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Herlitz L, Ashford E, Powell C, Herbert K, Morris S, Woodman J. Access to primary care for children and young people (CYP) in the UK: a scoping review of CYP's, caregivers' and healthcare professionals' views and experiences of facilitators and barriers. BMJ Open 2024; 14:e081620. [PMID: 38816045 PMCID: PMC11141190 DOI: 10.1136/bmjopen-2023-081620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/19/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVES To examine children and young people's (CYP), caregivers' and healthcare professionals' (HCPs) views or experiences of facilitators and barriers to CYP access to UK primary care services to better understand healthcare inequity. To explore differences across CYP subpopulations with greater health needs from deprived areas, identifying as ethnic minorities, with experiences of state care, special educational needs or disabilities, chronic conditions or mental health problems. DESIGN Scoping review. ELIGIBILITY CRITERIA Included studies were in English, published 2012-2022 and reported: the views/experiences of CYP (0-25 years), caregivers or HCPs about accessing UK primary care; using quantitative or qualitative empirical methods. DATA SOURCES PubMed, CINAHL, Web of Science, PsycINFO and Scopus. RESULTS We included 47 reports (46 studies). CYP/caregivers' decision to access care was facilitated by CYP/caregivers' or their family/friends' ability to identify a health issue as warranting healthcare attention. Barriers to accessing care included perceived stigma (eg, being seen as a bad parent), embarrassment and discrimination experiences. CYP and caregivers believed longer opening hours could facilitate more timely access to care. Caregivers and HCPs reported that delayed or rejected referrals to secondary or adult care were a barrier to having needs met, especially for CYP with poor mental health. CYP and caregivers in numerous studies emphasised the importance of communication and trust with HCPs, including taking their concerns seriously, being knowledgeable and providing continuity of care for CYP. Common barriers reported across high-need subpopulations were caregivers needing knowledge and confidence to advocate for their child, gaps in HCP's knowledge and a lack of connectedness between primary and secondary care. CONCLUSIONS Connecting general practices and community health workers/services, improving CYP/caregivers' understanding of common childhood conditions, addressing HCP's knowledge gaps in paediatric care and integrated approaches between primary and secondary care may reduce inequity in access.
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Affiliation(s)
- Lauren Herlitz
- NIHR Children and Families Policy Research Unit, Population, Policy and Practice, UCL GOS Institute of Child Health, London, UK
| | - Emily Ashford
- Thomas Coram Research Unit, UCL Social Research Institute, London, UK
| | - Claire Powell
- NIHR Children and Families Policy Research Unit, Population, Policy and Practice, UCL GOS Institute of Child Health, London, UK
| | - Kevin Herbert
- Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Morris
- Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Jenny Woodman
- Thomas Coram Research Unit, UCL Social Research Institute, London, UK
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2
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Franco M, Costa AP. Should Parents Only Use One Language with Their Autistic Children? The Relations Between Multilingualism, Children's Social Skills, and Parent-Child Communication. J Autism Dev Disord 2024:10.1007/s10803-024-06347-w. [PMID: 38809475 DOI: 10.1007/s10803-024-06347-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE Parents of autistic children are often advised to use only one language to simplify their child's language acquisition. Often this recommendation orients towards the geographically predominant language, which may cause difficulties especially for minority-language families. On the other hand, scientific evidence suggests that multilingualism does not hinder language acquisition and that communicating in exclusively foreign languages may even impede social interaction. Therefore, we investigated how parent language use is linked to the social skills of 68 autistic children and to their parents' ability to feel comfortable, authentic, and free to express themselves. METHODS Data was collected online, using parent-report questionnaires from parents of 25 different nationalities in the European context, assessing children's language, autistic traits (AQ-C), social skills (SRS-2), and parent-child communication. RESULTS Language use was not found to significantly relate to social skills in children. However, parents using their mother tongue, either only their mother tongue or in combination with other languages, reported feeling significantly more comfortable and more authentic than parents using exclusively foreign languages, either one or many. There were no significant differences between monolingual and multilingual families regarding parents' feelings in regard to their language use. CONCLUSIONS Our findings may encourage specialists to consider multilingualism more often and consult with parents whether monolingualism is worth risking the negative outcomes we have found. Especially, since advising parents to raise their child multilingually may facilitate access to therapeutic treatment, childcare, and social interaction in multilingual societies and families and subsequently improve support and orientation for stakeholders.
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Affiliation(s)
- Maïte Franco
- Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, Maison des Sciences Humaines, University of Luxembourg, 11 Porte des Sciences, Esch-sur-Alzette, L-4366, Luxembourg.
| | - Andreia P Costa
- Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, Maison des Sciences Humaines, University of Luxembourg, 11 Porte des Sciences, Esch-sur-Alzette, L-4366, Luxembourg
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3
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Onovbiona H, Quetsch L, Bradley R. Racial and Practical Barriers to Diagnostic and Treatment Services for Black Families of Autistic Youth: A Mixed-Method Exploration. J Autism Dev Disord 2023:10.1007/s10803-023-06166-5. [PMID: 38038872 DOI: 10.1007/s10803-023-06166-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 12/02/2023]
Abstract
The present study explored the role race-related barriers and practical barriers to treatment participation play in treatment effectiveness and satisfaction among Black families with autistic youth using a mixed-method approach. In a sample of Black caregivers with autistic youth (N = 101), multiple regressions were conducted to examine the impact of reported racial and practical barriers on parental stress, treatment effectiveness, and treatment satisfaction. Caregivers provided further narratives on their experience navigating diagnostic and treatment services in qualitative interviews. The study demonstrated that Black caregivers of autistic youth are still encountering several racial and logistical barriers when seeking treatment and diagnostic services for their children. These barriers negatively impact caregiver stress and caregiver perceived treatment quality. Contrary to the barriers and stress experienced by Black caregivers, caregivers are generally satisfied with the treatments they are utilizing and find them helpful. The narratives told by caregivers further elucidate the tumultuous experiences of Black caregivers as they seek diagnostic and treatment services for their children. An experience that may be worsened by family, professional, and systemic barriers, and can be improved by advocacy, acceptance, peer and community support, and increased knowledge. Black families of autistic youth call for increased compassion, support, training, and humility among professionals who serve autistic youth.
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Allport T, Ambrose A, Collin SM. Developmental referrals of pre-school children in a diverse community in England: The importance of parental migration for referral rates. Child Care Health Dev 2023; 49:240-247. [PMID: 35365868 PMCID: PMC10084135 DOI: 10.1111/cch.13009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 10/26/2021] [Accepted: 03/24/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Children born to migrant parents have higher rates of language difficulties, intellectual disability and autism. This study explores the relationship between migration, ethnicity and reasons for early years referrals to community paediatrics in a diverse multi-cultural population in a city in south west England. METHODS Observational retrospective study from a community paediatric service serving a multi-cultural urban population from June 2012 to February 2016. We tested associations of ethnicity and parental birth origin with reason for referral (developmental or non-developmental) for children under 5 years old and estimated crude rate ratios for referrals using population census data. RESULTS Data were available for 514 children (52% white or mixed race, 16% Asian, 21% African diaspora, and 11.5% Somali); 53% had two UK-born parents while 22% had two migrant (non-UK-born) parents. Referrals were for developmental reasons in 307 (60%) including 86 for possible autism. Parental birth origin and ethnicity were associated with reason for referral (p < 0.001). Children from African diaspora, Asian or Somali backgrounds had more than twice the rate (rate ratio [RR] 2.37, 95% CI 1.88-2.99, p < 0.001) of developmental referrals compared with white or mixed-race children. Children of Somali or African diaspora ethnicity were, respectively, six-times (RR 5.99, 95% CI 3.24-10.8, p < 0.001) and four times (RR 4.23, 95% CI 2.44-7.29, p < 0.001) more likely to be referred for possible autism spectrum than their white or mixed-race peers. Developmental referral as a proportion of all referrals was twice as high among children with one migrant parent (20.4%) and three times as high among children with two migrant parents (29.5%), compared with children whose parents were both UK-born (10.7%). CONCLUSIONS This study supports the importance of ethnicity and parental migration as factors in young children experiencing developmental difficulties, especially concerns about social communication or autism.
