Teacher responses to anxiety-related behaviours in students on the autism spectrum

When the Education System and Autism Collide: An Australian Qualitative Study Exploring School Exclusion and the Impact on Parent Mental Health

Autistic students experience elevated rates of school exclusion, whether this be through expulsion, suspension, informal suspension, refusal of enrolment, or school refusal. This exclusion can come about from a range of factors, including sensory or cognitive overload, a lack of training in neurodiversity for teachers, an absent sense of safety by the student at school, or poor attitudes towards the inclusion of autistic students in schools. The impacts of this exclusion on parents can be logistical, financial, and psychological, with a range of mental health outcomes. This Australian qualitative study presents case studies of seven parents of autistic students, as well as four themes that capture the recommendations of parents to address school exclusion. The findings demonstrate that parents experience stress in finding a suitable school for their child, working with staff to meet the needs of the child, and attempting to maintain employment and other commitments when the child experiences exclusion. Parents recommend greater acceptance of autism by education systems, better communication and use of neuro-affirming language, the option for flexible learning, and individualised support by the school for the student.

A cluster randomized controlled trial comparing the effectiveness of two school-based interventions for autistic youth with anxiety

BACKGROUND

Recent systematic reviews have indicated that cognitive behavioral therapy (CBT) is effective in reducing anxiety symptoms for autistic and non-autistic children. However, the vast majority of CBT research for autistic youth has been implemented within university settings and primarily by mental health providers. Schools hold great promise to equitably manage the mental health symptoms of autistic youth. Although preliminary research evaluating CBT within schools has been promising, CBT has not yet been compared to another readily available school mental health program. The goal of this protocol paper is to describe a multi-site study comparing two school-based interventions, Facing Your Fears-School Based (FYF-SB) and Zones of Regulation (ZOR) via a cluster randomized controlled type 1 hybrid effectiveness-implementation trial to determine which of the two interventions will best support autistic youth with anxiety in schools.

METHODS

Up to 100 elementary and middle schools will be randomized into FYF-SB or ZOR. Once schools are randomized, a minimum of two interdisciplinary school providers at each school will be trained to deliver either FYF-SB or ZOR over the course of 12 weeks to groups of 2-5 autistic students ages 8-14 years. Over the course of two years, a total of 200 autistic students will receive either ZOR or FYF-SB. The primary outcome of this trial is child anxiety, as rated by masked evaluators and via caregiver- and student-report, which will be measured at baseline, post-treatment, and 6-month follow-up. Semi-structured interviews will also be conducted with a purposive sample of students, caregivers, and school providers to understand the acceptability, appropriateness, and feasibility of either ZOR or FYF-SB. Stakeholder engagement is a central component of this project via two stakeholder advisory boards that will directly inform and oversee the project.

DISCUSSION

Results of this study will provide evidence about the relative impact of two school-based mental health interventions on outcomes reported as meaningful by caregivers and school providers. The additional focus on evaluating factors that support the implementation of FYF-SB and ZOR will allow future studies to test targeted implementation strategies that support mental health programming uptake and implementation within public schools.

TRIAL REGISTRATION

This trial is registered with clinicaltrials.gov (NCT05863520).

Collateral Damage: The Impacts of School Exclusion on the Mental Health of Parents Caring for Autistic Children

Despite legislative and policy mechanisms that promote inclusion in education for children with disabilities, many students still experience exclusion from the education setting. For example, autistic children are more likely than their neurotypical counterparts to be expelled or suspended from school or to refuse to attend school on an ongoing basis. This situation gives rise to various challenges for their parents. This discursive paper synthesizes current knowledge on school exclusion involving autistic children, including the causes and consequences of exclusionary practices. The paper also considers the negative impacts of these exclusionary practices on the emotional and psychological well-being of parents and caregivers. Mental health nurses who understand the issues related to school exclusion can better support the educational, social, and developmental needs of autistic children and the mental health needs of parents or caregivers.

