Thriving in Youth with Autism Spectrum Disorder and Intellectual Disability

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.

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.

The role of thriving in mental health among people with intellectual and developmental disabilities during the COVID-19 pandemic in Canada

BACKGROUND

The COVID-19 pandemic has had a negative impact on the mental health of people with intellectual and developmental disabilities. Numerous pandemic-related stressors experienced by people with intellectual and developmental disabilities may have impacted their ability to thrive, which has been linked to mental health outcomes. The current study examined the associations among COVID-19 stressors, thriving, and mental health problems among youth and adults with intellectual and developmental disabilities.

METHOD

Caregivers of 159 people with intellectual and developmental disabilities between 12 and 35 years of age from Canada completed an online questionnaire.

RESULTS

A mediation analysis revealed that COVID-19 stressors were positively associated with mental health problems, and that thriving partially mediated this association.

CONCLUSION

Our findings suggest that experiences of thriving may be an important target for mental health support for people with intellectual and developmental disabilities.

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.

Preparation for postsecondary education of transition aged youth with intellectual disability and autism spectrum disorder in the United States: An Analysis of data from the national longitudinal transition study 2012

Youth with intellectual disability and autism spectrum disorder increasingly access postsecondary education in many countries around the world. To ensure students are ready to access these options, preparation for postsecondary education must be part of their transition services. This study examines the postsecondary education preparation experiences of youth with intellectual disability and autism using the NLTS 2012 dataset to identify the extent to which these youth are accessing preparation activities and if this preparation differs from youth in other groups. Findings indicate few differences between the postsecondary education preparation of youth with intellectual disability and autism and autism without intellectual disability but highlight substantial differences in several preparation activities when compared with youth in other groups.

Toward understanding and enhancing self-determination: a qualitative exploration with autistic adults without co-occurring intellectual disability

Introduction

Self-determination is a fundamental human right positively related to quality of life. However, Autistic people are reported to be less self-determined than non-autistic people. We aimed to (1) understand what self-determination means to Autistic people from their perspective, (2) explore their perceptions of current barriers to being self-determined, and (3) learn from Autistic people about how they would like to be supported to be self-determined.

Methods

Semi-structured interviews were done with 19 Autistic adults without co-occurring intellectual disability. Data were analyzed by three Autistic and two non-autistic researchers through an iterative process of data familiarization, coding, and theme development, informed by reflexive thematic analysis. Autistic Community Partners (ACP) were also engaged throughout the study, and provided substantive feedback on all methods and results.

Results

Self-determination held the same meaning for Autistic people as non-autistic people. More specifically, participants discussed having the opportunity and support to make choices and decisions in life without unnecessary control from others. Experiences of self-determination were centered around: (1) lack of opportunity, influenced by ableist expectations and discrimination, and (2) executive processing differences that interfered with choice and decision-making. Desired areas of support related to providing opportunities to (1) make choices and exert autonomy, (2) be supported to unmask and be valued as one's authentic Autistic self, and (3) offering pragmatic support for executive processing differences.

Conclusion

Autistic adults desire to be self-determined and can flourish with support, as they determine to be appropriate, which might look different from support commonly offered or sought by non-autistic people. Although individualized support was discussed, the ideal desired support was for an inclusive society that values and respects their neurodivergence, rather than imposing ableist expectations. An inclusive society is only achievable through reduced (or eliminated) stigma and prejudice against Autistic people.

Parent-Reported Strengths and Positive Qualities of Adolescents and Adults with Autism Spectrum Disorder and/or Intellectual Disability

Despite increasing attention to understanding strengths in those on the autism spectrum, few studies have explored this in older individuals. The present study provides a qualitative analysis of parent-reported strengths and positive qualities of 68 15-30-year-olds with autism and/or intellectual disability (ID). Most parents (97%) reported at least one positive quality. Themes were consistent with previous studies; Personality characteristics (82%) and Sociability (53%) were reported most frequently. A Work Ethic/Motivation category not previously reported emerged. Autistic individuals (with/without ID) were more likely than those with ID-only to have a Specific Skill. Findings highlight the importance of recognizing strengths of autistic adults. Research is needed to understand how to best leverage positive qualities to promote goal achievement and quality of life.

