (acceptability), the technology club satisfied an unmet need (demand), with the program demonstrating the potential to be integrated into the current therapy system in Australia (integration). Feasibility areas that could be improved in delivering future clubs are discussed.

Development and content validity of the youth and young-adult participation and environment measure (Y-PEM)

PURPOSE

To develop and evaluate the content of a self-reported measure of participation and environment, named Youth, Young-adult Participation and Environment Measure (Y-PEM), capturing participation at home, school, community, and the workplace among individuals with physical disabilities aged 12-30.

MATERIALS AND METHODS

A multi-phase sequential design based on elements of COnsensus for Standard Measurements INstrument was employed. Five consecutive rounds of cognitive interviews with 24 participants aged 12-33 years (X̅ = 20.9; n = 19 with a physical disability) and consultation with experts (n = 15) were conducted for item development and validation. Relevancy and clarity of items in each setting were assessed using the 10-cm Visual Analogue Scales (VASs).

RESULTS

Participants recommended adding activities specific to this age group (i.e., dating, caregiving, preparing meals, employment). On a 4-point Likert scale, work-related items were perceived important by experts (X̅ = 3.4) and young adults (X̅ = 3.1) with average clarity of 8.8 and relevancy of 8.4 out of 10, on the VASs. Similarly, the average clarity of items across settings (home, school, community) ranged from 6.9 to 8.7 and relevancy from 7.4 to 8.1. No modifications were required in environmental items.

CONCLUSIONS

Results suggest that Y-PEM is clear, relevant, comprehensive, and can be completed by individuals aged 12-30 with physical disabilities.IMPLICATIONS FOR REHABILITATIONThe Y-PEM can provide a standardized and systematic method to assess the first-hand subjective experience of youth and young adults with disabilities aged 12-30 in their participation at home, school, community, and the workplace.The Y-PEM can provide information regarding participation in activities that prepare youth or young adults for the job market as well as their perspective on the environmental barriers or supports that they may face in their employment.Clinicians can use the Y-PEM to identify environmental barriers and facilitators that impact participation across different settings and address them to further promote participation in meaningful and age-related activities.

Youth and family engagement in childhood disability evidence syntheses: A scoping review

Within the last decade, stakeholder engagement in research has become increasingly popular in childhood disability research; however, literature on the engagement of youth with neurodisabilities and their families in evidence syntheses is underdeveloped. Involving patients as partners in research has the potential to improve applicability and relevance of the research and benefit patient partners (e.g. enhanced self-esteem, increased research knowledge and skills); however, the methods, challenges, outcomes and recommendations of engaging youth with neurodisabilities and their families in evidence syntheses are unknown. Two parents of youth with complex disability needs were engaged as partners throughout this review. Following methods outlined by Arksey and O'Malley (2005), the primary research question in this scoping review is twofold: (i) what activities have youth with neurodisabilities and their families been engaged in as part of evidence syntheses and (ii) what were the outcomes of that engagement? After full text review of 369 articles, nine articles were included. Youth and families were engaged prior to the evidence synthesis and at every stage in the project, most often during data analysis where they contextualized the findings. Youth and family engagement were not formally evaluated; however, positive outcomes were reported by parents and researchers. Challenges such as increased time, sustaining engagement, and parents' dissatisfaction with their level of involvement were reported. Recommendations centred around providing partners with information, building relationships via social media, and openly communicating about roles, feedback and logistics. Childhood disability researchers should be aware of how they can increase engagement opportunities at all stages of evidence syntheses and how they might improve accessibility for youth with neurodisabilities and their families. Further research is needed to solidify a unified framework for conduct and reporting of youth and family engagement in evidence syntheses.