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Affiliation(s)
- Tom Allport
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK.,Community Children's Health Partnership, Sirona CIC, Bristol, UK
| | - Alissamaryam Ambrose
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK.,Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| | - Simon M Collin
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK.,Public Health England, London, UK
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Smith J, Rabba AS, Ali A, Datta P, Dresens E, Faragaab N, Hall G, Heyworth M, Ige K, Lawson W, Lilley R, Syeda N, Pellicano E. 'Somali parents feel like they're on the outer': Somali mothers' experiences of parent-teacher relationships for their autistic children. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023:13623613221146077. [PMID: 36680459 DOI: 10.1177/13623613221146077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
LAY ABSTRACT Good relationships between parents and schools can improve autistic children's school success. There are many reasons why families from different cultural backgrounds find it harder to develop good relationships with schools, such as language barriers, discrimination and unfamiliarity with education systems. We know little about what 'good relationships' look like for these families. Here, we worked with a team of autistic and non-autistic researchers as well as an Advisory Group of Somali parents to conduct interviews with 15 Somali mothers of kindergarten and school-age autistic children. We asked mothers about their experiences of their child's education, communication with teachers and what a good relationship with schools would look like. We also asked how they felt the Somali community understood autism. We looked for common things that mothers said. We found that mothers were very proud of their children. They had high expectations, particularly about what children could do by themselves. Mothers found it frustrating that teachers had low expectations, that schools were not good at communicating with them and that autism-specific skills and experience were uncommon in schools. They also reported racist attitudes towards their children. Mothers experienced stigma and lacked resources, but support was gained from their daughters and their religion. Mothers themselves were proactively increasing community awareness and knowledge about autism in the hope that they and their autistic children would be valued and better supported. Our work has implications for how teachers and schools can work together with Somali parents to forge better futures for autistic children.
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Affiliation(s)
- Jodie Smith
- Macquarie University, Australia.,La Trobe University, Australia
| | | | | | | | | | - Nadia Faragaab
- Macquarie University, Australia.,Positive Partnerships, Australia
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Smith J, Rabba AS, Datta P, Dresens E, Wang R, Cong L, Dang N, Hall G, Heyworth M, Lawson W, Lee P, Lilley R, Ma E, Nguyen HTT, Nguyen KV, Nguyen P, Yeow CT, Pellicano E. 'It's really important to be collaborating': Experiences of participatory research for Chinese and Vietnamese parents of autistic children. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2023; 8:23969415231210482. [PMID: 38028582 PMCID: PMC10644728 DOI: 10.1177/23969415231210482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Background and aims Participatory research involves academic partners working together with the community that is affected by research to make decisions about that research. Such approaches often result in research that is more respectful of, and responsive to, community preferences - and is vital in the context of autism research with culturally and linguistically diverse (CALD) communities. Whilst participatory approaches are becoming more commonplace within CALD autism research, no studies have explored the experiences of being involved in autism research from the perspectives of CALD community partners over the course of a study. This paper intended to address this gap by reporting on the experiences of CALD parents of autistic children who were community partners in a 1-year Australian research project exploring home-school partnerships for CALD parents of autistic children. We aimed to: (1) report on how parents' involvement in the research process shaped the home-school partnerships study over time and (2) understand their experiences of being community partners on the home-school partnerships project. Methods Using key principles of participatory approaches, we established Chinese and Vietnamese parent advisory groups to contribute to a project exploring home-school partnerships for parents of autistic children from CALD backgrounds in Australia. Advisory groups included parents of autistic children from Chinese/Vietnamese backgrounds, as well as interpreters, professionals and researchers. We documented how parents' participation as community partners shaped the home-school partnerships study over the course of the project. We also elicited parents' own views and experiences of being community partners through informal, open-ended questions at the beginning and end of the study. Results We found that parents' input fundamentally shaped the broader home-school partnership study, from meaningful, accurate translation of interview schedules through to making decisions regarding community-specific recommendations and dissemination plans. Parents themselves reported being keen to collaborate and to hear and share opinions for the purpose of the home-school partnership study - although they noted how emotionally difficult sharing their stories could be. While they initially had some concerns about combining being involved as a community partner with their existing responsibilities, ultimately, parents were surprised by the scope of the home-school partnership study and their level of involvement as community partners. Through hearing others' stories and sharing their own in advisory group meetings, parents reported ancillary benefits of their involvement, including increased self-advocacy and well-being. Conclusions These findings show how research that is conducted in partnership with diverse members of the autism community has the capacity to improve the quality of the research and benefit community partners. Implications This study clearly documents the benefits and potential challenges of participatory approaches with CALD communities. These findings emphasise to researchers and funders the importance of including extra time and money within budgets in order to produce meaningful research that is respectful and responsive to communities.
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Affiliation(s)
- Jodie Smith
- Macquarie School of Education, Macquarie University, Sydney, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia; Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Aspasia Stacey Rabba
- Macquarie School of Education, Macquarie University, Sydney, Australia; Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia; Faculty of Education, School of Educational Psychology and Counselling, Monash University, Melbourne, Australia
| | - Poulomee Datta
- Macquarie School of Education, Macquarie University, Sydney, Australia
| | - Emma Dresens
- Positive Partnerships, Chatswood, NSW, Australia
| | - Rena Wang
- Macquarie School of Education, Macquarie University, Sydney, Australia; Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University,
Melbourne, Australia
| | - Lin Cong
- Macquarie School of Education, Macquarie University, Sydney, Australia
| | - Ngoc Dang
- Macquarie School of Education, Macquarie University, Sydney, Australia
| | - Gabrielle Hall
- Macquarie School of Education, Macquarie University, Sydney, Australia
| | - Melanie Heyworth
- Macquarie School of Education, Macquarie University, Sydney, Australia; Reframing Autism,
Sydney, Australia
| | - Wenn Lawson
- Macquarie School of Education, Macquarie University, Sydney, Australia
- Curtin University, Curtin Autism Research Group, Perth WA
| | - Patricia Lee
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia; Positive Partnerships, Forestville, NSW, Australia
- Positive Partnerships, Chatswood, NSW, Australia
| | - Rozanna Lilley
- Macquarie School of Education, Macquarie University, Sydney, Australia
| | - Emily Ma
- Macquarie School of Education, Macquarie University, Sydney, Australia; Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University,
Melbourne, Australia
| | - Hau T T Nguyen
- Macquarie School of Education, Macquarie University, Sydney, Australia
| | - Kim-Van Nguyen
- Macquarie School of Education, Macquarie University, Sydney, Australia
| | - Phuc Nguyen
- Macquarie School of Education, Macquarie University, Sydney, Australia
| | - Chong Tze Yeow
- Macquarie School of Education, Macquarie University, Sydney, Australia
| | - Elizabeth Pellicano
- Macquarie School of Education, Macquarie University, Sydney, Australia; Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Herzig van Wees S, Dini S. The silent shot: An analysis of the origin, sustenance and implications of the MMR vaccine - autism rumour in the Somali diaspora in Sweden and beyond. Glob Public Health 2023; 18:2257771. [PMID: 37750434 DOI: 10.1080/17441692.2023.2257771] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 09/06/2023] [Indexed: 09/27/2023]
Abstract
This article traces the origin, sustenance and implications of a persistent rumour that is responsible for low measles mumps and rubella (MMR) vaccination uptake in the Somali diaspora in a number of countries across the globe. The rumour stipulates that the MMR vaccine - the silent shot - causes autism spectrum disorder (ASD). Although the association between MMR and ASD is non-causal, and various public health initiatives have promoted health information campaigns, the rumour continues to circulate in the Somali diaspora in many countries, including Sweden. This paper shows that there are valid reasons for this. The findings from this paper draw on a systematic scoping review and qualitative interview data from Sweden. The results show that the Somali community experiences higher than average rates of ASD compared to the general population. Moreover, ASD does not exist in the Somali language or their home country, is considered a Western disease that only affects Somali children in the diaspora, and is a highly stigmatised disease. Also, the Somali diaspora has had negative experiences with ASD diagnosis and care. The rumour has been sustained by the absence of an answer to their ASD fear and through active diaspora networks on social media. The network that surrounds the rumour has arguably further helped to create an epistemic community for a community whose concerns have been silenced.