Profiles and predictors of thriving in children on the autism spectrum

BACKGROUND

Thriving is defined as the growth of attributes that mark a flourishing, healthy individual and include Competence, Confidence, Connectedness, Character, Caring and Contribution to self, family, community and civil society. Thriving has been linked to positive youth outcomes in neurotypical children and adolescents but has rarely been explored for individuals on the autism spectrum.

METHOD

This study explored the profiles and predictors of parent-reported thriving in 111 school children on the autism spectrum, aged 6 to 14 years.

RESULTS

Parents rated children as having relative strengths in the Caring and Connectedness dimensions and relative challenges in the Competence dimension. Stronger thriving outcomes were consistently predicted by stronger socialization scores; however, the other predictors of outcome differed by dimensions.

CONCLUSION

The current findings provide insight into the individual and contextual factors that predict thriving in children on the autism spectrum. As research into thriving is in its infancy, more work is needed to understand how child, family and contextual factors relate to thriving in individuals on the autism spectrum to foster positive outcomes.

Australian occupational therapists' knowledge of the purpose, scope, and funding of assistance dogs

BACKGROUND

Assistance dogs, considered a form of assistive technology within Australia's National Disability Insurance Scheme (NDIS), can support scheme participants to achieve greater independence. To receive funding, an allied health assessment report (most often from occupational therapists) is required to justify the animal as a reasonable and necessary support.

OBJECTIVES

Examine Australian occupational therapists' knowledge and perceptions of assistance dogs; NDIS funding of animal supports; and resources considered useful to guide occupational therapy assessment and report writing.

METHOD

An online anonymous survey was developed and distributed via social media channels, an email listserv, and professional association newsletters to Australian occupational therapists. Data were analysed using descriptive and inferential statistics. Inductive content analysis of open-ended question responses provided additional insights regarding occupational therapists' knowledge, experiences, and information needs in relation to animal supports.

RESULTS

One hundred forty-five completed surveys were received. A majority of participants had limited knowledge regarding the purpose, scope, and funding of assistance dogs. Only 14 participants had made a referral for an assistance dog for an NDIS participant. For the 36 participants who self-identified as having good or excellent knowledge of one or more types of assistance dogs, benefits included increasing users' independence, confidence, and quality of life. Although participants agreed they had suitable skills to prescribe assistance dogs, greater clarification regarding their role in the NDIS assessment, advisory, and application process was seen as necessary.

CONCLUSION

This research highlighted the need for increased information for occupational therapists regarding the various types of assistance dogs and NDIS funding rules. The provision of NDIS reporting templates, practice guidance, and professional development resources-as well as occupational therapy curriculum for near-graduate therapists-could enhance knowledge, clinical reasoning, and practice when considering the most appropriate support and whether an assistance dog is both reasonable and necessary based on the person's goals and needs.

The Impact of Anxiety on the Participation of Children on the Autism Spectrum

Anxiety is common in children on the autism spectrum, however its impacts are not fully understood. Participation is an important outcome, linked to the health and wellbeing of children. This study examined the relationship between anxiety and participation using parent reports for 131 children on the autism spectrum, aged 6-13 years. Hierarchical multiple regressions explored child and family factors in relation to participation in Home and Community settings. Anxiety was a unique, significant predictor of the frequency of children's participation (but not involvement in activities) in both settings, when controlling for autism characteristics, communication skills and family income. Anxiety symptomatology may contribute to the less frequent participation of children on the autism spectrum in home and community activities.

Understanding Stability and Change in Perceived Social Support in Parents of Autistic Children and Adolescents

Parents of children with autism often have their own support needs. Informal social support can be an important component of managing parenting-related stressors. We know very little about the factors that lead to higher levels of perceived social support or the potential reciprocal relationship social support has with other factors in parents of children with autism. The current longitudinal study examined the reciprocal relations of perceived social support and parent stress and child behavior problems across a 1-year period, using three time points. There was remarkable stability in variables over time. Baseline perceived social support significantly predicted changes in child behavior and parent stress at the 6-month time point, but neither of those variables significantly predicted social support. This study adds to our understanding of social support and clarifies how perceived social support relates to other factors longitudinally.

Thriving with Down syndrome: A qualitative multiple case study

BACKGROUND

Down syndrome (DS) is the most common genetic cause of intellectual disability. Prior research has primarily focused on associated medical problems and skill deficits. This study takes a novel positive psychology approach by examining critical individual characteristics and environmental factors that facilitate exceptional quality of life for people with DS.