Investigating Strategies Used to Foster Quality Participation in Recreational Sport Programs for Children With Autism Spectrum Disorder and Their Perceived Importance

Quality experiences in sport programming for children with autism spectrum disorder (ASD) can promote physical and psychosocial benefits and long-term quality participation (QP). Unfortunately, children with ASD often experience sport participation barriers and, consequently, participate less in sport compared with children without disabilities. This study investigated QP priorities and strategies that could foster QP for children with ASD. Caregivers (n = 13), volunteers (n = 26), and staff (n = 14) involved in sport programming for children with ASD rated experiential elements of QP using the Measure of Experiential Aspects of Participation. In addition , a two-round Delphi survey with staff (Round 1: n = 11; Round 2: n = 13) generated 22 strategies for promoting QP-each rated highly with regard to importance (5.69-6.85 on a 7-point scale). Strategies were substantiated with published research evidence. Findings informed the development of a QP tool designed to help instructors implement identified strategies in hopes of improving sport experiences for children with ASD.

Feasibility of Using Q-Sort to Map Conditional Participation in Physical Activity in Adolescents With Autism Spectrum Disorder

BACKGROUND

Participation in physical activity among adolescents with autism is often conditional. However, there is a lack of methods for identifying these specific conditions. Therefore, the purpose of this study was to develop and investigate the feasibility of a Q-sort tool to map individual-specific conditions for participation in physical activity among adolescents with autism and to identify different viewpoints regarding conditions for such participation.

METHOD

An exploratory mixed-methods design was employed to investigate the feasibility of using Q methodology and the Q-sort procedure to identify what individual-specific conditions are important for participation in physical activity for adolescents with autism.

RESULTS

The adolescents ranked the statements with varying levels of ease. Two viewpoints were identified: Autonomous participation without surprises and Enjoyment of activity in a safe social context.

CONCLUSION

Q-sort is a feasible method for mapping conditions for participation, which can guide the development of tailored physical activity interventions.

The Impact of the Urban Built Environment on the Play Behavior of Children with ASD

Anxiety caused by the lack of social skills is the biggest problem faced by children with ASD. Playing can improve children's social skills and relieve anxiety. This study aimed to explore the influence of urban built environments on ASD children's play behavior. The participants in this study were 57 parents of children with ASD. An anonymous questionnaire was used to collect and analyze data. At the same time, retrospective semi-structured interviews with 31 parents of ASD children were performed to validate the data analysis results. The results showed that lower residential building density, higher residential greening and higher destination accessibility have positive effects on ASD children's play behavior. Excellent transportation facilities and high NDVI vegetation coverage have positive effects on the play behavior of children with ASD. More recreational facilities and recreational playability have positive impacts on the play behavior of children with ASD. The population density and number of children in the destination, as well as public facilities, influence the play behavior of children with ASD. The research results can promote the integration of this group into urban life and further promote social equity. At the same time, with the social needs of autistic children as an intermediary, it is expected to further explore new directions for sustainable urban development. Finally, combined with the research results, parents of ASD children are given proposals for how to increase the likelihood of children's play behavior by choosing appropriate urban built environments.

Childhood experiences of being parented, adult attachment, psychological inflexibility, social engagement, and mental health of autistic adults

BACKGROUND

Autistic adults have an increased risk of poor mental health. Although parental care and overprotection in childhood influence later attachment and mental health in the general adult population, this has not been investigated in the autistic population. Likewise, the roles of psychological inflexibility and social engagement in influencing mental health outcomes for autistic adults have yet to be examined.

AIMS

To examine if retrospectively recalled childhood experiences of parental care and overprotection, as well as current adult attachment, psychological inflexibility and social engagement are associated with mental health in autistic adulthood. Further, to examine mediators of the association between parental care and overprotection and mental health in autistic adults.

METHODS AND PROCEDURES

A community-recruited convenience sample of 126 Australian autistic adults completed an online survey assessing childhood experiences of parental care and overprotection and current adult attachment, psychological inflexibility, social engagement, and mental health.

