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O'Connor RA, Doherty M, Ryan-Enright T, Gaynor K. Perspectives of autistic adolescent girls and women on the determinants of their mental health and social and emotional well-being: A systematic review and thematic synthesis of lived experience. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:816-830. [PMID: 38145308 DOI: 10.1177/13623613231215026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
LAY ABSTRACT Difficulties with mental health and low levels of well-being are more common among autistic girls and women than non-autistic people, but we do not fully understand why. Research does not focus enough on what autistic girls and women could tell us about this. This review aims to summarise the studies where autistic girls and women explain things that affect their mental health and well-being to help us understand how to prevent these difficulties from developing. Three research databases were searched to find possibly relevant studies. There were 877 studies found, which two researchers screened according to particular criteria. They found 52 studies that could be included in this review. One researcher evaluated the quality of these studies and extracted the key information from them. This review summarises the views of 973 autistic girls and women aged between 13 and 70+. The findings from the 52 studies were analysed, and we found many factors that affect the mental health and well-being of autistic girls and women. These factors fall into two categories: (1) difficulties living in a world not designed for autistic people and (2) the impact of stigma due to being autistic.
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Affiliation(s)
- Rachel Ag O'Connor
- School of Psychology, University College Dublin, Republic of Ireland
- Health Service Executive, Republic of Ireland
| | - Mary Doherty
- Brighton and Sussex Medical School, Brighton, UK
- Our Lady's Hospital, Navan, Republic of Ireland
| | - Theresa Ryan-Enright
- School of Psychology, University College Dublin, Republic of Ireland
- Health Service Executive, Republic of Ireland
| | - Keith Gaynor
- School of Psychology, University College Dublin, Republic of Ireland
- DETECT, Early Intervention Service, Blackrock, Republic of Ireland
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Hosozawa M, Cable N, Ikehara S, Aochi Y, Tanigawa K, Baba S, Hirokawa K, Kimura T, Sobue T, Iso H. Maternal Autistic Traits and Adverse Birth Outcomes. JAMA Netw Open 2024; 7:e2352809. [PMID: 38261317 PMCID: PMC10807295 DOI: 10.1001/jamanetworkopen.2023.52809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/13/2023] [Indexed: 01/24/2024] Open
Abstract
Importance Women with a high level of autistic traits in the general population may experience larger health disparities during pregnancy, particularly women diagnosed with autism spectrum disorder (ASD), which in turn may be associated with increased risk of adverse birth outcomes. Objective To investigate the association between maternal autistic traits and the risk of adverse birth outcomes in the general population. Design, Setting, and Participants This cohort study included mothers of singletons from a nationwide, multicenter prospective birth cohort, the Japan Environmental Children's Study. Expecting mothers were recruited between January 2011 and March 2014. Data were analyzed between June 2021 and November 2023. Exposures Autistic traits were self-reported during the second and third trimesters using the short form of the Autism-Spectrum Quotient Japanese version (AQ-J10) (score range, 0-10; clinical range, ≥7). Main Outcomes and Measures Data on preterm birth (<37 weeks' gestation) and neonates born small for gestational age (SGA) were transcribed from medical records. Additional analysis of gestational age groups (very preterm birth, <32 weeks' gestation; moderate-to-late preterm birth, 32-36 weeks' gestation) was also performed. Results Among 87 687 women (mean [SD] age, 31.2 [5.0] years) included in the study, 2350 (2.7%) had AQ-J10 scores within the clinical range yet only 18 (0.02%) were diagnosed with ASD. A higher AQ-J10 score was associated with an increased risk of all birth outcomes, including preterm births (relative risk [RR] per 1-SD increase, 1.06; 95% CI, 1.03-1.09), moderate-to-late preterm births (RR per 1-SD increase, 1.05; 95% CI, 1.01-1.08), very preterm births (RR per 1-SD increase, 1.16; 95% CI, 1.06-1.26), and child born SGA (RR per 1-SD increase, 1.04; 95% CI, 1.01-1.06) after adjusting for maternal and pregnancy-related factors. The risks of all outcomes increased with higher AQ-J10 scores; compared with women below the clinical range, women within the clinical range had greater risk of preterm births (RR, 1.16; 95% CI, 1.07-1.26), moderate-to-late preterm births (RR, 1.12; 95% CI, 1.03-1.22), very preterm births (RR, 1.49; 95% CI, 1.18-1.89), and a child born SGA (RR, 1.11; 95% CI, 1.04-1.19). Conclusions and Relevance In this cohort study, higher level of maternal autistic traits was associated with increased risk of adverse birth outcomes, particularly very preterm birth. Acknowledging the risks and providing tailored and timely antenatal care support to women with a high level of autistic traits in the general population, particularly women with autistic traits within the clinical range, regardless of formal diagnosis, is warranted.
