Treating the cause of illness rather than the symptoms: parental causal beliefs and treatment choices in autism spectrum disorder

Perception, Beliefs, and Causal Attribution of Autism Early Signs in Ecuadorian General Population

The identification and diagnosis of children with autism currently rely on behavioral presentation and developmental history. Cultural norms and other socio-demographic factors can influence what is expected or non-expected behaviors in a developing child. Perceptions, beliefs, and causal attribution of early signs can influence families’ help-search behaviors. Lack of recognition of autism’s first manifestations can critically delay the age of diagnosis, the provision of informed guidance to families, and the implementation of adapted interventions during the critical period of early development. Furthermore, a lack of understanding of early signs as the manifestations of a developmental condition may increase stigma and non-conventional explanations. Still, cultural and socio-demographic factors are largely understudied, particularly in low-and middle-income settings. Based on the hypothesis that non-specialists such as family members and friends are one of the first sources of referral in Latin American contexts, we aimed to study the general population’s perceptions and the explanatory causes of autism’s early signs. One-hundred-and-eighty-three Ecuadorian adults responded to a questionnaire developed for this study, describing sixteen ASD-related behaviors. Results indicated that, with the exemption of language impairment and self-injurious behaviors, a substantial proportion of participants did not endorse many behaviors as “concerning and requiring professional attention.” Also, language impairment was the only behavior identified as related to a developmental disorder. Additionally, most participants attributed the majority of behaviors listed in the questionnaire to causes unrelated to ASD, such as child personality. We discuss the impact of those findings in clinical practice and on awareness programs.

Parental Perceptions of Autism Spectrum Disorder in Latinx and Black Sociocultural Contexts: A Systematic Review

Parents of children with autism spectrum disorder (ASD) face challenges in accessing diagnostic and treatment services; these challenges vary by race, ethnicity, and culture. This systematic review examines parental perceptions of ASD within Latinx and Black American communities. Findings indicate that interconnections with family and religious groups promoted positive coping and describe positive impacts of having a child with ASD. Relative to White families, community members reported reduced access to information and more inaccurate beliefs about ASD, higher levels of ASD-related stigma, and more negative experiences with healthcare providers, which serve to exacerbate healthcare disparities. Conclusions are limited by an underrepresentation of minority groups in research. We call for efforts to address the specific needs of racial and ethnic minorities.

Mothers' Adjustment to Autism: Exploring the Roles of Autism Knowledge and Culture

INTRODUCTION

Autism spectrum disorder (ASD) service-use disparities are well-documented among racial/ethnic minorities. Yet the nuanced impact that culture has on barriers to ASD service-use has not been sufficiently explored among these populations. This study explores the interrelatedness of culture and service-use barriers (i.e., parent ASD knowledge and adjustment) among culturally diverse mothers of children with ASD.

METHODS

Twenty mothers from the Boston area participated in semi-structured qualitative interviews regarding their experiences with ASD. Applied thematic analysis was used to analyze data stratified by ethnicity (Latina vs. non-Latina) and nativity (immigrant vs. U.S. born).

RESULTS

All mothers had similar gains in ASD knowledge after their children's ASD diagnoses. Non-Latina mothers (immigrant and U.S. born) felt empowered by their gained ASD knowledge, while Latina mothers struggled to fully accept their child's diagnosis and were unable to apply their general ASD knowledge to better understand their child's ASD-related needs. Culturally based stigma against ASD, including rejection from the Latino community and internalized self-blame, appeared to drive Latina mothers' beliefs that ASD is an invalid diagnosis for their child.

CONCLUSION

Latina mothers' desire for community acceptance in the context of ASD stigma was a particularly salient cultural value among Latina mothers in this sample. Findings suggest that parent-focused ASD education programs may not sufficiently address ASD service-use disparities for Latina mothers. Rather, ASD education programs that address informational and cultural needs may better promote ASD adjustment among ethnic minority families.