OUTCOMES AND RESULTS

Linear regressions showed that psychological inflexibility was the strongest predictor of depression, anxiety, and stress, followed by attachment anxiety (depression, anxiety) and attachment avoidance (anxiety, stress). Mediation analyses revealed that psychological inflexibility and attachment anxiety mediated the associations between parental care and overprotection and mental health outcomes in autistic adulthood.

CONCLUSIONS AND IMPLICATIONS

Psychological inflexibility and adult attachment (anxious and avoidant attachment) are important to understanding mental health of autistic adults. Psychological inflexibility and attachment anxiety mediate associations between recalled childhood experiences of parental care and overprotection and mental health in autistic adulthood.

Exploring two subdimensions of participation, involvement and engagement: A scoping review

BACKGROUND

The conceptualisation of participation is an ongoing discussion with importance for measurement purposes. The aim of this study was to explore the two subjective subdimensions of participation, involvement and engagement. The purpose was related to measure development within the field of paediatric rehabilitation.

METHODS

In a scoping review, following the PRISMA-ScR, the databases MEDLINE, PubMed, Academic Research Complete, PsychINFO, and Business Source Complete were searched for publications that described engagement and/or involvement constructs.

RESULTS

Thirty-nine publications met the inclusion criteria. Involvement could be conceptualised as an unobservable state of motivation, arousal, or interest towards a specific activity or product. Building a consensus over different fields of research, engagement can be seen as the individual's behavioural, cognitive and affective investment during role performance.

CONCLUSIONS

This scoping review points in a direction that the two subdimensions of participation need to be separated, with involvement being a more stable internal state of interest towards an activity, and engagement referring to the specific behaviour, emotions, and thoughts meanwhile participating in a specific setting. Clear definition of concepts will enhance the development of measures to evaluate rehabilitation interventions in the field of occupational therapy and related fields.

Autism-friendly eyecare: Developing recommendations for service providers based on the experiences of autistic adults

PURPOSE

People with autism face significant barriers when accessing healthcare services. Eye examinations present unique challenges. Accessibility of this healthcare sector for people with autism has not been investigated previously. The aim of this research was to investigate eye examination accessibility for autistic adults and produce recommendations for autism-friendly eyecare.

METHODS

Two qualitative studies were conducted. In Study 1, 18 autistic adults took part in focus groups to elicit their eye examination experiences. Transcripts of the recorded discussions were thematically analysed. Study 1 findings were used to design autism-friendly eye examinations for autistic adults. These were conducted in Study 2. Twenty-four autistic adults participated in these examinations, during which they were interviewed about their experience and how it might be improved by reasonable modifications. Audio recordings of the interviews were content analysed.

RESULTS

Knowledge of what to expect, in advance of the eye examination, could greatly reduce anxiety. Participants liked the logical structure of the examination, and the interesting instrumentation used. However, the examination and practice environment did include sensory challenges, due to lights, sound and touch. Changes in practice layout, and interacting with multiple staff members, was anxiety provoking. Participants expressed a need for thorough explanations from the optometrist that outlined the significance of each test, and what the patient was expected to do.

CONCLUSION

A number of accessiblity barriers were identified. These suggested that UK eye examinations are not very accessible for autistic adults. Barriers began at the point of booking the appointment and continued through to the dispensing of spectacles. These caused anxiety and stress for this population, but could be reduced with easy-to-implement adaptations. Based on the findings, recommendations are presented here for the whole eyecare team which suggest how more autism-friendly eye examinations can be provided.

"Setting Them Up for Success": Including Youth on the Autism Spectrum in 4-H

Youth on the autism spectrum often face challenges accessing services in rural communities compared to those who live in higher resource areas. There is a particular need for services that support skills that will help youth transition to adulthood and future employment. 4-H is a national youth development program that is well-positioned to address the needs of youth on the autism spectrum; however, minimal empirical evidence exists about the implementation and effectiveness of inclusive practices in 4-H programs. The goal of this study was to better understand barriers to enrollment and to identify gaps in support for youth on the autism spectrum participating in 4-H. Twenty Extension Educators in Indiana participated in two focus groups. Thematic analysis of focus group transcripts identified barriers to enrollment including awareness of 4-H as an inclusive program and difficulties navigating 4-H culture. Our analysis identified themes related to new training content and delivery including a resource portfolio, communication, individualized accommodations, and working within the existing leadership training structure. Findings support the benefits of 4-H as a program that can promote life skills and personal development for youth on the autism spectrum but also highlight a significant need for additional training opportunities and resources to increase uptake and improve the implementation of inclusive practices.