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Affiliation(s)
- Mariko Hosozawa
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Noriko Cable
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Satoyo Ikehara
- Environmental Medicine and Population Sciences, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuri Aochi
- Environmental Medicine and Population Sciences, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kanami Tanigawa
- Osaka Maternal and Child Health Information Center, Osaka Women’s and Children’s Hospital, Osaka, Japan
| | - Sachiko Baba
- Osaka Maternal and Child Health Information Center, Osaka Women’s and Children’s Hospital, Osaka, Japan
| | - Kumi Hirokawa
- Faculty of Societal Safety Sciences, Kansai University, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomotaka Sobue
- Environmental Medicine and Population Sciences, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroyasu Iso
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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Hampton S, Allison C, Baron-Cohen S, Holt R. Autistic People's Perinatal Experiences I: A Survey of Pregnancy Experiences. J Autism Dev Disord 2024; 54:211-223. [PMID: 36261629 PMCID: PMC10791798 DOI: 10.1007/s10803-022-05754-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 01/07/2023]
Abstract
Qualitative studies of autistic people's pregnancy experiences have indicated sensory and communication related barriers to accessing adequate prenatal healthcare. However, quantitative work on the topic is scarce. This online survey study explored pregnancy experiences among 417 autistic and 524 non-autistic people. Compared with non-autistic people, autistic people reported heightened sensory and physical experiences during pregnancy and were more likely to experience prenatal depression and anxiety. Autistic people experienced lower satisfaction with prenatal healthcare, including having lower perceptions of their relationships with healthcare professionals and greater difficulties with antenatal classes. This study identifies key adjustments that can be made to prenatal healthcare, including sensory and communication adjustments. The findings highlight the need for greater autism understanding and awareness among professionals.
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Affiliation(s)
- Sarah Hampton
- Autism Research CentreDepartment of Psychiatry, University of Cambridge, Cambridge, UK
| | - Carrie Allison
- Autism Research CentreDepartment of Psychiatry, University of Cambridge, Cambridge, UK
| | - Simon Baron-Cohen
- Autism Research CentreDepartment of Psychiatry, University of Cambridge, Cambridge, UK
| | - Rosemary Holt
- Autism Research CentreDepartment of Psychiatry, University of Cambridge, Cambridge, UK
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Demartini B, Nisticò V, Limonta S, Tarantino V, Stefanelli G, Calistro F, Giambanco L, Faggioli R, Gambini O, Turriziani P. Long-term Memory of Sensory Experiences from the First Pregnancy, its Peri-partum and Post-partum in Women with Autism Spectrum Disorders without Intellectual Disabilities: A Retrospective Study. J Autism Dev Disord 2023:10.1007/s10803-023-06189-y. [PMID: 37966534 DOI: 10.1007/s10803-023-06189-y] [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: 11/07/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE To explore the recalled experience of pregnancy and motherhood in women diagnosed with Autism Spectrum Disorders (ASD) without intellectual disabilities, focusing on sensory perceptions and mood. METHODS We retrospectively evaluated, through an ad-hoc structured interview, the sensory sensitivity during the pre-partum, the peri-partum, and the post-partum of thirty-three mothers with ASD and thirty-two neurotypical mothers. Participants also underwent a psychometric assessment about autistic traits, general sensory sensitivity, and post-partum depressive symptomatology. RESULTS Mothers with ASD recalled a higher sensitivity than the comparison group across the three time-points; however, during the peri-partum their recalled hypersensitivity decreases, and in the post-partum it returned as high as before childbirth. The difference in the length of recall between groups did not statistically influence our results. Higher levels of autistic traits correlated with higher depressive post-partum symptomatology. CONCLUSIONS Mothers with ASD seem to recall their experience of pregnancy, childbirth, and post-partum period differently from neurotypical mothers, particularly in terms of hypersensitivity. The correlation with depressive symptoms and the potential role of oxytocin and of long-term memory (encoding and recollection) are discussed. Further exploring these aspects might give fundamental hints to provide tailored support to mothers with ASD during pregnancy and motherhood.
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Affiliation(s)
- Benedetta Demartini
- Unità di Psichiatria 51 e 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
- "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milano, Italy
| | - Veronica Nisticò
- "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milano, Italy.
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Presidio San Paolo, via A. Di Rudinì, 8, Milano, 20142, Italy.
- Dipartimento di Psicologia, Università degli Studi di Milano-Bicocca, Milano, Italy.