Mothers' and Fathers' Perspectives on the Causes of Their Child's Disorder

BACKGROUND

Parental beliefs about the cause of their child's illness are thought to affect parents' help-seeking behaviors, treatment decisions, and the child's health outcomes. Yet, research on parental beliefs about disease causation is still scarce. While a small number of studies assesses parental cause attributions for singular disorders (e.g., neurodevelopmental disorders), no study has compared disorders with differing physical versus mental conditions or with mixed comorbidities in children and adolescents or their caregivers. Furthermore, most pediatric research suffers from a lack of data on fathers.

OBJECTIVE

Hence, the objective of the current study was to test for possible differences in mothers' and fathers' perceptions about the etiology of their child's illness.

METHODS

Forty-two parent couples (overall N = 84) whose child had been diagnosed either with Attention Deficit Hyperactivity-Disorder (ADHD) or Autism Spectrum Disorder (ASD) (category "neurodevelopmental disorder") or with a primary physical illness and a comorbid mental disorder, e.g. depression (category "psychosomatic disorder") were asked to rate possible causes of their child's illness using a modified version of the revised Illness Perception Questionnaire (IPQ) Cause scale.

RESULTS

A two-way ANOVA showed that psychosomatic disorders were significantly more strongly attributed to be caused by medical and environmental stressors than neurodevelopmental disorders. A significant parent × illness category interaction revealed that this effect was more pronounced in fathers.

CONCLUSIONS

By providing first insights into parental beliefs about the etiology of their children's neurodevelopmental versus psychosomatic disorders, this study paves ground for future research and tailored counseling of affected families.

Vaccines and autism: a preliminary qualitative study on the beliefs of concerned mothers in Italy

Purpose: While a large body of evidence has shown that the administration of the measles-mumps-rubella (MMR) vaccine is not associated with an increased risk of autism spectrum disorder (ASD), a hesitant attitude towards childhood vaccination is still present among the public. In this study, we aim to investigate the mothers’ perceptions of the cause of their child’s ASD in order to increase our understanding of vaccine hesitancy.

Methods: This study draws on the analysis of 18 semi-structured interviews of mothers of children with ASD on the causes of autism.

Results: The interview material was content-analysed. The main themes were 1) childhood vaccines; 2) genetics; 3) specific conditions of the mother or the newborn at the moment of delivery; 4) environmental factors such as the mother’s lifestyle or her diet. The link between vaccines and autism was prevalent. About one third of the mothers reported that their child’s ASD was a consequence of a combination of two or more factors, i.e., childhood vaccines and specific conditions of the newborn or the mother at the moment of delivery.

Conclusion: This study provides preliminary insights into recurring sets of beliefs concerning the causes of ASD among the mothers of affected children.

Vaccine Hesitancy and Illness Perceptions: Comparing Parents of Children with Autism Spectrum Disorder to other Parent Groups

Fears persist despite compelling evidence refuting associations between vaccines and autism spectrum disorder (ASD). We compared vaccine hesitancy (VH) and beliefs about illness causes among parents of children in four groups: ASD, non-ASD developmental disorders, rheumatologic conditions, and the general pediatric population. VH was 19.9% overall; parents of children with ASD reported highest VH rates (29.5%) and more frequently attributed ASD to toxins in vaccines (28.9% vs. 15.7%, p=0.004). The odds of VH were increased among parents who attributed their child's condition to diet or eating habits (aOR 4.2; 95% CI: 1.6, 11.2) and toxins found in vaccines (aOR 20, 95% CI: 7.1, 55.9). Parents who attributed the condition to chance or bad luck were less likely to be vaccine hesitant (aOR 0.1; 95% CI: 0.03, 0.5).