Living arrangements and community participation among autistic adults: Exploring the possible influences of living alone or with others

BACKGROUND

With the increasing prevalence of autistic individuals, it is greatly needed to examine the factors impacting their community participation experiences. Where autistic adults live and how that may be related to their participation and quality of life is one environmental factor that has received little attention.

AIMS

This study explored the association between living arrangements in the community and community participation for autistic adults.

METHOD

This study used data from a statewide survey of autistic adults (N = 744) to investigate the relationship between living arrangements (live alone with or without support, live with roommate/spouse, or live with family) and the amount, breadth, and sufficiency of community participation.

RESULTS

After controlling for sociodemographic and clinical factors known to be associated with community participation, autistic adults living with family members participated less frequently in community activities over 30 days than those living with a roommate/spouse. However, they experienced similar levels of sufficiency with their participation. Autistic adults living alone with support reported the lowest levels of sufficiency with their participation, although the amount and breadth of their participation were no different from other adults.

CONCLUSION

These findings have several implications for providing support to enable autistic adults to participate in the areas that are important to them and to the extent they desire. Future research is needed to gain a better understanding of how interests and expectations for participation may be influenced by living situations.

Implementing Pathways and Resources for Engagement and Participation (PREP) for Children with Disabilities in Inclusive Schools: A Knowledge Translation Strategy

Aims: To examine the effectiveness of PREP (Pathways and Resources for Engagement and Participation) knowledge translation (KT)-program on (a) change in practice behaviors and improved knowledge of school-based occupational therapists, and (b) participation of children with disabilities in inclusive education.Methods: A mixed-methods design was employed. Therapists (n = 39) completed a 30-hour program. Each therapist applied PREP intervention to one child (n = 39) aged 4-15 (Mean = 9.31, SD = 2.4). Therapists' outcomes included: (a) knowledge of PREP evaluated using a clinical vignette, analyzed descriptively, (b) change in practice behavior measured by the Professional Evaluation and Reflection on Change Tool (PERFECT), analyzed thematically. Change in children' participation pre- and post-KT-program and during follow-up was measured by the Canadian Occupational Performance Measure (COPM), analyzed using ANOVA.Results: Therapists acquired knowledge of PREP (vignette mean score 17.7/20). PERFECT revealed therapists' self-perceived changes in practice: incorporating an environmental perspective, expanding partnerships, and redirecting focus on participation. Completing the KT-program was a primary enabler and reason for change. Children's participation significantly improved post KT-program and during follow-up in both performance (p < 0.001) and satisfaction (p < 0.001).Conclusions. KT strategies, as illustrated in this study, accelerated the uptake of evidence-based interventions, minimizing existing 'know-do' gaps and promoting children's health through participation.

Making lighting adjustments to establish new behavioral patterns in a child with autism: A follow-up study

Acknowledging the importance of lighting adjustment (a less-studied aspect of the environmental modification), this study showed novel effects of black light conditions, where white objects became part of the foreground of a blackened environment to train a child with autism to master a series of self-care tasks. This follow-up study provided details about how training progressed under black light conditions to teach the child a second task called self-feeding. The process of training self-feeding for this child was undergone after the child mastered the self-care task of toothbrushing. Healthcare practitioners may want to illuminate overlooked aspects of the non-human environment, which may be ignored by children with autism, to stimulate interest in objects following lighting adjustments.