| | - Serena Limonta
- Scuola di Specializzazione in Psichiatria, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Vincenza Tarantino
- Dipartimento di Scienze Psicologiche, Pedagogiche, dell'Esercizio Fisico e della Formazione, Università degli Studi di Palermo, Palermo, Italy
| | - Giulia Stefanelli
- Unità di Psichiatria 51 e 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | | | - Laura Giambanco
- U.O.C. Ostetricia e Ginecologia, Presidio Ospedaliero S.Antonio Abate, Trapani, Italy
| | - Raffaella Faggioli
- Unità di Psichiatria 51 e 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Orsola Gambini
- Unità di Psichiatria 51 e 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
- "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milano, Italy
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Presidio San Paolo, via A. Di Rudinì, 8, Milano, 20142, Italy
| | - Patrizia Turriziani
- Dipartimento di Scienze Psicologiche, Pedagogiche, dell'Esercizio Fisico e della Formazione, Università degli Studi di Palermo, Palermo, Italy
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Ferrara R, Ricci P, Damato FM, Iovino L, Ricci L, Cicinelli G, Simeoli R, Keller R. Pregnancy in autistic women and social medical considerations: scoping review and meta- synthesis. Front Psychiatry 2023; 14:1222127. [PMID: 37965368 PMCID: PMC10641492 DOI: 10.3389/fpsyt.2023.1222127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction This article addresses a topic that has been largely overlooked by scientific literature, namely pregnancy in autistic women. Generally, the issue of sexuality in disability, particularly in disabled women, autistic or otherwise, has been underexplored. However, it is necessary to scientifically investigate this topic to propose adequate social and health policies. Therefore, we chose to conduct a scoping review to answer three main questions: "What does it mean for an autistic woman to be pregnant?"; "How do these two conditions coexist?"; "Are health services prepared to receive this population adequately or does autism become a stigma for pregnant women?" Methods We conducted a systematic review and qualitative thematic synthesis following the Preferred Reporting Guidelines for Systematic Reviews and Meta-Analyses on autistic women and pregnancy in the last 10 years. Results The studies included in our review are 7, extremely diverse in terms of methodologies and sample sizes. Despite the heterogeneity of samples and methodologies, all research tends to highlight the following results. For autistic women during pregnancy, three areas seem to be the most difficult: sensory issues, mood disorders, and relationships with specialists. Discussion Our study found that women with ASD face unique challenges during childbirth that differ from those of neurotypical women. Participants often felt belittled, ignored, and uninformed about the care they received, and being placed at the centre of attention was often seen as negative and hindering rather than positive. However, the research shows us how some "expected" results, such as difficulties in breastfeeding, have been disproven.
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Affiliation(s)
- Rosaria Ferrara
- Department of Anatomy Histology, Legal Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
| | - Pasquale Ricci
- Department of Anatomy Histology, Legal Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
| | - Felice Marco Damato
- Department of Anatomy Histology, Legal Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
| | | | - Lidia Ricci
- Department of Anatomy Histology, Legal Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
| | - Giovanni Cicinelli
- Adult Autism Center, Mental Health Department, Local Health Unit ASL Città di Torino, Turin, Italy
| | - Roberta Simeoli
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
- Neapolisanit Research and Rehabilitation Center srl, Ottaviano, Italy
| | - Roberto Keller
- Adult Autism Center, Mental Health Department, Local Health Unit ASL Città di Torino, Turin, Italy
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Hampton S, Man J, Allison C, Aydin E, Baron-Cohen S, Holt R. A qualitative exploration of autistic mothers' experiences I: Pregnancy experiences. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:1271-1282. [PMID: 36325726 PMCID: PMC10291382 DOI: 10.1177/13623613221132435] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Little is known about how autistic people experience pregnancy. We interviewed 24 autistic and 21 non-autistic women during pregnancy to find out about their experiences. Autistic participants had more physical difficulties, such as nausea and pain, during pregnancy than non-autistic participants. They also sometimes felt that healthcare professionals, such as midwives, did not have a good understanding of autism and they did not always feel comfortable telling professionals about their autism diagnosis. Autistic participants told us that they needed professionals to communicate with them clearly and to make changes during appointments such as dimming lights. This research shows that autistic people would benefit from changes to pregnancy appointments and that more training about autism would help maternity care professionals to support autistic people during pregnancy.
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Heyworth M, Brett S, den Houting J, Magiati I, Steward R, Urbanowicz A, Stears M, Pellicano E. "I'm the Family Ringmaster and Juggler": Autistic Parents' Experiences of Parenting During the COVID-19 Pandemic. AUTISM IN ADULTHOOD 2023; 5:24-36. [PMID: 36941857 PMCID: PMC10024268 DOI: 10.1089/aut.2021.0097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Little is known about autistic parenthood. The literature that exists suggests that autistic parents can find it difficult to manage the everyday demands of parenting and domestic life. While emerging research has also highlighted more positive parenting experiences, greater understanding of autistic parenthood is needed. Objective This study sought to understand autistic parents' parenting experiences during the initial phase of the COVID-19 pandemic. Methods Thirty-five Australian autistic parents (95% women) of autistic children (aged 4-25 years) took part in semi-structured interviews designed to elicit their experiences of life during lockdown. We used reflexive thematic analysis using an inductive (bottom-up) approach to identify patterned meanings within the data set. Results Autistic parents repeatedly spoke of how the lockdown brought some initial relief from the intensity of their usual lives caring for their children. Nevertheless, most autistic parents felt that the "cumulative stress" of trying to juggle everything during lockdown proved very challenging, which eventually took its toll on parents' mental health. Parents were aware that they needed support but found it difficult to reach out to their usual social supports (including autistic friends) for help, and formal supports were virtually nonexistent. Consequently, they felt "very much forgotten." Nevertheless, they described how their connections with their children grew stronger over lockdown as they focused on nurturing their children's "mental health ahead of everything else." Conclusions Our analysis shows how challenging conventional life can be for autistic parents. Parenting requires grappling with a distinctive set of demands, which are usually partially manageable through the informal supports many autistic parents draw upon. The relative absence of informal supports during the pandemic, however, left them reliant on more formal supports, which were not forthcoming. Research is urgently needed to identify the most effective formal supports for autistic parents, ideally in partnership with autistic parents themselves.
