Children with Autism Spectrum Disorders in Low-Resource Settings: Reported Experiences and Needs of Parents in Mongolia

Strategies for capacity building in a low-resource setting: Stakeholders' voices

LAY ABSTRACT

Prevalence of autism is increasing all around the globe, but there is still great inequity in accessing evidence-based interventions. Although the field of autism research has made great strides in identifying and establishing evidence-based interventions, dissemination and implementation of these interventions have been reported as inequitable. This inequity is especially highlighted in many low-resource settings, such as Mongolia. As a field, there is still much to be learned about what strategies are used by stakeholders in low-resource settings to build capacity and to mitigate the hardships. To gain a deeper understanding of strategies for capacity building within a low-resource setting, we conducted five focus groups with 30 Mongolian caregivers of children with autism and 15 individual interviews with various professionals who work in Mongolia. These stakeholders reported three main strategies, including (a) partnership, (b) advocacy, and (c) empowerment, which included several strategies and implications on capacity-building practices. Furthermore, the findings from this study may suggest important implications for future intervention research.

Parent reported barriers and facilitators to support services for autistic children in Aotearoa New Zealand

LAY ABSTRACT

Parents might have problems in getting support services for their autistic child due to certain barriers. However, there might also be things that can ease or facilitate parents' access to support services. In this study, New Zealand parents were asked about their experiences in getting support services for their autistic child. We also looked at differences in reported barriers and facilitators based on several demographic factors with a focus on family level of financial resourcing. A total of 173 parents completed a survey. The results suggested that parents experienced several barriers, particularly related to service pathways. Facilitators were also experienced, predominantly related to providers. Financial resourcing predicted the number of parent-reported barriers. Both lower level of family financial resourcing and having a non-binary child predicted parents' rating of the extent of barriers. Child age and level of speech were predictors for reports of experiencing a higher number of facilitators, with parents of younger children or of non-speaking autistic children reporting a greater number of facilitators. We discuss how these results may be useful to support service delivery and identify areas for future research.

Machine learning for autism spectrum disorder diagnosis using structural magnetic resonance imaging: Promising but challenging

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder that affects approximately 1% of the population and causes significant burdens. ASD's pathogenesis remains elusive; hence, diagnosis is based on a constellation of behaviors. Structural magnetic resonance imaging (sMRI) studies have shown several abnormalities in volumetric and geometric features of the autistic brain. However, inconsistent findings prevented most contributions from being translated into clinical practice. Establishing reliable biomarkers for ASD using sMRI is crucial for the correct diagnosis and treatment. In recent years, machine learning (ML) and specifically deep learning (DL) have quickly extended to almost every sector, notably in disease diagnosis. Thus, this has led to a shift and improvement in ASD diagnostic methods, fulfilling most clinical diagnostic requirements. However, ASD discovery remains difficult. This review examines the ML-based ASD diagnosis literature over the past 5 years. A literature-based taxonomy of the research landscape has been mapped, and the major aspects of this topic have been covered. First, we provide an overview of ML's general classification pipeline and the features of sMRI. Next, representative studies are highlighted and discussed in detail with respect to methods, and biomarkers. Finally, we highlight many common challenges and make recommendations for future directions. In short, the limited sample size was the main obstacle; Thus, comprehensive data sets and rigorous methods are necessary to check the generalizability of the results. ML technologies are expected to advance significantly in the coming years, contributing to the diagnosis of ASD and helping clinicians soon.

Barriers and facilitators for obtaining support services among underserved families with an autistic child: A systematic qualitative review

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.

Parent peer coaching program: A cascading intervention for parents of children with autism in Mongolia

LAY ABSTRACT

Parents of children with autism are known to experience severe hardships related to raising their children. These hardships are exacerbated in low-resource settings internationally where there is very little resource for children and their families, including professionals who provide evidence-based treatment. Mongolia was chosen as an example of such low-resource settings in this single-case research, and four parent mentors and five parent peers and their children with autism participated and completed the study. A local parent group, the Autism Association of Mongolia, was actively involved in this study and helped with recruitment, development, adaptation, and implementation of the intervention to increase acceptability and feasibility. In addition, a local bilingual research assistant was also utilized as the purpose of this study was to build capacity of diverse stakeholders of children with autism in Mongolia. The research assistant was trained and coached by the research team on both content (communication teaching strategies and behavior management) and delivery (coaching adults), who then provided coaching to parent mentors via live videoconferencing in Mongolian. Parent mentors then similarly provided coaching to parent peers after observing the interactions with their children with autism. The findings suggest that parents can effectively deliver high-fidelity coaching to disseminate evidence-based treatment in low-resource settings when given proper training and coaching. Further examination on scalability and sustainment of effects is suggested.