A Systematic Review and Meta-Analysis of Moderate-to-Vigorous Physical Activity Levels in Children and Adolescents With and Without ASD in Inclusive Schools

Background: The health benefits of physical activity (PA) participation are well-documented. Little was known about the PA levels of students with autism spectrum disorder (ASD) and their typically developing (TD) peers in inclusive schools. This study aimed to synthesize available studies examining PA levels of children and adolescents with and without ASD and its associated factors that affected their PA participation during inclusive schools applying the social-relational model of disability (SRMD). Methods: Eight databases were searched including CINAHL Complete, SPORTDiscus with Full Text, PubMed, Embase, Web of Science, Eric, APA PsycINFO, and Scopus from inception through May 2021 to identify related studies. Two researchers independently screened studies, assessed methodological quality, and summarized relevant data. The McMaster Critical Reviewer Form for quantitative studies was used to evaluate the methodological quality of the included articles. Results: A total of seven articles were included in this systematic review. Overall, meta-analysis results indicated that children and adolescents with ASD had a moderately decreased PA levels compared with their TD peers [SMD = -0.585, 95% CI (-0.774, -0.425), p < 0.01]. Individual-, social-, and environmental-level factors that influence PA levels in children and adolescents with ASD were identified from the perspective of SRMD. Conclusion: This review indicates that children and adolescents with ASD have lower PA levels than their TD peers in inclusive schools and multilevel factors affect their PA.

From Someone Who May Cause Trouble to Someone You Can Play With: Stakeholders' Perspectives on Preschool Program Quality for Autistic Children

In Sweden, young autistic children typically attend community-based preschool programs, which may not be adapted to their needs. In the current study, stakeholders to autistic children receiving Early Intensive Behavioral Intervention were interviewed following a quasi-randomized study (#NCT03634761) aimed at improving the preschool program quality using the Swedish version of the Autism Program Environment Rating Scale (APERS). Stakeholders provided their perceptions and experiences concerning key factors for high quality preschool programs as well as well as their experiences of the abovementioned APERS study. Applying thematic analysis, stakeholder groups differed in what they emphasized, but all highlighted staff’s competence, children’s inclusion and participation, collaboration, and the learning environment as key program areas that had been positively influenced by the APERS-based intervention.

Parental Attitudes and the Attitude to Energy Saving among Young People with ASD

The aim of the study was to determine the association between parental attitudes and saving energy in the perception of young people with autism spectrum (13–17 years old). The character of studies was pilot. The diagnostic survey method was used, along with The Scale of Parental Attitudes by M. Plopa and an authored survey questionnaire. Deliberate random sampling was applied. Statistical analysis showed that an attitude towards autonomy manifested by mothers, as well as an attitude of acceptance in mothers and fathers, turned out to be significant in adolescents with ASD showing a positive attitude towards energy saving, and these correlations were positive, strong and statistically significant. An overly protective attitude of mothers turned out to be significant in shaping a negative attitude towards energy saving among adolescents with ASD with a significant, positive moderate correlation. Regression analysis showed that the perception of the father’s parental attitude as accepting was a statistically significant predictor of a positive attitude towards energy saving, and that the perception of the mother’s parental attitude as demanding and overly protective was a statistically significant predictor of a negative attitude to energy saving. The achieved results acquire an additional aspect, i.e., a financial dimension in the household budget.

Sitting on the Sidelines: Disparities in Social, Recreational, and Community Participation Among Adolescents with Autism Spectrum Disorder

Participation in extracurricular activities and community involvement during secondary school is important for the healthy social, emotional, mental, and physical development of adolescents, especially those with autism spectrum disorder (ASD). The current study utilized three waves of data (2016, 2017, and 2018) from the National Survey of Children's Health (NSCH) to examine disparities in extracurricular participation among 12- to 17-year old adolescents with ASD. Across the three waves, data demonstrate clear sociodemographic disparities among adolescents with ASD. These disparities were more evident in adolescents with caregivers that had less education and lower household income, as well as males. These disparities suggest a continued need for targeted interventions to promote engagement among adolescents with ASD to narrow this social disparity gap.