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Affiliation(s)
| | - Samira Dini
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
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Greer JMH, Sood SSM, Metcalfe DR. Perceptions of autism spectrum disorder among the Swahili community on the Kenyan coast. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 131:104370. [PMID: 36343581 DOI: 10.1016/j.ridd.2022.104370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/09/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In high-income and Western societies there is great understanding and awareness of autism spectrum disorder (ASD); however, for many low-middle income countries, research and knowledge is notably lacking. In Africa, there is a growing prevalence of ASD due to increased diagnosis, yet it is still a poorly understood condition. AIMS Emerging literature has emphasised how cultural and societal beliefs underpin the level of understanding of ASD, and which typically results in lack of awareness and acceptance. As such it is important to investigate the cultural perceptions towards ASD within low-middle income communities of African culture, to further understand the challenges and barriers individuals with ASD face. The aim of the current study was to probe participants from the Swahili community, on the coast of Kenya, of their cultural views towards ASD. METHOD Semi-structured interviews were conducted with seven participants, and the data analysed using thematic analysis. RESULTS Three key themes developed from the data; stigma, lack of awareness, and Government responsibility. CONCLUSION Cultural perceptions negatively impacted awareness and are exacerbated by lack of directive from the Government in providing appropriate diagnostic and educational support.
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Affiliation(s)
- J M H Greer
- Department of Psychology, Northumbria University, Newcastle-upon-Tyne, UK.
| | - S S M Sood
- Department of Psychology, Northumbria University, Newcastle-upon-Tyne, UK
| | - D R Metcalfe
- Department of Psychology, Northumbria University, Newcastle-upon-Tyne, UK
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Wallace-Watkin C, Sigafoos J, Waddington H. Barriers and facilitators for obtaining support services among underserved families with an autistic child: A systematic qualitative review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 27:588-601. [PMID: 36081366 DOI: 10.1177/13623613221123712] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Families from underrepresented ethnic or racial groups and those with limited financial resources could experience more difficulty in accessing support services for their autistic child due to certain types of barriers. We searched academic journals, websites, and other sources for studies which looked at what barriers might be present for such families and what might help families access support services for their autistic child. The search found 18 studies. Results from each study were examined and coded into themes. Parents reported that accessibility, diversity of support services, and stigma influenced their experiences with support services. We discuss what these findings might mean for future research and for service delivery.
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Support Needs and Parent Outcomes in Arab Families of Children with Autism Living in the United Kingdom. Brain Sci 2022; 12:brainsci12081114. [PMID: 36009177 PMCID: PMC9405880 DOI: 10.3390/brainsci12081114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/14/2022] [Accepted: 08/19/2022] [Indexed: 11/27/2022] Open
Abstract
Research on the experiences of Arab families of children with autism living in non-Arab countries is scarce. A survey investigated the support needs, psychological distress, and parental relationships of Arab parents (n = 100) of children with autism living in the United Kingdom (UK). The survey consisted of five main questionnaires: a demographic questionnaire, the GO4KIDDS Brief Adaptive Scale, the Family Needs Survey, the Strengths and Difficulties Questionnaire, and the Hospital Anxiety and Depression Scale. Descriptive analysis indicated that the most frequently identified support needs were information, community services, and explaining to others. Parents reported high levels of psychological distress, a high level of parental relationship satisfaction with their spouse, and few parental disagreements about their child with autism. Regression analyses showed that increased child behavior problems predicted more total family needs. Higher levels of child prosocial behavior, the better health status of parents, and a larger number of children in the family were associated with lower levels of parental psychological distress. A longer time living in the UK was associated with more parental disagreement over issues related to the child with ASD. Reducing child behavior problems and increasing child prosocial behavior may be important targets for support and intervention to improve outcomes for Arab parents of autistic children.
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Turnock A, Langley K, Jones CR. Understanding Stigma in Autism: A Narrative Review and Theoretical Model. AUTISM IN ADULTHOOD 2022; 4:76-91. [PMID: 36605561 PMCID: PMC8992913 DOI: 10.1089/aut.2021.0005] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The experience of stigma by autistic people is relatively understudied, despite contributing to a range of poor outcomes and having an overarching impact on well-being. The current review of the literature synthesizes research to determine what is currently known and presents a theoretical model of autism stigma. Autism stigma is primarily influenced by a public and professional understanding of autism in combination with interpretation of visible autistic traits. Moderating factors include the quality and quantity of contact with autistic people, cultural factors, sex and gender, individual differences, and diagnostic disclosure. Stigma can reduce well-being as well as increase the presence of camouflaging behaviors, which mask autistic traits. Caregivers of autistic people can experience stigma by association, that is, affiliate stigma, which can impact their own well-being. A variety of interventions and approaches to reduce stigma are discussed, including "autism friendly" spaces, positive media representation, educational and psychosocial training for the public and professionals, as well as cultural and systemic shifts that foster inclusivity and recognize neurodiversity.
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Affiliation(s)
- Alice Turnock
- School of Medicine, Cardiff University, University Hospital of Wales, Cardiff, United Kingdom
| | - Kate Langley
- Wales Autism Research Centre, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Catherine R.G. Jones
- Wales Autism Research Centre, School of Psychology, Cardiff University, Cardiff, United Kingdom.,Address correspondence to: Catherine R.G. Jones, PhD, School of Psychology, Cardiff University, Park Place, Cardiff CF10 3AT, United Kingdom
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12
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Tackling healthcare access barriers for individuals with autism from diagnosis to adulthood. Pediatr Res 2022; 91:1028-1035. [PMID: 33767375 PMCID: PMC7993081 DOI: 10.1038/s41390-021-01465-y] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/21/2020] [Accepted: 02/23/2021] [Indexed: 02/04/2023]
Abstract
Most individuals with autism spectrum disorder (ASD)-a complex, life-long developmental disorder-do not have access to the care required to address their diverse health needs. Here, we review: (1) common barriers to healthcare access (shortage/cost of services; physician awareness; stigma); (2) barriers encountered primarily during childhood (limited screening/diagnosis; unclear referral pathways), transition to adulthood (insufficient healthcare transition services; suboptimal physician awareness of healthcare needs) and adulthood (shortage of services/limited insurance; communication difficulties with physicians; limited awareness of healthcare needs of aging adults); and (3) advances in research/program development for better healthcare access. A robust understanding of barriers to accessing healthcare across the lifespan of autistic individuals is critical to ensuring the best use of healthcare resources to improve social, physical, and mental health outcomes. Stakeholders must strengthen healthcare service provision by coming together to: better understand healthcare needs of underserved populations; strengthen medical training on care of autistic individuals; increase public awareness of ASD; promote research into/uptake of tools for ASD screening, diagnosis, and treatment; understand specific healthcare needs of autistic individuals in lower resource countries; and conduct longitudinal studies to understand the lifetime health, social, and economic impacts of ASD and enable the evaluation of novel approaches to increasing healthcare access. IMPACT: Despite the growing body of evidence, our understanding of barriers to healthcare encountered by individuals with ASD remains limited, particularly beyond childhood and in lower resource countries. We describe current and emerging barriers to healthcare access encountered by individuals with ASD across the lifespan. We recommend that stakeholders develop evidence-informed policies, programs, and technologies that address barriers to healthcare access for individuals with ASD and consider broad, equitable implementation to maximize impact.
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Hermaszewska S, Sin J. End-user perspectives on the development of an online intervention for parents of children on the autism spectrum. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:1234-1245. [PMID: 33423522 PMCID: PMC8264643 DOI: 10.1177/1362361320984895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
LAY ABSTRACT Parent caregivers play an essential role in the lives of individuals on the autism spectrum. The demands of caregiving can have negative effects on the mental and physical wellbeing of parents. Different types of formal support have been developed to help parents to cope with caregiving; however, many parents struggle to access services due to limited availability and busy schedules. The Internet could offer parents more accessible and flexible support. We asked 17 parents what content they would like to include in an online resource. Parents told us about their experiences trying to access and use existing formal support and websites. They overwhelmingly supported the development of an online resource informed by their suggestions. Parents emphasised the need for easier access to information through educational components and direct access to healthcare professionals online. Parents also wanted help with finding existing services and reliable, locally relevant information. Parents stressed the need for a safe environment to meet and chat with other parents online. This research forms the first stage in the development process of an online health resource for parents.