The parenting experiences and needs of Asian primary caregivers of children with autism: A meta-synthesis

Parents of children with autism are faced with higher risks of unemployment, divorce, and poorer mental health than parents of children with other disorders. Such parenting stress can be further exacerbated by cultural and environmental factors such as the more conservative and collectivistic Asian values. Therefore, this review identifies and synthesizes literature on the parenting experiences and needs of Asian primary caregivers of children with autism using a critical interpretive method. A qualitative meta-summary was conducted. Seven electronic databases (CINAHL, Embase, ProQuest, PsycINFO, PubMed, Scopus, and Web of Science) were searched from each database’s date of inception to November 2018. In total, 44 studies were included in this review. Thirteen studies examined Asian immigrant parents’ experiences, and 31 studies were done among Asia-based parents. Six domains were identified: “personal parenting journey”; “adaptation and coping strategies”; “family, community, and social support”; “experiences with healthcare, education, and social services”; “future hopes and recommendations”; and “unique experiences of immigrants.” The distinctive influence of religious beliefs, cultural values, and environmental factors on Asian parenting experiences were discussed, and recommendations were proposed to better meet the needs of parents with autistic children.

Use of GFCF Diets in Children with ASD. An Investigation into Parents' Beliefs Using the Theory of Planned Behaviour

Gluten free/Casein free (GFCF) diets are one of the most common types of Complementary and Alternative Medicines (CAM) used in Autism Spectrum Disorders (ASD) despite little evidence to support positive effects. There has been no theory driven literature that has investigated parent’s reasons for their use. The Theory of Planned Behaviour (TPB) was used to examine parent’s intentions to use GFCF diets for their child with an ASD. Treatment and causal beliefs were also examined. Parents (n = 33, children aged 3–17 years) were influenced by anticipated regret, positive outcomes and attitude. Future interventions should provide information to parents and health professionals about the possible causes of ASD and therapy options which are in line with current recommendations.

From 'Parent' to 'Expert': How Parents of Children with Autism Spectrum Disorder Make Decisions About Which Intervention Approaches to Access

Parents of children with Autism Spectrum Disorder are responsible for deciding which interventions to implement with their child. There is limited research examining parental decision-making with regards to intervention approaches. A constructivist grounded theory methodology was implemented in this study. Semi-structured interviews were undertaken with 14 participants from 12 family units. Data collection and analysis occurred concurrently, allowing a grounded theory to be constructed. Parental decision-making was influenced by many factors, arranged into seven core categories (values, experience, information, motivation, understanding, needs and logistics). Decision-making evolved over time, as parents transformed from 'parent' to 'expert'. The results of this study provide an insight into parental decision-making, which has implications for the support provided to parents by health professionals.

Correlates of genetic attributions among parents of children in the USA with developmental disabilities

Introduction

As technologies for identifying causal genetic variants in children with autism spectrum disorders (ASD) and other developmental conditions continue to advance, there is a need to understand the factors that influence parental beliefs about the causes of their child’s disabilities. This study assessed the correlates of etiologic attributions among US parents of children with ASD, intellectual disability (ID), and/or developmental delay (DD).

Methods

Data were obtained from the Centers for Disease Control and Prevention’s nationally representative Survey of Pathways to Diagnosis and Services. Respondents were classified according to whether their child had ASD without ID or DD (ASD-only), ASD with ID and/or DD (ASD+ID/DD), or ID and/or DD without ASD (ID/DD-only). Respondents rated the extent to which they believed that genetics/heredity and environmental exposures (prenatal and/or postnatal) had contributed to their child’s condition. Logistic regression analyses and chi-square tests were used to assess the relationship between parental beliefs and child characteristics.

Results

The parents of children with comorbid ASD and ID/DD were found to be significantly less likely than those in the other condition groups to attribute their child’s condition to genetics. Within the ASD+ID/DD group, parental endorsement of genetics was lower among those who reported a history of language regression (p=0.006).

Conclusion

Further research is needed to evaluate the impact of parental genetic attributions on medical decision-making.