The effect of ambient sounds on decision-making and heart rate variability in autism

LAY ABSTRACT

Many autistic people report difficulties making decisions during everyday tasks, such as shopping. To examine the effect of sounds on decision-making, we developed a supermarket task where people watched a film shown from the shopper's perspective and were asked to make decisions between different products. The task was divided into three sections and participants completed each section in a different auditory environment: (1) no sounds, (2) non-social sounds (e.g. fridges humming) and (3) social sounds (e.g. people talking). Thirty-eight autistic and 37 neurotypical adults took part. We measured decision-making by examining how long it took to make a decision and how consistent people were with their decisions. We also measured heart rate variability because this biological response provides a measure of anxiety. After the supermarket shopping task, participants told us in their own words about their experiences. Autistic participants said that they found the non-social and social sound conditions more difficult than the no sound condition, and autistic participants found the social sound condition more negative than neurotypical participants. However, decision-making and heart rate variability were similar for autistic and neurotypical participants across the sound conditions, suggesting that these measures may not have been sensitive enough to reflect the experiences the autistic participants reported. Further research should consider alternative measures to explore the experiences reported by autistic people to help us understand which specific aspects of the environment autistic people are sensitive to. This, in turn, may enable more specific and evidence-based autism-friendly changes to be made.

Community Participation Comparison Between Adults on the Autism Spectrum and Adults in the General Population

Little research has examined the full-range of participation among adults on the autism spectrum. The current study addresses this knowledge gap by comparing the frequency, importance, breadth, and sufficiency of participation between autistic adults and adults in the general population. Autistic adults participated less, had fewer areas that were important to them, participated in fewer areas that were important to them, and were less satisfied with their participation even after controlling for demographic characteristics. Moreover, this study raises questions about what influences their perceptions about the breadth of activities that are important to them and the degree to which they desire to participate in those areas. Suggestions for future interventions and research are offered.

Towards a paradigm shift in pediatric rehabilitation: Accelerating the uptake of evidence on participation into routine clinical practice

PURPOSE

Evidence for the importance of focusing on participation to promote health and wellbeing in childhood-onset disability exists, but practice is slow to change. This paper provides a knowledge translation roadmap to accelerate uptake of participation evidence into day-to-day practice.

MATERIALS AND METHODS

A structured roadmap to guide knowledge translation initiatives for implementing participation-based practices in co-creation with service users was developed based on elements from: the Five-factorframework for predicting implementation outcomes, the Cultural Cone framework, and the Knowledge-to-Action model.

RESULTS

Guiding principles paired with examples of multi-component knowledge implementation strategies to facilitate readiness for change by stakeholders at the micro (e.g., client/family, service providers), meso (e.g., administrators within organisations such as rehabilitation centres, hospitals, schools) and macro (e.g., local and governmental policy, regulatory bodies) levels are introduced. Solution-based strategies are provided to facilitate "readiness to change" for each stakeholder group. The strategies are examples for successful implementation of evidence-based interventions/approaches that can be contextualized across settings.

CONCLUSIONS

The knowledge translation roadmap can assist children and families, service providers, administrators, and policymakers to bridge existing knowledge-to-practice gaps surrounding participation. Partnering and collaborating through a "family-clinician-manager-community leader-policymaker" synergy is key for achieving strategic practice change focussed on participation.Implications for RehabilitationSound evidence surrounding the topic of participation, including effective assessments and interventions, is available and ready for use.Shifting towards participation-focused practices for children and youth with disabilities requires a systemic multi-level KT approach.Our Participation-KT roadmap, comprised of a framework and a list of principles and strategies for implementation, can be used to guide all stakeholders to foster a shift in practice.Forming partnerships and working collaboratively with all stakeholders is key for successful implementation.