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Affiliation(s)
- Melanie Heyworth
- Macquarie School of Education, Macquarie University, Sydney, Australia
- Reframing Autism, Sydney, Australia
| | - Simon Brett
- Macquarie School of Education, Macquarie University, Sydney, Australia
| | - Jacquiline den Houting
- Macquarie School of Education, Macquarie University, Sydney, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Australia
| | - Iliana Magiati
- School of Psychological Science, University of Western Australia, Perth, Australia
| | | | | | - Marc Stears
- Sydney Policy Lab, University of Sydney, Sydney, Australia
| | - Elizabeth Pellicano
- Macquarie School of Education, Macquarie University, Sydney, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Australia
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Smit S, Hopper J. Love, Joy, and a Lens of Childhood Trauma: Exploring Factors That Impact the Mental Health and Well-Being of Autistic Parents via Iterative Phenomenological Analysis. AUTISM IN ADULTHOOD 2023; 5:63-75. [PMID: 36941861 PMCID: PMC10024273 DOI: 10.1089/aut.2021.0101] [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: 11/12/2022]
Abstract
Background The autistic community have called for an increase in autism research exploring the lifespan experiences of autistic people. Researchers have notably neglected the parenting experiences of autistic adults. We aimed to study the factors that impact the mental health of autistic parents. We also explored the possible influence of childhood trauma. Methods Nine autistic parents took part in remote semi-structured interviews. We used participants' chosen communication modalities during interviews to facilitate accessibility. We carried out data analysis using the principles of Iterative Phenomenological Analysis, a qualitative approach where meaning is co-constructed by both the participant's interpretation of their personal experience and the researcher's subjective interpretation. Results We identified three superordinate themes: Identity and Purpose; Looking Through a Lens of Trauma; and External Factors. Our participants described intimate connections with their children, who were sources of love and joy. Their childhood trauma influenced their parenting experiences. They experienced extreme empathy, perfectionism, and a drive to protect their children from the same trauma. We found that professionals' acceptance and awareness of autism was essential for positive outcomes during interactions with participants. Participants also experienced pervasive sensory overload from their environments, related to a loss of trusted coping mechanisms when they became parents. Conclusions Our study draws attention to the influence of childhood trauma on the parenting experience of autistic adults. We reveal an unexplored long-term impact of childhood trauma resulting from a lack of support and othering of autistic children. Professionals should consider that autistic parents may be parenting through a lens of historical trauma. Professionals should be trained in trauma-informed approaches for providing support. Researchers should investigate this phenomenon to explore how this knowledge can be used to inform practise. Researchers should also investigate wider systemic and societal issues that have an impact on the mental health of autistic parents.
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Affiliation(s)
- Simone Smit
- Department of Psychology, Manchester Metropolitan University, Manchester, United Kingdom
| | - Jeremy Hopper
- Department of Psychology, Manchester Metropolitan University, Manchester, United Kingdom
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9
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Talcer MC, Duffy O, Pedlow K. A Qualitative Exploration into the Sensory Experiences of Autistic Mothers. J Autism Dev Disord 2023; 53:834-849. [PMID: 34251566 PMCID: PMC9944021 DOI: 10.1007/s10803-021-05188-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 12/22/2022]
Abstract
Research has found 96% of autistic individuals experience sensory processing difficulties, and being a parent presents many sensory demands that may be especially challenging for autistic mothers. Despite the high prevalence, no research exists exploring the sensory experiences of autistic mothers, highlighting the gap in current knowledge. Semi-structured interviews were conducted with 7 autistic mothers, data were analysed using thematic analysis identifying 5 major themes: antenatal experiences, sensory experiences in motherhood, the impact of sensory processing difficulties, strategies and needs, diagnosis. This research provides greater insight and understanding into the sensory experiences of autistic mothers which can influence earlier diagnosis and inform appropriate support and adaptations for autistic mothers in a variety of different sectors and highlights a possible emerging role for Occupational Therapists.
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Affiliation(s)
| | - Orla Duffy
- Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, Ulster University, Shore Road, Newtownabbey, BT37 0QB, UK.