Using latent class analysis to identify treatment-use subgroups among parents of children with autism spectrum disorder

Among parents of 2,582 children (ages 4-17 years old) with autism spectrum disorder (ASD), we used latent class analysis to identify subgroups and profiles of treatment users and included annual household income in the specification of the models, then described characteristics of each subgroup. Based on three indicators of fit (Akaike's Information Criterion, Bayesian Information Criterion, and Lo-Mendell-Rubin), six latent classes of treatment users emerged. Subgroups included users of: (a) mostly private and school speech and occupational therapies; (b) nearly all treatment types; (c) mostly speech and occupational therapies, plus intensive behavioral and "other" treatments, but little medication use; (d) private therapies almost exclusively; (e) primarily psychotropic medications; and (f) mostly school-based therapies. Income significantly predicted class differences for all but one latent class. Probabilities of families' lifetime use of nine treatment types varied depending on latent classification. Proportions of families reporting having observed children's developmental regression were largest in those with the highest overall treatment use, and these children also had the lowest cognitive and adaptive-functioning scores and the highest ASD symptom scores. Understanding patterns of treatment use among families of children with ASD is an important first step in enhancing treatment-related selection and implementation. Autism Research 2019, 12: 843-854. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: We identified six different groups of treatment users to help explain patterns in treatment implementation among parents of children and adolescents with autism. These included families who used: (a) mostly used private and school speech and occupational therapies; (b) nearly all treatment types (private and school therapies, intensive behavioral, biomedical, psychotropic medications, and other treatments); (c) mostly speech and occupational therapies, plus intensive behavioral and "other" treatments, but little medication use; (d) private therapies almost exclusively; (e) primarily psychotropic medications; and (f) mostly school-based therapies.

Mental Health Literacy of Autism Spectrum Disorder in Korea: Recognition, Etiology, Treatment

OBJECTIVE

The objective of this study was to investigate the Korean public's recognition of autism spectrum disorder (ASD), revealing underlying factors regarding perception relative to etiology and treatment of ASD, and examining variables related to those factors.

METHODS

An online survey was held to investigate mental health literacy (MHL) on ASD of the general public in Korea. A total of 673 adults participated and completed questionnaires on socio-demographic characteristics and if they know someone with ASD. Next, participants were provided with a vignette describing a child with ASD. Only those that recognized there was a problem with the child moved to the next part which asked their perception regarding etiology and treatment of ASD.

RESULTS

According to our study, approximately 25% of participants correctly recognized the child in the vignette as having ASD. Perception regarding etiology and treatment of ASD varied among socio-demographic characteristics. Participants acquainted with someone with ASD and correctly recognized ASD held mixed perception regarding cause and treatment.

CONCLUSION

This study investigated MHL of ASD in Korea. The result reveals there is much room for improvement relative to raising awareness on MHL of ASD. Intervention considering socio-demographic characteristics and acquaintance with ASD are needed.

Multistakeholder Etiological Explanation Agreement and Adolescent/Parent Treatment Engagement

Client-therapist consensus has been hypothesized to be an important element of culturally competent care. However, little is known about the relationship between explanatory model agreement and treatment engagement, particularly for services involving adolescents, where both parent and youth perspectives may need to be considered. This longitudinal study collected youth, parent, and therapist survey data on etiological beliefs as well as therapist-rated treatment engagement related to a culturally diverse sample of 285 outpatient mental health service-using youth (aged 12-18, M = 14.06 at Time 1 interview; 40% female). Youth-therapist and parent-therapist agreement on beliefs about the etiology of the youth's mental health problems were examined in relationship to later treatment engagement. Although parent-therapist agreement was unrelated to parent engagement, youth-therapist coendorsement of etiological beliefs predicted overall youth treatment engagement. In addition, youth-therapist agreement significantly predicted specific aspects of youth engagement: client-therapist interaction, communication/openness, and client's perceived usefulness of treatment. Results speak to the importance of agreement between therapist and youth upon key issues related to the youth's problems in mental health treatment settings and support facilitation of consensus as a component of culturally competent care. Differences between findings for youth and parents suggest that therapeutic relationships may vary for different stakeholders, indicating a need to consider individual perspectives and contributions separately.

Comparison of maternal beliefs about causes of autism spectrum disorder and association with utilization of services and treatments

BACKGROUND

This study aimed to describe parental perceptions of the causes of autism spectrum disorder (ASD) in an ethnically diverse sample and explore whether these perceptions relate to treatment choices.

METHODS

The sample consisted of White (n = 224), Hispanic (n = 85), and Asian (n = 21) mothers of a child with ASD. A mixed methods approach was used in this secondary analysis focusing on parental perceptions about the causes of ASD and the relationship of these to utilization of services and treatment.