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Affiliation(s)
| | - Jacqueline Sin
- University of Reading, UK
- City, University of London, UK
- St George’s, University of London, UK
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Fouche C, Richter S, Vallianatos H, Mason A, Fernández-Sánchez H, Mazzucato V, Kariwo M, Salami B. African immigrant child health: A scoping review. J Migr Health 2021; 4:100054. [PMID: 34405197 PMCID: PMC8352012 DOI: 10.1016/j.jmh.2021.100054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 06/08/2021] [Accepted: 06/13/2021] [Indexed: 11/17/2022] Open
Abstract
The health of migrant children is a pressing issue. While most African migration takes place within Africa, a significant number of African migrants travel to outside of the continent. This article reports findings from a scoping review on the health of African immigrant children from sub-Saharan Africa now living outside of Africa. A systematic search for studies published between 2000 and 2019 resulted in only 20 studies reporting on the health of children up to 18 years of age migrating from sub-Saharan Africa. Data from these articles were thematically analyzed, highlighting concerns related to the children's nutrition status (n = 8), mental health (n = 7), and physical health (n = 5). Study participants were primarily from Somali and Ethiopia, and most studies were conducted in Australia or Israel. The review highlights several gaps related to the scope, range, and nature of evidence on the health of African immigrant children living outside of Africa. In particular, most focus on children's nutritional and mental health, but pay little attention to other health concerns this specific population may encounter or to the benefits associated with effective responses.
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Affiliation(s)
- C. Fouche
- Faculty of Education and Social Work, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - S. Richter
- Faculty of Nursing, University of Alberta, Canada
| | | | - A. Mason
- Faculty of Nursing, University of Alberta, Canada
| | | | - V. Mazzucato
- Faculty of Arts and Social Sciences, Maastricht University, Netherlands
| | - M. Kariwo
- Faculty of Nursing, University of Alberta, Canada
| | - B. Salami
- Faculty of Nursing, University of Alberta, Canada
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15
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Han E, Tan MMJ, Crane L, Legido-Quigley H. A qualitative study of autism services and supports in Singapore: Perspectives of service providers, autistic adults and caregivers. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:2279-2290. [PMID: 34049440 DOI: 10.1177/13623613211016112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
LAY ABSTRACT Because autism is a lifelong and complex condition, autistic people may need a range of supports cutting across different sectors (e.g. health, education and social care) at different stages of their lives. Studies in some countries have shown that autistic people and their families face difficulties accessing the services they need, but no research has been done on this topic in Singapore. To start addressing this gap, we interviewed 21 service providers, autistic adults and caregivers/parents of autistic children to find out their perceptions and experiences of autism services and supports in Singapore. Our participants told us that beyond improving access to autism-specific services, they also hoped to see more flexible supports in an inclusive environment and a broader change in societal attitudes. This study highlights that autism service provision should be informed by autistic voices and not only focus on impairment but also recognise the strengths of autistic people alongside their very real needs. The whole of society - including policymakers, professionals, employers, educators, families and autistic people themselves - needs to work together to fight autism stigma and discrimination.
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Affiliation(s)
- Emeline Han
- National University of Singapore, Singapore.,UCL Institute of Education, UK
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16
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Attitudes and Perceptions of Muslim Parents Toward Their Children with Autism: a Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00256-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Howard K, Gibson J, Katsos N. Parental Perceptions and Decisions Regarding Maintaining Bilingualism in Autism. J Autism Dev Disord 2021; 51:179-192. [PMID: 32388758 PMCID: PMC7810638 DOI: 10.1007/s10803-020-04528-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A growing body of evidence suggests that bilingual exposure does not negatively impact children on the autism spectrum. This study sought to illuminate parents’ perceptions and choices regarding maintaining bilingualism in autism. Semi-structured interviews were conducted with 16 family members in England and Wales. Data were analysed using interpretative phenomenological analysis (IPA). Although parents expressed positive attitudes towards bilingualism, these views were not always congruent with their language practices. Instead, several factors influenced decisions about language maintenance in autism, including the severity of the child’s autism, advice received, and the importance of English as the dominant societal language. This article calls for greater support for families in making language decisions that are suitable for the individual child and their family.
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Affiliation(s)
- Katie Howard
- Theoretical and Applied Linguistics, University of Cambridge, Cambridge, UK. .,Jesus College, Jesus Lane, Cambridge, CB5 8BL, UK.
| | - Jenny Gibson
- Faculty of Education, University of Cambridge, Cambridge, UK
| | - Napoleon Katsos
- Theoretical and Applied Linguistics, University of Cambridge, Cambridge, UK
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18
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Salami B, Fernandez-Sanchez H, Fouche C, Evans C, Sibeko L, Tulli M, Bulaong A, Kwankye SO, Ani-Amponsah M, Okeke-Ihejirika P, Gommaa H, Agbemenu K, Ndikom CM, Richter S. A Scoping Review of the Health of African Immigrant and Refugee Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073514. [PMID: 33800663 PMCID: PMC8038070 DOI: 10.3390/ijerph18073514] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 12/02/2022]
Abstract
Migration is a growing phenomenon around the world, including within the African continent. Many migrants, especially African children, face challenges related to health and social inclusion and can face increased health risks. A systematic scoping review of available literature on the health of African migrant children across the globe was conducted to offer insight into these health risks. The review was conducted over a 15-month period from January 2019 to April 2020, yielding 6602 articles once duplicates were removed. This search included electronic databases, reference lists of articles reviewed, and searches of libraries of relevant organisations. A total of 187 studies met the inclusion criteria, of which 159 were quantitative, 22 were qualitative, and 6 used mixed methods. The findings reveal decreased health in this population in areas of nutrition, infectious diseases, mental health, birth outcomes, sexual and reproductive health, physical and developmental health, parasitic infections, oral health, respiratory health, preventative health, endocrine disorders, health care services, and haematological conditions. The findings offer insights into factors influencing the health of African immigrant and refugee children. Further studies, especially qualitative studies, are needed to determine barriers to service access after migration and to investigate other underexplored and overlooked health concerns of African migrant children, including pneumonia and child maltreatment.
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Affiliation(s)
- Bukola Salami
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 0Z7, Canada; (H.F.-S.); (M.T.); (A.B.); (S.R.)
- Correspondence:
| | - Higinio Fernandez-Sanchez
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 0Z7, Canada; (H.F.-S.); (M.T.); (A.B.); (S.R.)
| | - Christa Fouche
- Faculty of Education and Social Work, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand;
| | - Catrin Evans
- School of Health Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK;
| | - Lindiwe Sibeko
- Department of Nutrition, School of Public Health and Health Sciences, University of Massachusetts, 204 Chenoweth Laboratory, Amherst, MA 01003-9282, USA;
| | - Mia Tulli
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 0Z7, Canada; (H.F.-S.); (M.T.); (A.B.); (S.R.)
| | - Ashley Bulaong
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 0Z7, Canada; (H.F.-S.); (M.T.); (A.B.); (S.R.)
| | - Stephen Owusu Kwankye
- Regional Institute for Population Studies, University of Ghana, P.O. Box LG 96, Legon, Accra GA184, Ghana;
| | - Mary Ani-Amponsah
- School of Nursing, University of Ghana, P.O. Box LG 43, Legon, Accra GA184, Ghana;
| | | | - Hayat Gommaa
- Department of Nursing Science, Ahmadu Bello University, Sokoto Road, PMB 06, Zaria 810107, Nigeria;
| | - Kafuli Agbemenu
- School of Nursing, The State University of New York (SUNY), University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA;
| | | | - Solina Richter
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 0Z7, Canada; (H.F.-S.); (M.T.); (A.B.); (S.R.)
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19
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Vanegas SB. Examining factors related to the age of diagnosis of children with autism spectrum disorder from immigrant and non-immigrant backgrounds in a diverse clinical sample. Autism Res 2021; 14:1260-1270. [PMID: 33624946 DOI: 10.1002/aur.2489] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 02/10/2021] [Indexed: 11/07/2022]
Abstract
A timely diagnosis of autism spectrum disorder (ASD) is important for children as that may help inform the best services and supports needed for optimal outcomes. However, disparities in the identification of ASD have been consistently documented for racial/ethnic minority and immigrant populations. The majority of studies of immigrant populations have focused on the qualitative experience of ASD, however, greater knowledge about the predictors of the age of initial ASD diagnosis is needed. This study examined the child, maternal, and family-level factors that predicted the age of initial ASD diagnosis in a diverse clinical sample through a retrospective medical record review. Medical records of clinical evaluations conducted between 2004 and 2014 were reviewed for children with ASD born to immigrant and non-immigrant mothers. Regression analyses found that for both groups of children with ASD, using verbal language to communicate and having another diagnosis (attention-deficit/hyperactivity disorder or another condition) predicted an older age of initial ASD diagnosis. For children with ASD born to immigrant mothers, residing in a multilingual household was associated with a younger age of diagnosis. These results highlight the complexities of an ASD diagnosis among diverse children and families, particularly among immigrant communities. LAY SUMMARY: This research looked at predictors of when children received their first autism spectrum disorder diagnosis across children born to immigrant mothers and children born to U.S.-born mothers. Living in a multilingual home was related to a younger age of diagnosis for children of immigrant mothers; being verbal and having another diagnosis was related to an older age of diagnosis for both groups of children. This highlights the need to improve diagnostic services for diverse children.