| | - Katy Pedlow
- grid.12641.300000000105519715Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, Ulster University, Shore Road, Newtownabbey , BT37 0QB UK
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10
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Eidelman AI. Challenges to the Autistic Mother Who Wishes to Breastfeed. Breastfeed Med 2022; 17:979-980. [PMID: 36475938 DOI: 10.1089/bfm.2022.29228.editorial] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Arthur I Eidelman
- -Arthur I Eidelman, MD, FABM, Editor-in-Chief, Breastfeeding Medicine
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11
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Hampton S, Allison C, Baron-Cohen S, Holt R. Autistic People's Perinatal Experiences II: A Survey of Childbirth and Postnatal Experiences. J Autism Dev Disord 2022:10.1007/s10803-022-05484-4. [PMID: 35445371 DOI: 10.1007/s10803-022-05484-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/29/2022]
Abstract
Qualitative accounts indicate there are sensory and communication related barriers to adequate childbirth and postnatal healthcare for autistic people. However, little quantitative work has explored the topic. This online survey study explored childbirth and postnatal experiences among 384 autistic and 492 non-autistic people. Compared with non-autistic people, autistic people were more likely to find the sensory aspects of birth overwhelming, and experienced lower satisfaction with birth-related and postnatal healthcare. Autistic people were more likely to experience postnatal depression and anxiety. The findings highlight that sensory and communication adjustments should be made to birth and postnatal healthcare for autistic people. The findings indicate the need for greater autism understanding among professionals and greater postnatal mental health support for autistic people.
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Affiliation(s)
- S Hampton
- Department of Psychiatry, Autism Research Centre, University of Cambridge, Cambridge, UK.
| | - C Allison
- Department of Psychiatry, Autism Research Centre, University of Cambridge, Cambridge, UK
| | - S Baron-Cohen
- Department of Psychiatry, Autism Research Centre, University of Cambridge, Cambridge, UK
| | - R Holt
- Department of Psychiatry, Autism Research Centre, University of Cambridge, Cambridge, UK
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12
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Grant A, Jones S, Williams K, Leigh J, Brown A. Autistic women's views and experiences of infant feeding: A systematic review of qualitative evidence. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1341-1352. [PMID: 35411810 PMCID: PMC9344572 DOI: 10.1177/13623613221089374] [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] [Indexed: 11/16/2022]
Abstract
Low breastfeeding rates are driven by multiple bio-psycho-social factors.
Experience of breastfeeding is known to differ by maternal demographic factors
(age, education and ethnicity) but there is less recognition of factors such as
neurodivergence. This review, prospectively registered with PROSPERO
(registration number: CRD42021271465), systematically identified qualitative
research, commentaries and personal accounts related to Autistic mothers and
infant feeding. Database searching identified 1225 records, with thematic
synthesis undertaken on 22 (eight peer-reviewed studies and 14 grey literature)
pieces. Our analysis identified that maternity and infant feeding services were
built on a lack of understanding of Autistic needs, and were often inaccessible
at a time when Autistic mothers already felt a loss of control and lack of
social support. Specifically relating to breastfeeding, knowledge and
determination were often high, and a minority of mothers reported positive
breastfeeding experiences. However, sensory challenges, pain and interoceptive
differences (exacerbated by a lack of support) made breastfeeding impossible for
some. Infant formula was viewed as second-best to breastmilk, but a minority of
mothers found the ritual of preparing bottles of formula positive. There is an
urgent need for maternity and infant feeding services to accommodate the needs
of Autistic mothers, including service design and staff training.
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Sibeoni J, Massoutier L, Valette M, Manolios E, Verneuil L, Speranza M, Revah-Levy A. The sensory experiences of autistic people: A metasynthesis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1032-1045. [PMID: 35362340 DOI: 10.1177/13623613221081188] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Sensory atypicalities are very common among autistic people and are integrated in several theories and explanatory models of autism. Qualitative studies have explored these singular sensory experiences from the perspectives of autistic people themselves. This article gathers all these qualitative studies and provides original findings regarding the everyday sensory experience of autistic people, that is, around four dimensions - physical, emotional, relational and social - experienced holistically, as inseparable, and not hierarchically or in terms of cause and effect. Adopting this holistic view could improve the adaptation of the sensory environment in health care facilities and the training of professionals around this specific issue.
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Affiliation(s)
- Jordan Sibeoni
- Argenteuil Hospital Centre, France.,Université de Paris, France
| | - Laura Massoutier
- Université de Paris, France.,Centre Hospitalier de Gonesse, France
| | | | - Emilie Manolios
- Université de Paris, France.,Hôpital Européen Georges Pompidou, France
| | - Laurence Verneuil
- Université de Paris, France.,GHU Paris Psychiatrie & Neurosciences, France
| | - Mario Speranza
- Centre Hospitalier de Versailles, France.,Université Paris-Saclay, France
| | - Anne Revah-Levy
- Argenteuil Hospital Centre, France.,Université de Paris, France
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Hampton S, Allison C, Aydin E, Baron-Cohen S, Holt R. Autistic mothers' perinatal well-being and parenting styles. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1805-1820. [PMID: 35105233 PMCID: PMC9483197 DOI: 10.1177/13623613211065544] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Autistic people may be at higher risk of perinatal mental health conditions, given that autism and mental health conditions commonly co-occur and that autistic people face additional stressors such as barriers to appropriate maternity care. This study explored self-reported stress, depression, anxiety and satisfaction with life during the third trimester of pregnancy (n = 27 autistic women; n = 25 non-autistic women), 2 to 3 months after birth (n = 24 autistic women; n = 26 non-autistic women) and 6 months after birth (n = 22 autistic women; n = 29 non-autistic women). Self-reported parenting confidence and parenting styles were explored at 6 months after birth. Autistic participants scored significantly higher than non-autistic participants on stress, depression and anxiety across the time-points as a whole, although there were no group differences for satisfaction with life. Anxiety scores significantly decreased over time for both groups. No group differences were found for parenting confidence nor parenting anxiety, nurturance, involvement or routine, although the autistic group scored lower on parenting discipline. The findings highlight the need for effective screening and support for perinatal mental health conditions for autistic people. Professionals working with autistic parents should be aware that autistic and non-autistic parents report being equally likely to engage in positive parenting behaviours such as nurturance and involvement.