RESULTS

Environmental and genetic factors were most often believed to be the cause or one of the causes of ASD by mothers across all ethnic groups studied. Asian mothers were more likely to cite multiple causes. Environmental causes were associated with receiving 20 or more hours of autism-related services per week, whereas belief in environmental exposures and vaccines and medications as causes were associated with complementary-alternative medicine (CAM) use.

CONCLUSION

Our findings suggest that ethnic differences in autism causal beliefs and treatment choices may exist. Future research should be conducted to specifically confirm the findings, to understand parental motivation behind their service and treatment choices, and to gain more insight into the types, usage, and sources of CAM treatments. Clinicians can use parental autism causal beliefs in discussions about treatment recommendations.

Adult perceptions of children with dyslexia in the USA

This study examined adult perceptions of dyslexia among US adults. Participants (n = 623) answered survey questions pertaining to characteristics, views, and possible causes of DYS. Exploratory factor analysis revealed five distinct factors: (1) psychosocial causes, (2) external causes, (3) biological causes, (4) consequences, and (5) controllability. Three-way ANOVA's were conducted to determine the effects of ethnicity, gender, and parental status on how DYS was perceived. The results revealed ethnic, gender, and parental status differences. Males endorsed psychosocial causes and external causes more often than females. Those who self-identified as Asian viewed DYS as more controllable in comparison to Whites. Results also revealed a three-way interaction regarding controllability. Understanding the public's perceptions about developmental disorders helps distinguish true from erroneous beliefs, and understanding differences that may exist in particular groups can help implement targeted actions to improve awareness, care, and interventions for families.

Maternal beliefs about autism: A link between intervention services and autism severity in White and Latino mothers

Variation in parental beliefs about Autism Spectrum Disorder (ASD) may impact subsequent service use profiles. This study aimed to examine (1) variation in beliefs about ASD among English language proficient White (EP-W) mothers, English language proficient Latino (EPL) mothers, and limited English language proficient Latino (LEP-L) mothers of children with ASD; (2) variation in beliefs about ASD in the context of the child's ASD severity, among EP White mothers, EP Latino others, and LEP Latino mothers; and (3) potential links between maternal beliefs about ASD and children's current ASD treatment. This multi-site study included 305 English or Spanish-speaking parents of children with ASD, ages 2-10 years, who completed a survey about their beliefs about their child's ASD, their child's ASD severity, and treatments used by their children. Results showed that mothers in the EP-W, EP-L, and LEP-L groups differed in their beliefs about viewing ASD as a mystery. Only maternal views of ASD severity in the EP-W group were linked to their beliefs about ASD. Finally, maternal beliefs about ASD having major consequences on their child's life, and ASD being a mystery were strongly associated with a child's use of ASD intervention services. These findings provide new knowledge of how maternal beliefs about ASD vary in linguistically diverse groups, how a child's ASD severity may influence such beliefs, and how maternal beliefs correlate with the amount of therapy children with ASD receive. Future research should address how these beliefs or views are formed, what factors influence them, or whether they are malleable. Understanding parents' beliefs or views of having a child with ASD can potentially help us increase use of ASD intervention services in families of children with ASD.

Autism Treatment: Families’ Use Varies Across U.S. Regions

Many treatment types are available for children with autism spectrum disorder (ASD), and various factors affect treatment selection. This study investigated potential variations in treatment types selected by parents in all four U.S. Census Bureau Regions + Montreal, Quebec. Data from 2,647 families from the Simons Simplex Collection were analyzed, and statistically significant differences in using various treatment types were found, depending on where families lived. For example, compared with other Regions, families from the Northeast were more likely to have used most treatment types queried, whereas families from the South and Midwest were more likely to have used psychotropic medications. Statistically significant differences were also found within geographical regions. Understanding variations in the use of treatment types by families affected by ASD is important in identifying needs and opportunities for services in different locations. These findings have implications for addressing families’ treatment access and use when they are considered in terms of both research and practice policies.