METHOD

A qualitative multiple case study design was used to document the lives of four adults thriving with DS. Thriving was defined as high subjective well-being coupled with continued personal development.

RESULTS

Descriptive contexts were provided for each case along with four overarching themes: a supportive social ecology, high expectations for independence, advocacy, and strengths facilitating happiness. A new conceptual framework for understanding thriving with DS was proposed.

CONCLUSIONS

These findings provide insight as to what is possible for people with DS, including ideas for future research and practice to promote thriving in the DS population.

Cohort profile: the Australian Longitudinal Study of Adults with Autism (ALSAA)

​PURPOSE: There is a significant knowledge gap regarding the lives of adults on the autism spectrum. Some literature suggests significant health and mental health inequalities for autistic adults, yet there is a lack of comprehensive longitudinal studies exploring risk factors. Further, most research does not include the perspective of autistic adults in its conduct or design. Here, we describe the baseline characteristics and inclusive research approach of a nationwide longitudinal study. ​PARTICIPANTS: The Autism Cooperative Research Centre for Living with Autism's Australian Longitudinal Study of Adults with Autism (ALSAA) is a questionnaire-based longitudinal study of autistic adults (25+ years old) with follow-up at 2-year intervals. Autistic advisors were involved in each stage of research apart from data analysis. Three questionnaires were developed: self-report, informant report (ie, proxy report) and carers (ie, carer experiences and characteristics). ​FINDINGS TO DATE: An inclusive research protocol was developed and agreed with autistic advisors. Baseline data were collected from 295 autistic adults (M=41.8 years, SD=12.0) including 42 informant responses, 146 comparison participants and 102 carers. The majority of autistic participants (90%) had been diagnosed in adulthood (M=35.3 years, SD=15.1). When compared with controls, autistic adults scored higher on self-report measures of current depression and anxiety. Participant comments informed ongoing data gathering. Participants commented on questionnaire length, difficulty with literal interpretation of forced response items and expressed gratitude for research in this area. ​FUTURE PLANS: A large comprehensive dataset relating to autistic adults and their carers has been gathered, creating a good platform for longitudinal follow-up repeat surveys and collaborative research. Several outputs are in development, with focus on health service barriers and usage, caregivers, impact of diagnosis in adulthood, further scale validations, longitudinal analyses of loneliness, suicidal ideation, mental illness risk factors and other areas. Baseline data confirm poorer mental health of autistic adults. The ALSAA demonstrates a working approach to inclusive research.

Beyond the Benefits of Assistance Dogs: Exploring Challenges Experienced by First-Time Handlers

Simple Summary

People with disabilities employ many forms of assistive technology, including assistance dogs (AD), to assist them with managing their disability. Most previous research has focused on the benefits of ADs for their handlers with disability; little is known about the challenges they face. The aim of this study was to explore the experiences of first-time handlers when working with an AD. It was found that handlers experienced many benefits from their dog, as would be expected. However, they also reported experiencing many challenges which hindered or delayed these benefits. These challenges arose from the handler’s medical conditions, cognitive ability and social environment, as well as from dog-related factors. They are important for potential handlers and AD organizations to consider prior to placing an AD, since this will assist individuals and organizations to better determine if an AD is the right form of assistive technology for a particular individual, and, if so, how best to prepare to integrate the dog into the person’s life.

Abstract

The purpose of this study was to explore first time handlers’ experiences when working with an assistance dog (AD). Interviewees included seven first time AD handlers and 14 other individuals close to these handlers, including family members, carers and AD instructors. Semi-structured interviews were conducted six months and one year after each handler received their AD. Interview questions were informed by the Thriving Through Relationships theory of social support and previous interviews with the participants. Inductive content analysis corroborated previous findings regarding the benefits that ADs provide. In addition, four factors were revealed to substantially influence the challenges handlers experienced when learning to utilize their dog. These included the handlers’ medical conditions, cognitive ability and social environment, and dog-related factors. Organizations would benefit from considering these factors in their operational processes.

Participation of children on the autism spectrum in home, school, and community

BACKGROUND

Children on the autism spectrum participate less frequently, and in a narrower range of activities, than their nonautistic peers, but little is known about exact participation patterns across contexts or how this is perceived by caregivers. This study aimed to document patterns of participation and caregiver views with regard to frequency and intensity of activities.