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Affiliation(s)
- Sandra B Vanegas
- School of Social Work, Texas State University, San Marcos, Texas, USA
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20
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Schmengler H, Cohen D, Tordjman S, Melchior M. Autism Spectrum and Other Neurodevelopmental Disorders in Children of Immigrants: A Brief Review of Current Evidence and Implications for Clinical Practice. Front Psychiatry 2021; 12:566368. [PMID: 33815159 PMCID: PMC8012490 DOI: 10.3389/fpsyt.2021.566368] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 02/24/2021] [Indexed: 12/12/2022] Open
Abstract
Children of immigrants may have higher neurodevelopmental risks than those of non-immigrant populations. Yet, some evidence suggests that this group may receive late diagnosis, and therefore miss beneficial early interventions. Clinicians may misattribute symptoms of disorders to other social, behavioral or language problems. Likewise, there might be cultural differences in parents' likelihood of perceiving or reporting first developmental concerns to clinicians. Population-based standardized screening may play an important role in addressing ethnic inequalities in the age at diagnosis, although further research focusing on cross-cultural use is necessary. Once children are diagnosed, clinicians may rely on culturally sensitive procedures (translation services, cultural mediators) to increase the accessibility of interventions and improve adherence among immigrant families. In this brief review, we provide an overview about what is currently known about the epidemiology and risk factors of neurodevelopmental disorders, paying special attention to autism spectrum disorder (ASD), in children of immigrants and suggest the necessity of population-based screening and culturally sensitive care.
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Affiliation(s)
- Heiko Schmengler
- INSERM U1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France.,École des Hautes Études en Santé Publique, Rennes, France.,Department of Interdisciplinary Social Science, Utrecht Centre for Child and Adolescent Studies, Utrecht University, Utrecht, Netherlands
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Reference Centre for Rare Psychiatric Diseases, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France.,Institute for Intelligent Systems and Robotics, CNRS UMR 7222, Sorbonne Université, Paris, France
| | - Sylvie Tordjman
- Pôle Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Université de Rennes 1 and Centre Hospitalier Guillaume-Régnier, Rennes, France.,Integrative Neuroscience and Cognition Center, CNRS UMR 8002 and University of Paris, Paris, France
| | - Maria Melchior
- INSERM U1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
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21
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A Review of Barriers Experienced by Immigrant Parents of Children with Autism when Accessing Services. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2020. [DOI: 10.1007/s40489-020-00216-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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"Crazy person is crazy person. It doesn't differentiate": an exploration into Somali views of mental health and access to healthcare in an established UK Somali community. Int J Equity Health 2020; 19:190. [PMID: 33109227 PMCID: PMC7592587 DOI: 10.1186/s12939-020-01295-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 10/06/2020] [Indexed: 11/30/2022] Open
Abstract
Background Mental health conditions have been shown to disproportionately affect those from Black, Asian and Minority Ethnic (BAME) communities. Somali communities globally have relatively high levels of mental illness, but low levels of mental health service use, with numerous barriers to care identified. This study was conducted in an established UK Somali community in the South West of England and aimed to explore community beliefs and views about the causes of mental illness, treatment for mental illness, and access to medical services in general. Participants were asked about how mental health and illness are understood and conceptualised, along with the cultural meaning of mental illness and its manifestations in relation to men, women and young people. Design Using a community-based participatory research design, in partnership with local Somali community organisations, the research team conducted four focus groups with a total of 23 participants aged over 18. Open-ended questions were used to facilitate discussion. Transcripts were analysed thematically. Results The participants discussed the role of migration and associated stress from the civil war and how that could contribute to mental illness. Participants tended to view the symptoms of mental illness as physical manifestations such as headaches and to describe a strong community stigma where those with mental health conditions were viewed as “crazy” by others. Barriers to accessing healthcare included language barriers, waiting times and a mistrust of doctors. Various ideas for improvements were discussed, including ideas to reduce stigma and ideas for community initiatives. Conclusion Cultural considerations and reducing stigma are vital in improving understanding of mental illness and improving access to mental health services, along with building relationships and trust between the Somali community and health care workers.
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23
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Linney C, Ye S, Redwood S, Mohamed A, Farah A, Biddle L, Crawley E. "Crazy person is crazy person. It doesn't differentiate": an exploration into Somali views of mental health and access to healthcare in an established UK Somali community. Int J Equity Health 2020; 19:190. [PMID: 33109227 PMCID: PMC7592587 DOI: 10.1186/s12939-020-01295-0#citeas] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Mental health conditions have been shown to disproportionately affect those from Black, Asian and Minority Ethnic (BAME) communities. Somali communities globally have relatively high levels of mental illness, but low levels of mental health service use, with numerous barriers to care identified. This study was conducted in an established UK Somali community in the South West of England and aimed to explore community beliefs and views about the causes of mental illness, treatment for mental illness, and access to medical services in general. Participants were asked about how mental health and illness are understood and conceptualised, along with the cultural meaning of mental illness and its manifestations in relation to men, women and young people. DESIGN Using a community-based participatory research design, in partnership with local Somali community organisations, the research team conducted four focus groups with a total of 23 participants aged over 18. Open-ended questions were used to facilitate discussion. Transcripts were analysed thematically. RESULTS The participants discussed the role of migration and associated stress from the civil war and how that could contribute to mental illness. Participants tended to view the symptoms of mental illness as physical manifestations such as headaches and to describe a strong community stigma where those with mental health conditions were viewed as "crazy" by others. Barriers to accessing healthcare included language barriers, waiting times and a mistrust of doctors. Various ideas for improvements were discussed, including ideas to reduce stigma and ideas for community initiatives. CONCLUSION Cultural considerations and reducing stigma are vital in improving understanding of mental illness and improving access to mental health services, along with building relationships and trust between the Somali community and health care workers.
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Affiliation(s)
- Catherine Linney
- grid.5337.20000 0004 1936 7603Centre for Academic Child Health, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU UK
| | - Siyan Ye
- grid.5337.20000 0004 1936 7603Centre for Academic Child Health, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU UK
| | | | | | | | - Lucy Biddle
- ARC West, Bristol, UK ,grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Esther Crawley
- grid.5337.20000 0004 1936 7603Centre for Academic Child Health, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU UK
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24
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Gemegah E, Hartas D, Totsika V. Public attitudes to people with ASD: contact, knowledge and ethnicity. ADVANCES IN AUTISM 2020. [DOI: 10.1108/aia-01-2020-0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The increase in autism prevalence and presentation in the media suggests a rise in public awareness. This paper aims to explore what factors (contact, knowledge and ethnicity) may be associated to positive attitudes towards individuals with autism spectrum disorder (ASD).
Design/methodology/approach
An online survey examined contact with and knowledge of ASD among Black, Asian and White ethnic groups to predict public attitudes to people with ASD.
Findings
In multiple regression models, the results suggested that the level of contact predicts positive attitudes towards autism when demographic factors were accounted. The level of knowledge about autism were significantly associated to attitudes, but not consistently when demographic factors were accounted. However, differences in knowledge and attitudes to people with ASD were identified amongst Black, Asian and White ethnic groups.
Research limitations/implications
These findings have implications for policy and public health and education campaigns, including ensuring contact and knowledge of autism among the public.
Originality/value
These findings have implications for policy and public health and education campaigns, including ensuring contact and knowledge of autism among the public. Additionally, further effort is required to target public knowledge and attitudes to autism, particularly among ethnic groups. Institutional support tailored to encourage structured and unstructured contact across public domains such as education, health, social and care practices could effectively reduce prejudice between the public and people with ASD over time.
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25
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Johnson NL, Krueger W, Jilek E, Haglund K. Conversations With Health Care Providers and Parents Before Autism Diagnosis: A Qualitative Study. J Pediatr Health Care 2020; 34:453-461. [PMID: 32674885 DOI: 10.1016/j.pedhc.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The purpose of this study was to explore communication with health care providers from the perceptions of parents before their child's diagnosis of autism spectrum disorder and provide some examples of how communication may contribute to the autism diagnosis. METHOD This study used a qualitative descriptive design with multiple individual structured in-person interviews. RESULTS Three themes captured parents' (n = 8) descriptions of the phases of communication during their children's diagnoses including, (1) anguished questioning, (2) urgently seeking help, and (3) expecting a diagnosis. In addition, three themes characterized the communication style that parents needed, although not always received, in each of the periods of diagnosis including (1) compassionate curiosity, (2) acknowledgment and affirmation, and (3) engagement with parents. DISCUSSION Results point to opportunities for pediatric providers to use a more empathic and engaging communication style during the diagnostic process with better identification of education and support needed by parents and families.