Analyzing the Status of the Autism Spectrum Disorder Amid Children with Intellectual Disabilities in Bangladesh

Autism spectrum disorders (ASDs) are a collection of conditions characterized by stereo typed behaviors and narrow interests and pervasive problems with communication and social interactions. Globally, researchers are working on identifying the root cause and management of ASD. Although research on autism is at nascent stage in Bangladesh but in terms of social epidemicity, it is currently an utmost important issue. The aim of the study is to analyze the effect of age, sex, birth weight, mother’s pregnancy duration, pregnancy time complicacy and genetic linkage on autism. The study also related, the socio-economic status of the autistic children and satisfaction of parent on government response in this issue. The study was conducted on 50 patients in 2 Autistic Schools (Bangladesh Protibondhi Foundation and Autistic Children Welfare Foundation, Bangladesh) of the Dhaka City from June 2010 to December 2010. Study related data were collected through a predesigned questionnaire In our study out of 50 children with autism 86% were male and 24% were in the age range between 73to 84 months. About 84% children with autism were lived in urban area and about 52% were belonging at the upper middle class. The main signs and symptoms observed, was prefer to play alone (i.e. 74%). Moreover 60% children with autism talks later than age 2 and 58% had poor eye contact. During our study we have observed that 14% children were linked by heredity and 10% have siblings with same problem. Rett syndrome (i.e. 40%) and autistic disorder (i.e., 32%) were more commonly observed. From the prescription, the study revealed, physicians diagnosed speech delay in 32% patient and 8% were diagnosed with attention deficit hyperactivity disorder. For treatment physicians mainly prescribes vitamins (i.e. 50%), antiepileptic drugs (i.e. 12%), and antipsychotic drugs (i.e. 4%). Besides most of the children were treated with physical and occupational therapy but no objection was found with vaccine. During our study we had observed that, 82% parents were not satisfied by the steps taken by the government yet. This study observed that, apart from alarming increase rate of autism in Dhaka City, modern diagnosis and medication facilities as well as therapies are deficit. Therefore, the new born babies and upcoming parents are at great risk due to insufficiency of awareness. So proper awareness programs and more facilities for autistic children should be introduced by both government and non-government sectors.

Crenças Indicativas de Resiliência Parental no Contexto do Autismo

RESUMO A resiliência parental refere-se a uma parentalidade sensível e cuidadosa diante de situações críticas, como em processos diagnósticos de autismo envolvendo os filhos. Trata-se de um processo que permite aos pais desenvolver uma relação protetora frente às necessidades dos filhos e às do próprio casal, bem como elaborar o diagnóstico recebido. No atual estudo, investigaram-se indicativos de resiliência parental através da análise de conteúdo de seis entrevistas com casais cujo filho apresenta autismo. Os resultados revelaram que (a) a busca e a atribuição de sentido ao comportamento do filho e ao próprio termo autismo e (b) a capacidade de desenvolver um empoderamento nessa vivência, foram indicativos de resiliência parental importantes no processo de elaboração do diagnóstico de autismo do filho.

Parental Perceptions and Child Emotional and Behavioral Problems in Autism

Emotional and behavioral difficulties in children with autism often present problems for families seeking appropriate treatment interventions. Using data from the 2011 Survey of Pathways to Diagnosis and Services, ordinal logistic regression models were used to examine the association between parental perceptions about autism and their reports of child emotional and behavioral problems. Results showed that parents who attributed their child's autism to environmental factors, experienced emotional upset or confusion about autism, or perceived the condition to be pervasive or burdensome, were more likely to reported clinically significant emotional and behavioral difficulties. Findings suggest that support services must consider parent perceptions when developing interventions to assist with children's emotional and behavioral challenges. Implications for practice and research are discussed.