Analysis of the Autism Spectrum Disorder (ASD) Knowledge of Cuban Teachers in Primary Schools and Preschools

Teachers’ knowledge of autism spectrum disorder (ASD) plays a key role in the successful inclusion of children with ASD in regular schools. The objective of this study was to analyze Cuban teachers’ knowledge of ASD of at inclusive primary schools and preschools and to compare it with the results obtained in previous studies carried out at an international level. To do this, a cross-sectional study was conducted with Cuban teachers from urban and rural areas throughout the country. The sample was selected using a non-probabilistic technique. In total, 131 primary school and preschool teachers participated. Data were collected by applying the Autism Knowledge Questionnaire (AKQ) that measures ASD knowledge. The results indicated that Cuban teachers had an acceptable knowledge regarding ASD (0.57). Primary education teachers (17.58 ± 4.06) showed a higher level of knowledge than preschool teachers (15.35 ± 2.74). Regarding previous training, teachers who claimed to have received some type of specific ASD training (10.88 ± 3.29) made a greater number of errors than teachers who had not received specific training on ASD (8.91 ± 3.06). At the international level, Cuban teachers were observed to have similar knowledge about ASD when compared to active teachers or pre-service teachers from other countries where similar studies have been carried out. The results suggest that the training of Cuban teachers is not yet optimal to educate students with ASD in primary schools and preschools which are open to diversity.

'There isn't a checklist in the world that's got that on it': Special needs teachers' opinions on the assessment and teaching priorities of pupils on the autism spectrum

Two focus groups were conducted with special needs teachers to: (a) identify barriers to learning for autistic pupils, (b) consider broad assessment domains and specific skills or behaviours which teachers consider important for these pupils, and (c) give their opinions on teacher assessments. Data analysis resulted in six main themes: (a) barriers to learning, (b) teacher priorities for autistic pupils, (c) ways of overcoming barriers, (d) the concept of 'true mastery', (e) assessing the bigger picture, and (f) practicalities of assessment. Results showed that teachers have priorities for the pupils they know well and concerns about the assessments they regularly use. To ensure face and content validity of teacher assessments, and for assessments to be useful to and valued by the teachers who use them, it is recommended that teachers have opportunities to input during various aspects of the assessment development process.

National Profile of Caregivers' Perspectives on Autism Spectrum Disorder Screening and Care in Primary Health Care: The Need for Autism Medical Home

Although autism spectrum disorder (ASD) is a common developmental disorder, primary healthcare providers show a deficit in providing early diagnosis. To understand parents' experience and perspective in the diagnosis and intervention process of their children, a survey was deployed through social media to parents' with at least one child diagnosed with ASD. The survey included parents experience, satisfaction and perception in the diagnosis process and services provided for their children, stigma and type of support received. A total of 223 participants were enrolled. Although 62% of ASD patients were diagnosed by three years old, most diagnoses (66%) were non-physician initiated. Additionally, 40.8% of the parents reported that the services required for their child are available in their area of residence, but only 7.9% were satisfied with these services. Parents who received psychological support (9.9%) started early intervention, and their children have a better prognosis (p ≤ 0.005). Stigmatized parents were more likely to delay intervention (p ≤ 0.005). Parents' perception is to have qualified healthcare and educational professionals experienced in ASD. Our findings suggest that a specialized family-centred medical home for ASD patients would significantly benefit ASD patients, increase parents' satisfaction, reduce parents' stress, and ease their children's transition to adolescents.

The Anxiety Caused by Secondary Schools for Autistic Adolescents: In Their Own Words

Secondary schools are increasingly becoming inclusive of all students whatever their individual needs, but we question whether teachers understand enough about specific needs in order to effectively support all their students. Research indicates that autistic students often struggle with aspects of school (conformity; social communication; sensory challenges; bullying) but very few studies ask autistic adolescents about their experiences. One of the key elements of the school experience for autistic adolescents is the levels of anxiety experienced by many students on a daily basis. This research set out to explore the extent to which autistic students in secondary schools in the UK were able to recognise and reflect on their own anxiety. The eighteen participants in this co-produced qualitative study took part in semi-structured interviews planned by a team of autistic and non-autistic researchers. The themes that emerged from this study, in terms of triggers for anxiety, included other people’s behaviour, fear of the unknown, and sensory sensitivities. A theoretical view of their difficulties concurs with the concept of intolerance of uncertainty. Our data suggest that autistic students continue to experience high levels of anxiety throughout their secondary education, despite supports put in place by some schools. Strategies are highlighted that could be implemented by all schools to promote truly inclusive settings.