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26
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Zakirova-Engstrand R, Hirvikoski T, Westling Allodi M, Roll-Pettersson L. Culturally diverse families of young children with ASD in Sweden: Parental explanatory models. PLoS One 2020; 15:e0236329. [PMID: 32716951 PMCID: PMC7384670 DOI: 10.1371/journal.pone.0236329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 07/05/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Research suggests that families' knowledge and cultural perceptions of autism spectrum disorder (ASD), and beliefs about its etiology and prognosis, can affect parents' recognition of the first signs of autism in their children and influence help seeking and treatment decisions. OBJECTIVE This study investigated explanatory models of autism among parents of young children with ASD in the multicultural context of Sweden. METHOD Seventeen parents from diverse cultural, ethnic and linguistic backgrounds participated in semi-structured interviews. A deductive approach to qualitative content analysis was used to analyze data. Five domains of the Explanatory Model supplementary module of the Cultural Formulation Interview (CFI) were used as coding categories, operationalized as 'Parents' understanding of autism'; 'Autism prototypes'; 'Causal explanations'; 'Course of autism', and 'Help seeking and treatment expectations'. RESULTS The results showed that parents' prior knowledge of autism and experience of young children's typical developmental trajectories, as well as the opinions of children's grandparents and preschool teachers, affected symptom recognition and help seeking. There were differences in parents' explanatory models before and after ASD diagnosis. Initial interpretations of the disorder included medical conditions and reaction to environmental influences, while genetic, supernatural/religious factors, and vaccinations were mentioned as definite causes after obtaining a clinical diagnosis. Parents also held multiple explanatory models, influenced by the views of family members and information obtained from media or from health care professionals. Parents' treatment decisions included use of available state-funded support services, and complementary and alternative treatments. CONCLUSION The results demonstrate the utility of the CFI's Explanatory Model supplementary module in autism research. Implications for clinical practice are discussed.
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Affiliation(s)
| | - Tatja Hirvikoski
- Department of Women’s and Children’s Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet, Stockholm, Sweden
- Habilitation & Health, Region Stockholm, Stockholm, Sweden
- Center for Psychiatry Research, Region Stockholm, Stockholm, Sweden
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27
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de Leeuw A, Happé F, Hoekstra RA. A Conceptual Framework for Understanding the Cultural and Contextual Factors on Autism Across the Globe. Autism Res 2020; 13:1029-1050. [PMID: 32083402 PMCID: PMC7614360 DOI: 10.1002/aur.2276] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 01/02/2020] [Accepted: 01/24/2020] [Indexed: 12/14/2022]
Abstract
Autism research is heavily skewed toward western high-income countries. Culturally appropriate screening and diagnostic instruments for autism are lacking in most low- and middle-income settings where the majority of the global autism population lives. To date, a clear overview of the possible cultural and contextual factors that may affect the process of identifying and diagnosing individuals with autism spectrum disorders (ASD) is missing. This study aims to outline these factors by proposing a conceptual framework. A multidisciplinary review approach was applied to inform the development of the conceptual framework, combining a systematic review of the relevant autism research literature with a wider literature search spanning key texts in global mental health, cultural psychiatry, cross-cultural psychology, and intellectual disability research. The resulting conceptual framework considers the identification, help-seeking, and diagnostic process at four interrelated levels: (a) the expression; (b) recognition; (c) interpretation; and (d) reporting of autism symptoms, and describes the cultural and contextual factors associated with each of these levels, including cultural norms of typical and atypical behavior, culture-specific approaches to parenting, mental health literacy, cultural beliefs, attitudes and stigma, as well as the affordability, availability, accessibility, and acceptability of services. This framework, mapping out the cultural and contextual factors that can affect the identification, help-seeking, and diagnosis of ASD may function as a springboard for the development of culturally appropriate autism screening and diagnostic instruments, and inform future cross-cultural autism research directions. The framework also has relevance for clinicians and policy makers aiming to improve support for underserved autism populations worldwide. Autism Res 2020, 13: 1029-1050. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The vast majority of autism research is conducted in western high-income settings. We therefore know relatively little of how culture and context can affect the identification, help-seeking, and diagnosis of autism across the globe. This study synthesizes what is known from the autism research literature and a broader literature and maps out how culture and context may affect (a) the expression, (b) recognition, (c) interpretation, and (d) reporting of autism symptoms.
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Affiliation(s)
- Anne de Leeuw
- Amsterdam University Medical Centre, location VUmc, Amsterdam, The Netherlands
| | - Francesca Happé
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Rosa A Hoekstra
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
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28
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Tromans S, Chester V, Gemegah E, Roberts K, Morgan Z, Yao GL, Brugha T. Autism identification across ethnic groups: a narrative review. ADVANCES IN AUTISM 2020. [DOI: 10.1108/aia-03-2020-0017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of the paper is to review autism identification across different ethnic groups. Diagnosis of autism may be missed or delayed in certain ethnic groups, leading to such groups being underserved relative to their needs. This can result in members of such groups being effectively denied essential avenues of support that can substantially improve the quality of life of autistic persons as well as those whom care for them.
Design/methodology/approach
A literature search for articles reporting autism identification across ethnic groups was undertaken. Data are compared, with a special focus on possible explanations for any inter-group variation.
Findings
Autism identification appears to be generally lower in minority ethnic groups relative to the majority population. Individuals presenting with autism from minority groups appear to have more severe forms of the condition.
Originality/value
There are a multitude of potential explanations for inter-ethnicity variation in autism identification, including health care-related factors, broader environmental influences, cultural factors and possible biological differences. Implications for clinical practice and public health include a need to look at means of ensuring equitable access to relevant autism diagnostic and support services across ethnic groups. Further work is required to better understand the belief systems that operate within specific ethnic groups, how this may potentially impact upon autism identification and measures to address the concerns of such groups.
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29
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Papoudi D, Jørgensen CR, Guldberg K, Meadan H. Perceptions, Experiences, and Needs of Parents of Culturally and Linguistically Diverse Children with Autism: a Scoping Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2020. [DOI: 10.1007/s40489-020-00210-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AbstractA scoping review of studies carried out in the UK and the USA was conducted to explore the perceptions, experiences, and needs of culturally and linguistically diverse families of children with autism. Overall, 32 articles met the inclusion criteria, 25 studies were conducted in the USA and 7 studies in the UK. Four themes emerged including (a) knowledge and beliefs about autism and their impact on the family; (b) autism and family life; (c) family experiences of accessing services and support, and parents’ needs; and (d) multilanguage. Findings highlighted that family perceptions of autism are influenced by an often-reported lack of knowledge; experiences include social stigma as well as difficulties in having access to services. Needs indicate the development of culturally sensitive interventions, information in multiple languages, and parent–professional collaboration. Implications for research, policy, and practice are included.
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Should Autism Spectrum Conditions Be Characterised in a More Positive Way in Our Modern World? ACTA ACUST UNITED AC 2020; 56:medicina56050233. [PMID: 32413984 PMCID: PMC7279498 DOI: 10.3390/medicina56050233] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/04/2020] [Indexed: 01/18/2023]
Abstract
In a special issue that focuses on complex presentations related to Autism, we ask the question in this editorial whether an Autism Spectrum Condition without complexity is a disorder, or whether it represents human diversity? Much research into Autism Spectrum Conditions (ASCs) over the years has focused on comparisons between neuro-typical people and people with Autism Spectrum Conditions. These comparisons have tended to draw attention to ‘deficits’ in cognitive abilities and descriptions of behaviours that are characterised as unwanted. Not surprisingly, this is reflected in the classification systems from the World Health Organisation and the American Psychiatric Association. Public opinion about ASC may be influenced by presentations in the media of those with ASC who also have intellectual disability. Given that diagnostic systems are intended to help us better understand conditions in order to seek improved outcomes, we propose a more constructive approach to descriptions that uses more positive language, and balances descriptions of deficits with research finding of strengths and differences. We propose that this will be more helpful to individuals on the Autism Spectrum, both in terms of individual self-view, but also in terms of how society views Autism Spectrum Conditions more positively. Commentary has also been made on guidance that has been adjusted for people with ASC in relation to the current COVID-19 pandemic.