Enhancing the social networks of adults with ASD: a low level community intervention

Purpose

This paper aims to design and evaluate an innovative community-based service for adults with autism in a rural region of Northern Ireland. The goal was to reduce their social isolation through gaining social skills and building social networks.

Design/methodology/approach

Over three years, 54 persons with a median age of 21 years received 12 months of one-to-one, personalised support and opportunities to participate in peer groups and social activities which are detailed in the paper. Quantitative and qualitative information about the impact of the service was obtained from its users, their relatives, as well as service personnel.

Findings

Service users rated themselves to have changed in more ways than did their relatives and staff although there was a consensus that the changes were most marked in terms of spending more time out of the house, engaging in more community activities, being more independent and increased confidence. The main benefits they perceived from participation in the project were socialising, new experiences and learning new things.

Research limitations/implications

As with many service projects, a longer term follow-up of service users was not possible due to resource constraints.

Practical implications

The service could be replicated with suitable staff although current constraints on social care budgets have limited its expansion to more users and extension to other areas in Northern Ireland.

Social implications

Reducing the social isolation of adult persons with autism spectrum disorders needs to be personalised to the person, their living circumstances and the community in which they live. Family carers also stand to gain from community support services.

Originality/value

This low level, low cost service was implemented in a predominantly rural area with a majority of users from socially deprived areas.

Influence of Neighborhood Environment on Physical Activity Participation among Children with Autism Spectrum Disorder

Despite the positive influence of environmental factors on physical activity (PA) levels of children, further investigation is necessary when considering the unique characteristics of children with autism spectrum disorder (ASD). The purpose of this study was to examine the relationship between neighborhood environment factors and PA among children with ASD by examining the extent to which (a) the built environment, (b) neighborhood safety, and (c) neighborhood support contributes to PA. A secondary data analysis using the 2016 and 2017 combined dataset of the National Survey of Children's Health was used. The total sample included 14,944 children between the ages of 6-17 years; of this, a sample of 494 children had a parent-reported diagnosis of ASD. Multivariate logistic regressions were conducted to explore the unique influences of the above three neighborhood environment factors on PA engagement. Among children with and without ASD, an association was found between feeling safe and engaging in PA, that is, the odds of engaging in PA are greater among children who were safe in their neighborhoods than children who were not in safe neighborhoods. Surprisingly, other neighborhood factors do not have a significant relationship with PA participation among children with ASD at this time. Future studies should consider how to incorporate the support of others and feeling of safety into the neighborhood along with how to improve accessibility of the built environment in order to increase PA for children with ASD. LAY SUMMARY: The results of this study showed that neighborhood factors influence physical activity (PA) among children with ASD differently compared to their peers without ASD. Children with ASD who live in safe neighborhoods are more likely to engage in PA, while other neighborhood factors, such as playgrounds and support, are not associated with an increased likelihood of engaging in PA at this time. Efforts should be made to improve neighborhood accessibility and design in order to increase PA among children with ASD.

A Brief Report: Community Supportiveness May Facilitate Participation of Children With Autism Spectrum Disorder in Their Community and Reduce Feelings of Isolation in Their Caregivers

Children with autism spectrum disorder (ASD) participate at lower rates in their community, and their caregivers experience higher levels of stress, in comparison to families of typically developing (TD) children. The social model of disability positions the environment as the central issue when children with disabilities are unable to participate, yet little is known about the relationship between poor community support, reduced community participation in children with ASD, and caregiver stress. This study examined caregiver perceptions of community supportiveness for the community participation of 48 children with ASD (aged 5–12 years), alongside caregiver-reported child ASD symptom severity, adaptive functioning, and caregiver stress. Community supportiveness predicted child involvement, but not attendance, when child characteristics were held constant. Caregiver perceptions of low community supportiveness significantly predicted caregiver feelings of isolation. The importance of modifying community programs to better support inclusion of children with ASD is discussed.