METHOD

Caregivers of children on the spectrum aged 5 (n = 90) and 9-10 years (n = 128) completed the Participation and Environment Measure for Children and Youth for home, school, and community. Caregivers reported on frequency of child's participation, level of involvement, and caregivers' desire for change in participation patterns.

RESULTS

Item-level analyses revealed similar patterns of participation across home, school, and community for both cohorts with some small age-appropriate differences. Caregivers generally desired increased diversity, frequency, and involvement in activities but a decreased use of electronics (computers, games, TV, and DVDs).

CONCLUSION

The possibility of autism-specific participation patterns could inform future interventions aimed at enhancing social inclusion. This warrants further investigation through multiinformant designs that seek the perspectives of the child and caregivers.

Patterns of sport participation for youth with autism spectrum disorder and intellectual disability

BACKGROUND

Little is known about sport participation in youth with Autism Spectrum Disorder (ASD). The current study examined sport characteristics (frequency, diversity, positive social experiences [PSE]) for youth with ASD and intellectual disability compared to youth with intellectual disability alone and explored the personal and contextual correlates of involvement.

METHOD

Parents (N = 409) completed an online survey, and multiple mediation analyses were used to examine the factors that explained the relationships between sport involvement in youth with ASD and intellectual disability.

RESULTS

No significant main effects of ASD status were found for frequency or diversity, but youth with intellectual disability alone had higher scores for PSE compared to youth with ASD and intellectual disability. Sociocommunicative abilities, coach relationship and resources mediated the relationship between ASD status and PSE.

CONCLUSIONS

A better understanding of the factors related to sport is essential for allowing families, service providers and policy makers to improve involvement for youth with ASD.

Participation in recreational activities buffers the impact of perceived stress on quality of life in adults with autism spectrum disorder

As the number of adults with autism spectrum disorder (ASD) grows, the need to identify modifiable correlates of positive outcomes and quality of life (QoL) gains in importance. Research indicates that perceived stress is significantly correlated with QoL in adults with ASD. Studies in the general population of individuals without disabilities indicate that greater participation in social and recreational activities may lessen the negative impact of perceived stress on well-being, and this association may also hold among adults with ASD. We hypothesized that: (1) perceived stress would be negatively associated with QoL; and (2) higher frequency of participation in social activities and recreational activities would moderate the relationship between perceived stress and QoL. We used data collected from 60 adults with ASD aged 24-55 and their mothers to address our hypotheses. Findings indicate that adults with ASD with higher perceived stress are likely to have poorer QoL. Furthermore, greater participation in recreational activities buffers the impact of perceived stress on QoL, but no buffering effect was observed for participation in social activities. These findings suggest that interventions and services that provide supports and opportunities for participation in recreational activities may help adults with ASD manage their stress and lead to better QoL. Autism Res 2017, 10: 973-982. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

Community participation of youth with intellectual disability and autism spectrum disorder

BACKGROUND

Community participation is associated with a range of positive developmental outcomes; however, the frequency, depth and resources associated with participation for youth with intellectual disability (ID) and autism spectrum disorder (ASD) are not well understood.

METHOD

Caregivers of 212 youth with ASD and ID and only ID, aged 11-22 years, completed an online survey. Comparisons were made of caregiver reports of diversity and frequency of participation, levels of participation involvement and related environmental barriers and supports.

RESULTS

The diversity and frequency of community participation of youth with ASD and ID approximated that of youth with ID only. Youth with ASD and ID were reported to be significantly less involved in the community activities in which they participated. Environmental features, and in particular, the social demands of community-based activities, were significant barriers to youths' participation.

CONCLUSIONS

The current study highlights individual and environmental factors amenable to intervention that may foster successful community participation among youth with ASD and ID.

Participation in Daily Activities of Young Adults with High Functioning Autism Spectrum Disorder

Young adults with an autism spectrum disorder (ASD) struggle to assume adult roles. This research assessed the feasibility of using the Adolescent and Young Adult Activity Card Sort (AYA-ACS) with emerging adults with high functioning ASD. Two phases were utilized during this research: (1) comparing the activity participation reported by emerging adults with an ASD and that reported by their caring adult; (2) examining the barriers to participation reported. Preliminary results demonstrate that the AYA-ACS appears to be a reliable and valid method of identifying emerging adults' participation strengths as well as personal and environmental challenges in a variety of age-appropriate activities. The AYA-ACS could assist service providers by providing an understanding of the challenges to participation faced by this population and aid in developing client centered interventions.