Sociocultural Factors and Parent-Therapist Agreement on Explanatory Etiologies for Youth Mental Health Problems

Sociocultural factors were examined in relationship to parent-therapist agreement on beliefs about the etiology of mental health problems in a sample of youth receiving outpatient mental health services (n = 277 parents). When examined individually, racial/ethnic match was unrelated, but higher parental affinity to mainstream American culture, higher parent education level, and greater similarity in parent and therapist scores on affinity to mainstream American culture were all significantly associated with greater parent-therapist co-endorsement of etiological explanations, while higher parental affinity to an alternative/indigenous culture was significantly associated with lower co-endorsement. When examined simultaneously in one model, only parent education level remained significantly associated. Findings suggest a complex relationship between sociocultural factors and that attention to parent cultural affinity and parent education level may facilitate parent-therapist agreement on beliefs about child problem causes.

Parent Beliefs About the Causes of Learning and Developmental Problems Among Children With Autism Spectrum Disorder: Results From a National Survey

This study aimed to assess variation in parent beliefs about causes of learning and developmental problems in U.S. children with autism spectrum disorder, using data from a nationally representative survey. Results showed that beliefs about a genetic/hereditary cause of learning/developmental problems were most common, but nearly as many parents believed in exposure causes. Forty present of parents had no definite causal beliefs. On multivariate analysis, parents who were non-White, publicly insured or poor were more likely than other parents to endorse exposure causes, or less likely to endorse genetic causes, compared to other parents. Further research should assess how these beliefs modify health care quality or services use.

Emergence of autism spectrum disorder in children from simplex families: relations to parental perceptions of etiology

Current research describes a four-category scheme of Autism Spectrum Disorder (ASD) onset: early, regressive, plateau, delay + regression. To replicate prevalence of different onset types, ASD onset (per the Autism Diagnostic Interview--Revised) was examined in a large North American sample; for a subset, parents' causal beliefs were ascertained via the Revised Illness Perception Questionnaire to examine potential associations with ASD-onset types. Onset rates were similar across samples, with a slightly higher proportion of children in the subsample categorized with regression. Top-rated causes of ASD were genetics, brain structure, will of God, toxins in vaccines, and environmental pollution. Parents reporting regression more often believed that toxins in vaccines caused ASD. Influences on treatment selection and broader public-health ramifications are discussed.

Autism spectrum disorder etiology: Lay beliefs and the role of cultural values and social axioms

Recent research examining the explanations given by the public (i.e. lay beliefs) for autism spectrum disorder often reveals a reasonably accurate understanding of the biogenetic basis of the disorder. However, lay beliefs often manifest aspects of culture, and much of this work has been conducted in western cultures. In this study, 215 undergraduate university students in Macau, a Special Administrative Region of China, completed self-report measures assessing two beliefs concerning autism spectrum disorder etiology: (1) a belief in parental factors and (2) a belief in genetic factors. Potential correlates of lay beliefs were sought in culture-specific values, and more universal social axioms. Participants were significantly more likely to endorse parenting, relative to genetic factors, as etiological. A perceived parental etiology was predicted by values of mind-body holism. Beliefs in a parental etiology were not predicted by values assessing collectivism, conformity to norms, a belief in a family's ability to obtain recognition through a child's achievement, or interpersonal harmony, nor by the social axioms measured (e.g. social cynicism, reward for application, social complexity, fate control, and religiosity). Beliefs in a genetic etiology were not predicted by either culture-specific values or social axioms. Implications of the current results are discussed.

Differences in relatives' and patients' illness perceptions in functional neurological symptom disorders compared with neurological diseases

OBJECTIVE

The illness perceptions of the relatives of patients with functional neurological symptom disorders (FNSDs) and their relation to the illness perceptions of the patients have been little studied. We aimed to compare illness perceptions of relatives of patients with FNSDs with those held by patients themselves. We used control pairs with neurological diseases (NDs) to examine the specificity of the findings to FNSDs.

MATERIAL AND METHODS

Patients with FNSDs (functional limb weakness and psychogenic nonepileptic seizures) and patients with NDs causing limb weakness and epilepsy, as well as their relatives, completed adapted versions of the Illness Perception Questionnaire - Revised (IPQ-R).