Parent-Teacher Disagreement on Ratings of Behavior Problems in Children with ASD: Associations with Parental School Involvement Over Time

ASD symptomology and behavioral problems pose challenges for children with ASD in school. Disagreement between parents and teachers in ratings of children's behavior problems may provide clinically relevant information. We examined parent-teacher disagreement on ratings of behavior problems among children with ASD during the fall and spring of the school year. When child, teacher, and class characteristics were considered simultaneously, only ASD symptom severity predicted informant disagreement on internalizing and externalizing behavior problems. We also examined associations between informant disagreement and parent school involvement. Cross-lagged panel analyses revealed that higher informant disagreement on children's behavior problems in the fall predicted lower parent school involvement in the spring, suggesting that greater informant agreement may foster parental school involvement over time.

Family accommodation of anxiety in a community sample of children on the autism spectrum

Anxiety is recognised as one of the most common co-occurring conditions for individuals with a diagnosis on the autism spectrum, with approximately 40 % of children on the spectrum receiving a clinical diagnosis of an anxiety disorder. To date, research has tended to focus upon understanding presentation and evaluating treatment, with little focus on assessing systemic factors, such as the way that family members accommodate the anxiety. This study aimed to investigate the relationship between parent and child anxiety levels and child autism characteristics on the four domains of family accommodation; Participation, Modification, Distress, and Consequence. A community sample (n = 132) of parents of children on the spectrum completed questionnaires on their child's autism characteristics and anxiety symptomatology as well as their own levels of anxiety and family accommodation behaviours. Regression models identified specific aspects of child anxiety as well as parent anxiety as predictive of family accommodation, with the child's difficulties with uncertainty being a consistent predictor of all four domains. Clinical and research implications of this study, including the importance of understanding similarities or differences in the nature and consequence of family accommodation in children on the autism spectrum, are discussed.

Exploring Anxiety at Home, School, and in the Community Through Self-Report From Children on the Autism Spectrum

Research investigating anxiety in children on the autism spectrum usually reports caregiver rather than self-report perspectives. This study aimed to document children's own descriptions of their anxiety symptomatology by combining profiles on a standardized autism-specific self-report measure of anxiety (ASC-ASD-C) with the answers from closed- and open-answer questions about anxiety across home, school, and community settings. Across the sample of 113 children on the spectrum aged 6-14 years, the two most frequently endorsed items on the ASC-ASD-C were from the Uncertainty and Performance Anxiety subscales, and the least endorsed were both from the Anxious Arousal subscale. Almost all (96.5%) of the children on the spectrum reported experiencing anxiety in at least one setting, with 40.7% reporting anxiety in all three contexts (home, school, and community). Approximately half of the sample felt their anxiety goes unrecognized by others at school and almost 60% felt it was unrecognized by others when out in the community. The proportion of children reporting having someone to help reduce their anxiety differed across home (86%), school (76%), and community (45%) settings. This highlights the importance of understanding anxiety and its impact, not only within the context of autism but also for each particular child. Autism Res 2020, 13: 603-614. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: There has been a lot of research focusing on anxiety and autism, but most of it has used parent reports, rather than asking the child themselves. This study summarizes data from 113 children on the autism spectrum, aged 6-14 years. It reports the symptoms of anxiety that these children most and least commonly experience. The results suggest only 40-50% of children feel that others are able to recognize their anxiety at school and when out in the community, suggesting that more training is needed to help adults in these settings to recognize and support anxiety.