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Hidalgo PM, Martínez MM, González AG, Petisco LG, Forcadell CA, D'Agostino CI, de la Varga LP. Self-Perceived Quality of Life in Spanish-Speaking Women with Autism Spectrum Disorders. J Autism Dev Disord 2021; 52:5428-5439. [PMID: 34953140 PMCID: PMC9637056 DOI: 10.1007/s10803-021-05400-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 12/03/2022]
Abstract
Perceived personal wellbeing tends to be lower in individuals with autism spectrum disorders (ASD), especially in the case of women. To develop the present study, the Personal Wellbeing Index (PWI-A) was administered to a Spanish-speaking sample of women with ASD (N = 401) and self-diagnosed ASD (N = 343), women without ASD (N = 373) and men with ASD (N = 65) to compare their self-perceptions. Women with ASD showed significantly lower wellbeing rates than women in the control group for the total PWI-A and across all the domains, and there were no significant differences when compared with self-diagnosed women with ASD and men with ASD. Autism explained between 24 and 26% of the decline in the PWI-A total score, with life achievement, future security, safety and relationships being the domains most highly correlated with the total. These findings are an effective contribution to improving diagnosis and professional intervention in women with ASD.
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Affiliation(s)
- Paula Morales Hidalgo
- Research Group on Nutrition and Mental Health (NUTRISAM), Research Center for Behavioral Assessment (CRAMC), Department of Psychology, University Rovira i Virgili, Tarragona, Spain.
- Asperger- ASD Association of Camp de Tarragona, Tarragona, Spain.
- Spanish Association of Autism Professionals (AETAPI), Cadiz, Spain.
| | - María Merino Martínez
- Science of Education Department, Specific Didactics Department, Universidad de Burgos, Burgos, Spain
- Burgos Autism Association, Burgos, Spain
- Spanish Association of Autism Professionals (AETAPI), Cadiz, Spain
| | - Angélica Gutiérrez González
- Department of Social Anthropology, Basic Psychology Public Health, Universidad Pablo de Olavide, Sevilla, Spain
- Sevilla Autism Association, Sevilla, Spain
- Spanish Association of Autism Professionals (AETAPI), Cadiz, Spain
| | - Lola Garrote Petisco
- Centro de Evaluación, Diagnóstico e Intervención (CEDIN), Valencia, Spain
- Spanish Association of Autism Professionals (AETAPI), Cadiz, Spain
| | - Carol Amat Forcadell
- Maresme Health Consortium, Mataró Hospital, Mataró, Spain
- Gabinet d'Especialitats Mèdiques Associades Mataró (GEMASI), Mataró, Spain
- Spanish Association of Autism Professionals (AETAPI), Cadiz, Spain
| | - Cynthia I D'Agostino
- Department of Psychology and Pedagogical Sciences, Universidad CAECE, Buenos Aires, Argentina
- Pediatrics Service, Hospital de Clinicas José T. San Martín, Buenos Aires, Argentina
- Spanish Association of Autism Professionals (AETAPI), Cadiz, Spain
| | - Laura Pérez de la Varga
- Science of Education Department, Universidad de Burgos, Burgos, Spain
- Spanish Association of Autism Professionals (AETAPI), Cadiz, Spain
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Khan M, Brown HK, Lunsky Y, Welsh K, Havercamp SM, Proulx L, Tarasoff LA. A Socio-Ecological Approach to Understanding the Perinatal Care Experiences of People with Intellectual and/or Developmental Disabilities in Ontario, Canada. Womens Health Issues 2021; 31:550-559. [PMID: 34556400 PMCID: PMC8595790 DOI: 10.1016/j.whi.2021.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Accessible and quality care during the perinatal period is critical for optimal maternal and neonatal health. Using the socio-ecological model, the purpose of this study was to explore barriers and facilitators that shape the perinatal care experiences of people with intellectual and/or developmental disabilities (IDD). METHODS Semi-structured interviews were conducted with 10 individuals with IDD in Ontario, Canada, who had given birth within the past 5 years. Interviews focused on care experiences before, during, and after pregnancy. Data were analyzed using a directed content analysis approach, and the socio-ecological model guided analysis. RESULTS Barriers at the societal (e.g., cultural norms of motherhood), policy/institutional (e.g., child protection policies and practices), interpersonal (e.g., inadequate formal and informal support), and intrapersonal levels (e.g., internalized stigma) contributed to participants having negative perinatal care experiences. Conversely, we identified facilitators on the interpersonal level (e.g., positive interactions with perinatal care providers and familial and social service supports) as positively shaping participants' perinatal care experiences. CONCLUSIONS Findings reveal that the perinatal care experiences of people with IDD are shaped by several interrelated factors that largely stem from societal-level barriers, such as dominant (stigmatizing) discourses of disability. To improve the perinatal care experiences of people with IDD, there is a need for interventions at multiple levels. These include the development of policies to support perinatal care for diverse populations and training care providers to enact policies at the institutional and interpersonal levels.