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Alallawi B, Hastings RP, Gray G. A Systematic Scoping Review of Social, Educational, and Psychological Research on Individuals with Autism Spectrum Disorder and their Family Members in Arab Countries and Cultures. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2020. [DOI: 10.1007/s40489-020-00198-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AbstractCultural dimensions of autism spectrum disorder (ASD) are relatively unexplored in the research literature. The current study is a systematic scoping review describing social, educational, and psychological research focused on individuals with ASD and their family members in Arab countries and cultures. Seventy studies met eligibility criteria. Most of the studies were from Jordan, Saudi Arabia, and Lebanon. Most of the identified research addressed three major domains: the prevalence of ASD and diagnosis issues, the experiences and outcomes for Arab caregivers of individuals with ASD, and social and communication behaviour of Arab individuals with ASD. There were significant gaps in research evidence base, including research on interventions and on ASD services. Overall, the included research was appraised as being of weak quality.
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Gonzalez M, Phoenix M, Saxena S, Cardoso R, Canac-Marquis M, Hales L, Putterman C, Shikako-Thomas K. Strategies used to engage hard-to-reach populations in childhood disability research: a scoping review. Disabil Rehabil 2020; 43:2815-2827. [DOI: 10.1080/09638288.2020.1717649] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Miriam Gonzalez
- Department of Physical and Occupational Therapy, McGill University, Montréal, Canada
- Research Institute of the McGill University Health Centre, McGill University, Montréal, Canada
| | - Michelle Phoenix
- School of Rehabilitation Science and CanChild, McMaster University, Hamilton, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Shikha Saxena
- Department of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Roberta Cardoso
- Research Institute of the McGill University Health Centre, McGill University, Montréal, Canada
| | - Michelle Canac-Marquis
- Centre for Innovative Medicine, Research Institute of the McGill University Health Centre, Montréal, Canada
| | - Lindsay Hales
- McConnell Resource Centre, McGill University Health Centre, Montréal, Canada
| | - Connie Putterman
- CHILDBRIGHT Knowledge Translation Committee, CHILD-BRIGHT Network, Montréal, Canada
- Canada-Israel Autism Research Initiative, Toronto, Canada
| | - Keiko Shikako-Thomas
- Department of Physical and Occupational Therapy, McGill University, Montréal, Canada
- Research Institute of the McGill University Health Centre, McGill University, Montréal, Canada
- Canada Research Chair in Childhood Disability: Participation and Knowledge Translation, McGill University, Montréal, Canada
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Alsharaydeh EA, Alqudah M, Lee RLT, Chan SWC. Challenges, Coping, and Resilience Among Immigrant Parents Caring for a Child With a Disability: An Integrative Review. J Nurs Scholarsh 2019; 51:670-679. [DOI: 10.1111/jnu.12522] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Ethar A. Alsharaydeh
- PhD candidate, Faculty of Health and Medicine, School of Nursing and Midwifery University of Newcastle Callaghan NSW Australia
| | - Muhammad Alqudah
- Lecturer school of Nursing and Midwifery, Faculty of Health and Medicine University of Newcastle Callaghan NSW Australia
| | - Regina Lai Tong Lee
- Professor, School of Nursing and Midwifery, Faculty of Health and Medicine University of Newcastle Callaghan NSW Australia
| | - Sally Wai-Chi Chan
- Pro Vice-Chancellor, University of Newcastle Singapore campus University of Newcastle Callaghan NSW Australia
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Aabe NO, Fox F, Rai D, Redwood S. Inside, outside and in-between: The process and impact of co-producing knowledge about autism in a UK Somali community. Health Expect 2019; 22:752-760. [PMID: 31318129 PMCID: PMC6737832 DOI: 10.1111/hex.12939] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 11/29/2022] Open
Abstract
Background Co‐production is predicated on equal power‐sharing and responsibility in research partnerships. However, relatively few accounts exist that explore the subjective experience of how co‐researchers achieve such equality, from the perspectives of public contributors and researchers. Aim This paper aims to provide a unique insight into the process of co‐production, by weaving personal reflections with principles to evaluate the impact arising from co‐produced knowledge. It is based upon participatory research that was initiated by a ‘lay’ person, on behalf of a community organization, seeking support for Somali families who are affected by autism. The paper explores the evolving partnerships that began with community theatre and qualitative research and leading to extensive dissemination and impact, all of which has been jointly owned and negotiated by the co‐researchers and community organizations. Discussion Initially, this paper reflects on the process, drawing on principles defined for co‐production in health research and combining it with the co‐researcher's personal reflections of their experiences as insiders and outsiders, stepping in and out of each other's worlds. The value of reciprocity, flexibility and continuous reflection is illustrated. The latter part of the paper explores the impact of this co‐produced knowledge using a theoretical framework, to assess the specific impacts and its broader transformative potential. It demonstrates how (1) opportunities for all partners to be equitably involved to the maximum degree possible throughout the research process can affect social change and (2) co‐produced research can become a catalyst that is dynamic and complex, achieving multi‐layered impact.
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Affiliation(s)
| | - Fiona Fox
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) and Bristol Medical School, University of Bristol, Bristol, UK
| | - Dheeraj Rai
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sabi Redwood
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) and Bristol Medical School, University of Bristol, Bristol, UK
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The Scientific Study of Parents and Caregivers of Children with ASD: A Flourishing Field but Still Work to be Done. J Autism Dev Disord 2019; 48:976-979. [PMID: 29502150 DOI: 10.1007/s10803-018-3526-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
There is a long history of research on parents and caregivers of individuals within autism. Parents and other primary caregivers typically play the most important part in the lives of persons with ASD although the need for support as the child becomes of age varies widely. This special issue includes 30 articles on central areas related to parenting and caregiving for people with ASD. Some of the key themes include intervention and training, mental health issues related to parent and family stress, measurement and assessment, and parent-child transactional processes. Other articles in this issue consider different but equally important topics such as sibling as potential future caregivers and parent support of preschool peer relationships.
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Crane L, Jones L, Prosser R, Taghrizi M, Pellicano E. Parents' views and experiences of talking about autism with their children. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 23:1969-1981. [PMID: 30915857 DOI: 10.1177/1362361319836257] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The way an autism diagnosis is disclosed to parents has been found to play a crucial role in their acceptance of, and the way they cope with, their child's diagnosis. Yet, research into parents' subsequent experiences of disclosing a diagnosis to their children, and talking to their families about autism more generally, is limited. Using an online survey, the current study examined 558 parents' experiences of talking about autism with their autistic and non-autistic children. Results demonstrated that most parents (n = 379, 67.9%) had told their autistic children about their diagnosis. Despite few parents (n = 163, 20.4%) receiving advice or support regarding the disclosure of the diagnosis, those that had disclosed felt satisfied with the process (n = 319, 84.2%) and felt confident in talking about autism with their children (n = 339, 92.4%). Those who had not told their autistic children about the diagnosis largely planned to discuss this with their child in the future (n = 100, 73.5%), felt confident in doing so (n = 95, 70.9%) and were satisfied with their decision (n = 95, 70.4%). Analysis of open-ended data, using thematic analysis, highlighted the importance of openness and the need to tailor explanations to individual children's needs, while acknowledging that disclosure could often be challenging for parents.