RESULTS

We included 112 pairs of patients with FNSDs and their relatives and 60 pairs of patients with NDs and their relatives. Relatives of patients with FNSDs were more likely to endorse psychological explanations and, in particular, stress as causal factors than patients with FNSDs (p<.001). Relatives of patients with FNSDs were also more pessimistic about the expected duration of the disorder and perceived a greater emotional impact compared with patients themselves (p<.001). However, the latter two differences between patients and relatives were also found in pairs of patients with NDs and their relatives.

CONCLUSION

The main difference in illness perceptions between relatives and patients that appeared specific to FNSDs was a tendency for relatives to see psychological factors as more relevant compared with patients. Some other differences were observed between pairs of patients with FNSDs and their relatives, but the same differences were also seen in pairs of patients with NDs and their relatives. These other differences were, therefore, not specific to FNSDs. Discussion about possibly relevant psychological factors with patients suffering from FNSDs may be helped by including relatives.

Examining treatment adherence among parents of children with autism spectrum disorder

BACKGROUND

Children with Autism Spectrum Disorder (ASD) participate in a variety of treatments, including medication, behavioral, alternative and developmental treatments. Parent adherence to these treatments is crucial for positive child outcomes.

OBJECTIVE

The current study: 1) Explored patterns of parent adherence across the full range of treatments that are prescribed to children with ASD and, 2) Examined whether parent demographics, parent treatment attitudes, and child ASD severity contribute to parents' adherence across ASD treatments.

METHOD

Questionnaires were distributed to parents of children with ASD in a southeastern state. Parents (N = 274) were included if they were parenting a child with ASD who was receiving treatment for ASD symptoms. Paired t-tests and multiple linear regression were used to assess the study aims.

RESULTS

Adherence to medication treatment was significantly greater than adherence to behavioral, developmental, or alternative treatments (adjusted p-values 0.0006, 0.0030, 0.0006 respectively). Perceived family burden of a treatment was associated with lower adherence to medication, developmental, and alternative treatments. Finally, greater ASD severity was associated with lower adherence to alternative treatments.

CONCLUSION

Overall, the independent variables accounted for more variance in adherence to medication and alternative treatments than in behavioral and developmental treatments. Parents' adherence to ASD treatment differs significantly by treatment type and is influenced by parental perceptions of the burden of treatment on the family. These findings highlight the importance of understanding and addressing the impact of ASD treatment regimens on family life.

Parent Reports of Treatments and Interventions Used With Children With Autism Spectrum Disorders (ASD): A Review of the Literature

With the increasing number of treatment and intervention options for parents of children with autism spectrum disorders (ASD) in recent years, the number and types of interventions that parents are choosing to use has become of interest. In the present paper, the authors review 41 articles (describing 42 studies) presenting quantitative data on intervention choices of parents of children with ASD. Speech therapy was the most commonly reported intervention for both current and lifetime use. Across the studies, parents were reported to be using a variety of interventions, from those with strong empirical support, such as applied behaviour analysis (ABA), to others that lacked such support, such as dietary interventions. Some differences in the data presented across studies may be attributed to the range of different methodologies used to collect the data. Recommendations for future research, including those related to collecting treatment usage data more consistently, are discussed.

Overuse of psychotropic medications among children and adolescents with autism spectrum disorders: perspective from a developing country

Psychopharmacotherapy can be an effective part of the treatment for individuals with autism spectrum disorders (ASDs). However debate continues over the potential benefits and costs of these treatments; additionally little is known about the pattern of psychotropic medication use in developing countries. We aimed to survey the use of psychotropic medication, their subcategories and its associations among a representative local sample of 345 Iranian pupils with ASDs. All required information about demographics as well as clinical and medication history of children was collected through interviews with the families. Overall, 80% of participants were currently using at least one psychotropic medication while, and up to 97% of the sample had at least one psychotropic medication claim during the last year. Antipsychotics were the most frequent medications (57.4%) while antidepressants were used by only a small proportion of participants (8.7%). Further analysis revealed no significant association between any psychotropic medication use on one hand and clinical and demographic characteristics on the other hand. Time differences, cross cultural variations, and also cost and availability of treatment options in developing countries are discussed as possible explanations for different patterns and more than expected rate of psychotropic medication use in pupils with ASD.