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Affiliation(s)
- Momina Khan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hilary K Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada.
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kate Welsh
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | | | - Laurie Proulx
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Lesley A Tarasoff
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada; Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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17
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Lewis LF, Schirling H, Beaudoin E, Scheibner H, Cestrone A. Exploring the Birth Stories of Women on the Autism Spectrum. J Obstet Gynecol Neonatal Nurs 2021; 50:679-690. [PMID: 34543606 DOI: 10.1016/j.jogn.2021.08.099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore birth stories of autistic women to understand how they make sense of the experience of childbirth. DESIGN Narrative analysis. SETTING Online interviews. PARTICIPANTS Sixteen women on the autism spectrum shared 19 birth stories. METHODS Participants were recruited from online autism forums and were invited to share their birth stories via online asynchronous interviews. Using Burke's approach to narrative analysis, we identified five elements within each story, including Scene (when/where), Agents (who), Act (what), Agency (how), and Purpose (why). We explored parts of the narratives where two or more elements were out of balance with each other. RESULTS Tension most often occurred when actions taken by the health care team (Act) were out of balance with their approach to care (Agency), which left participants feeling that their concerns were minimized, their wishes were ignored, and they were left out of critical communication and education. Participants also struggled when their own autistic traits (Agent), such as sensory sensitivities, were out of balance with the birth environment (Scene), which impaired their ability to communicate with providers and participate in the birth. CONCLUSION Poor communication, untreated pain, and sensory overload dominated the birth narratives of participants. Nurses should trust women's reports of pain and anxiety because autistic women may appear calm even when in severe distress. Environmental adjustments, such as dimming the lights, can help minimize sensory overload. Nurses need to provide thorough and nonjudgmental education about the birth process to ensure that autistic women feel safe and in control and do not withdraw from care.
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18
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Hampton S, Man J, Allison C, Aydin E, Baron-Cohen S, Holt R. A qualitative exploration of autistic mothers' experiences II: Childbirth and postnatal experiences. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:1165-1175. [PMID: 34482747 PMCID: PMC9340136 DOI: 10.1177/13623613211043701] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Very little research has looked at how autistic people experience childbirth and the first few months of parenthood. We interviewed 21 autistic and 25 non-autistic women 2-3 months after their baby was born, to find out how they experienced giving birth and being a parent. Some autistic participants found sensory aspects of giving birth difficult, such as noise and being touched. They also wanted healthcare professionals to give them clear information while giving birth. Participants sometimes thought that healthcare professionals did not know enough about autism. Autistic and non-autistic participants both found parenthood difficult at times and autistic parents sometimes had extra difficulties, such as with planning and organising. Autistic participants also felt good at understanding their baby's needs. This research suggests that autistic people would benefit from changes to childbirth and postnatal healthcare such as being communicated with more clearly. It also indicates that healthcare professionals should receive more training about autism.
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Mo S, Viljoen N, Sharma S. The impact of socio-cultural values on autistic women: An interpretative phenomenological analysis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:951-962. [PMID: 34388943 PMCID: PMC9014764 DOI: 10.1177/13623613211037896] [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] [Indexed: 11/24/2022]
Abstract
It is well recognised that culture plays an important role in how people
experience the world. However, there is limited knowledge on the
impact of socio-cultural norms and values on the lives of autistic
women. This qualitative study used individual semi-structured
interviews to explore how eight cis-gendered autistic women, without
co-occurring intellectual disabilities, describe dominant
socio-cultural beliefs, values and norms and their influence on their
own sense of self. Findings elucidated three interdependent themes
related to the ‘pervasive influence of cultural values’,
‘individualisation as an autistic woman’ and ‘social connectivity’.
Autistic women described how they experienced their environments and
made choices about their place within the dominant culture and the
impact of these decisions on their identities and experience. The
findings of this study have implications for the continued need to
shift societal and clinical attitudes towards understanding and
appreciating diversity among autistic women.
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Affiliation(s)
| | - Nina Viljoen
- Hertfordshire Partnership University NHS Foundation Trust, UK
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20
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Samuel P, Yew RY, Hooley M, Hickey M, Stokes MA. Sensory challenges experienced by autistic women during pregnancy and childbirth: a systematic review. Arch Gynecol Obstet 2021; 305:299-311. [PMID: 34085111 DOI: 10.1007/s00404-021-06109-4] [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] [Received: 09/09/2020] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this systematic review was to identify challenges faced by autistic women during pregnancy and birth due to sensory issues or other features of Autism Spectrum Disorder. METHODS A systematic search of literature was conducted using Medline, PubMed, Embase, PsycINFO, CINAHL, MIDIRS, ProQuest Dissertations and Theses Global, and Open Access Theses and Dissertations. Eligible studies addressed autistic women's pregnancy or birth experiences, and were assessed for methodological quality. RESULTS The search generated 2656 results, with six meeting inclusion criteria. Data from 427 autistic participants were extracted from four qualitative and two quantitative studies for synthesis. CONCLUSION We found that the literature was exploratory and lacked focussed research questions addressing sensory issues in pregnancy. Sensory challenges were, however, identified as a key finding in all qualitative studies. Other challenges faced by autistic women during pregnancy and birth included communication issues in healthcare settings and lack of appropriate information and supports for pregnancy and birth. Implications for health professionals and challenges associated with research in this area are discussed.