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Pollard N, Kantartzis S, Ismail MM, Fransen-Jaïbi H, Viana-Moldes I. The occupation of accessing healthcare and processes of (dis)citizenship in UK Somali migrants: Sheffield case study. WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 2019. [DOI: 10.1080/14473828.2018.1434989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Nick Pollard
- Occupational Therapy and Vocational Rehabilitation, Sheffield Hallam University, Sheffield, UK
| | - Sarah Kantartzis
- Division of Occupational Therapy and Arts Therapies, Queen Margaret University, Edinburgh, UK
| | - Mubarak Musa Ismail
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Hetty Fransen-Jaïbi
- Head of Occupational Therapy Education, Ecole Supérieure des Sciences et Techniques de la Santé de Tunis, Université Tunis El Manar, Tunis, Tunisia
| | - Ines Viana-Moldes
- Department of Health Sciences, Faculty of Health Sciences, Universidade da Coruña, A Coruña, Spain
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Nilses Å, Jingrot M, Linnsand P, Gillberg C, Nygren G. Experiences Of Immigrant Parents In Sweden Participating In A Community Assessment And Intervention Program For Preschool Children With Autism. Neuropsychiatr Dis Treat 2019; 15:3397-3410. [PMID: 31827325 PMCID: PMC6902863 DOI: 10.2147/ndt.s221908] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/31/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Barriers inherent in service systems for autism can hinder parents from getting help for their children, and this is probably especially true for immigrant parents. In order to provide accessible assessment and interventions for preschool children with autism, a multidisciplinary team was established in one district of a Swedish city, with a majority population of immigrants. AIM The aim of the present study was to gain knowledge of the parents' experiences of participating in the community assessment and intervention program. METHODS AND PROCEDURES A qualitative study with semi-structured interviews was conducted with parents of 11 children aged 3-5, who had been diagnosed with autism and participated in the community intervention program for at least 1 year. The interviews were recorded and transcribed verbatim, and data were analyzed following a phenomenological hermeneutical method. RESULTS The overall meaning of the parents' narratives was interpreted as "A new way of understanding my child made life more hopeful and more challenging than before". Their experience was interpreted as a process, captured in the three main themes: "An overwhelming diagnosis", "Cooperating with the team", and "Growing as a parent". CONCLUSION As lacking knowledge of available resources and support seems to be an important barrier to access services, the results underscore the importance of providing individually tailored services including comprehensive societal support to immigrant families with young children suffering from autism. The study also highlights the importance of addressing the parents' previous awareness and knowledge of autism early in the assessment process, as well as continually involving parents in the intervention program, and this may enhance parental growth.
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Affiliation(s)
- Åsa Nilses
- Center for Progress in Children's Mental Health, Region Vastra Gotaland, Gothenburg, Sweden
| | - Marianne Jingrot
- Research and Development Primary Health Care, Region Vastra Gotaland, Gothenburg, Sweden
| | - Petra Linnsand
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Child and Adolescent Specialist Centre, Angered Hospital, Region Vastra Gotaland, Angered, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Gudrun Nygren
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Child and Adolescent Specialist Centre, Angered Hospital, Region Vastra Gotaland, Angered, Sweden
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Sritharan B, Koola MM. Barriers faced by immigrant families of children with autism: A program to address the challenges. Asian J Psychiatr 2019; 39:53-57. [PMID: 30572272 DOI: 10.1016/j.ajp.2018.11.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 11/16/2018] [Accepted: 11/24/2018] [Indexed: 10/27/2022]
Abstract
Autism spectrum disorder (ASD) is a pervasive neurodevelopmental disorder characterized by social, communication, and behavioral deficits. Fortunately, early intervention has proved to be of significant benefit in the lives of children with ASD. However, timely access to health services and support requires equitable access, which is often a challenge for immigrant families. Barriers to equal access and support for immigrant families of children with ASD include cultural beliefs about child development and ASD, delayed diagnosis, access to services, and negative perceptions of services. There is a shortage of studies that explore how to increase understanding and collaboration among the immigrant population and health care practitioners to address these barriers. The barriers can indeed be appropriately addressed with structured programs and cultural models. The objectives of this article are to shed light on how barriers impact outcomes of immigrant children with ASD and to describe a culturally sensitive program model to address the barriers and provide awareness, education, and interventions for these immigrant families. The South Asian Autism Awareness Center in Toronto, Canada is presented as an example of such a model.
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Affiliation(s)
| | - Maju Mathew Koola
- Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington DC, USA.
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Crane L, Batty R, Adeyinka H, Goddard L, Henry LA, Hill EL. Autism Diagnosis in the United Kingdom: Perspectives of Autistic Adults, Parents and Professionals. J Autism Dev Disord 2018; 48:3761-3772. [PMID: 29948530 PMCID: PMC6182717 DOI: 10.1007/s10803-018-3639-1] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Accessing an autism diagnosis is a key milestone, both for an individual and their family. Using a qualitative methodology, the current study examined the views and experiences of ten autistic adults, ten parents of children on the autism spectrum, and ten professionals involved in autism diagnosis, all based in the United Kingdom (UK). Interviewing these 30 respondents about the diagnostic process and subsequent support options, the goal was to identify aspects of the diagnostic process that are working well, and areas in which improvements are needed. Using thematic analysis, three key themes were identified: the process of understanding and accepting autism; multiple barriers to satisfaction with the diagnostic process; and inadequate post-diagnostic support provision.
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Affiliation(s)
- Laura Crane
- Centre for Research in Autism and Education, UCL Institute of Education, University College London, London, WC1H 0NU, UK.
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Hussein AM, Pellicano E, Crane L. Understanding and awareness of autism among Somali parents living in the United Kingdom. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:1408-1418. [PMID: 30486651 DOI: 10.1177/1362361318813996] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Using vignettes and interviews, this study examined understanding and awareness of autism, and (a)typical development more broadly, among 32 Somali parents living in the United Kingdom. Results demonstrated that parents of both autistic (n = 16) and non-autistic (n = 16) children were just as likely to identify vignettes of typically developing children, yet parents of autistic children appeared more astute to signs of atypical development. Across the whole sample, parents commonly identified and labelled vignettes of autistic children, but experienced more difficulty labelling vignettes that described children with other forms of atypical development, sometimes mislabeling these children as autistic. This suggests that there is a need for greater support in recognising and identifying different types of atypical development in the Somali community (to mitigate the risk that the term 'autism' may take on its own meaning within the Somali community, becoming a euphemism for a range of developmental conditions). Analysis of interview data identified key sociocultural factors that either helped or hindered the inclusion of families with autistic children within the community, including the Somali community's: (1) perceptions of disability, (2) beliefs about the causes of autism in the Western world and (3) strong reliance on religious beliefs in understanding and accepting an autism diagnosis.
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Ellen Selman L, Fox F, Aabe N, Turner K, Rai D, Redwood S. 'You are labelled by your children's disability' - A community-based, participatory study of stigma among Somali parents of children with autism living in the United Kingdom. ETHNICITY & HEALTH 2018; 23:781-796. [PMID: 28277014 DOI: 10.1080/13557858.2017.1294663] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Social stigma is commonly experienced by parents of children with autism. Our aim was to understand the nature of stigma experienced by Somali parents of children with autism in the United Kingdom (UK), and to consider how they coped with or resisted such stigma. DESIGN We used a community-based participatory research approach, collaborating with a community organisation of Somali parents. In-depth interviews with simultaneous translation were conducted with 15 Somali parents of children with autism living in Bristol, UK, in 2015. Parents were sampled purposively to capture diversity in children's age, severity of autism and time since diagnosis. Directed thematic analysis used Link and Phelan's model of stigma. RESULTS Of the 15 participants, 12 were mothers (mean age 36). The 17 children with autism they cared for were 4-13 years' old, and five were girls. Two main themes with sub-themes were identified: the nature of stigma (labelling and stereotyping; separation; emotional reactions, discrimination and power), and coping and resistance (the power of language; faith as a resource; learning, peer support and community relationships). Children with autism were labelled and stereotyped (e.g. as 'sick', 'naughty', 'different') and parents blamed for not controlling them, leading to social rejection and isolation. Stigma was associated with a poor understanding of autism, a lack of vocabulary related to autism in the Somali community, and prejudice against mental illness and disability. There was evidence of enacted and felt stigma and examples of discrimination. Finding their own language to describe their child's condition and drawing on faith, learning and peer support were important resources in resisting stigma. CONCLUSIONS Findings inform support for this community, highlighting the need to raise awareness of autism, enable parents to speak openly, and ensure appropriate professional services and interventions are available.
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Affiliation(s)
- Lucy Ellen Selman
- a School of Social and Community Medicine, Faculty of Health Sciences , University of Bristol , Bristol , UK
| | - Fiona Fox
- a School of Social and Community Medicine, Faculty of Health Sciences , University of Bristol , Bristol , UK
- b The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust , Bristol , UK
| | - Nura Aabe
- c Autism Independence , Bristol , UK
| | - Katrina Turner
- a School of Social and Community Medicine, Faculty of Health Sciences , University of Bristol , Bristol , UK
- b The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust , Bristol , UK
| | - Dheeraj Rai
- a School of Social and Community Medicine, Faculty of Health Sciences , University of Bristol , Bristol , UK
- d Avon and Wiltshire Partnership Mental Health NHS Trust , Chippenham , UK
| | - Sabi Redwood
- a School of Social and Community Medicine, Faculty of Health Sciences , University of Bristol , Bristol , UK
- b The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust , Bristol , UK
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