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Affiliation(s)
- Priscilla Samuel
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap St., Geelong, VIC, 3220, Australia
| | - Rui Ying Yew
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap St., Geelong, VIC, 3220, Australia
| | - Merrilyn Hooley
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap St., Geelong, VIC, 3220, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
| | - Mark A Stokes
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap St., Geelong, VIC, 3220, Australia. .,School of Psychology, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
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21
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Tint A, Brown HK, Chen S, Lai MC, Tarasoff LA, Vigod SN, Parish S, Havercamp SM, Lunsky Y. Health characteristics of reproductive-aged autistic women in Ontario: A population-based, cross-sectional study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:1114-1124. [PMID: 33467914 PMCID: PMC8089036 DOI: 10.1177/1362361320982819] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT While an increasing number of girls and women are being identified with autism, we know little about reproductive-aged autistic women's health. This study used administrative data from Ontario, Canada, to compare the health of reproductive-aged autistic women with non-autistic women. Overall, reproductive-aged autistic women had poorer health compared with non-autistic women, including increased rates of material deprivation, chronic medical conditions, psychiatric conditions, history of assault, and use of potentially teratogenic medications (i.e. drugs that can be harmful to the development of an embryo or fetus). These findings suggest that there is a need for health interventions tailored to the needs of reproductive-aged autistic women.
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Affiliation(s)
- Ami Tint
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
| | - Hilary K. Brown
- Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Women’s College Hospital and Research Institute, Toronto, Ontario, Canada
| | | | - Meng-Chuan Lai
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
- The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
- Centre for Brain and Mental Health and Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada
- Department of Psychology, University of Toronto, Toronto, Canada
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Lesley A. Tarasoff
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
- Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
| | - Simone N. Vigod
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Women’s College Hospital and Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Susan Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
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22
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McDonnell CG, DeLucia EA. Pregnancy and Parenthood Among Autistic Adults: Implications for Advancing Maternal Health and Parental Well-Being. AUTISM IN ADULTHOOD 2021; 3:100-115. [PMID: 36601267 PMCID: PMC8992883 DOI: 10.1089/aut.2020.0046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Strikingly little research has considered how autistic adults experience pregnancy and parenthood, two key transition periods in adult development with potentially far-reaching implications for physical and psychosocial health outcomes across the lifespan. This article reviews the research on pregnancy and parenthood among autistic adults, to summarize existing research and identify future directions to advance this critical area of study. Methods We conducted a systematic review of the literature on pregnancy and parenthood among autistic adults. Researchers extracted selected articles for key information, including methodology and sample size, study location, demographic characteristics of participants, measurement approaches, and key study findings. Results Overall, we identified 13 studies that used a range of quantitative and qualitative approaches to study pregnancy experiences and outcomes and parenthood among autistic adults. The findings show that autistic adults (1) experience difficulties and dissatisfaction communicating with health care providers throughout pregnancy and birth, (2) are more likely to experience depression during and after pregnancy, and (3) experience higher rates of pregnancy complications, including preterm birth, cesarean delivery, and pre-eclampsia. During parenthood, autistic adults report lower parenting competence, experience parenthood as isolating, have difficulty communicating with professionals about their child and are questioned by providers about their ability to parent, experience high rates of involvement with child protective services, and express a desire for increased parenting support. Autistic adults also reported parenting strengths, including high levels of finding parenthood rewarding and putting their children's needs ahead of their own. Conclusions A key limitation of the literature is the significant lack of sociodemographic diversity among participants, the small number of existing studies, and reliance on cross-sectional mono-method designs. Future research should be conducted in partnership with autistic adults to develop assessment and intervention approaches for supporting pregnancy health and parental well-being among diverse and underserved communities. Lay summary Why is this topic important?: Very little is known about how autistic adults experience pregnancy and parenthood. Better understanding these experiences is important, because pregnancy and parenthood are key transition periods in adult development that are associated with a range of health outcomes later in life.What is the purpose of this article?: This article reviews the existing research on pregnancy and parenthood among autistic adults. We wanted to summarize what is already known, evaluate how that knowledge was created, and consider who has and who has not been included in this research to inform future research. We summarized 13 studies that considered pregnancy or parenthood among autistic adults.What did the authors find about pregnancy among autistic adults?: One study used data from hospital and birth records in Sweden, and showed that autistic women experience higher rates of pregnancy complications, such as preterm birth (early delivery before 37 weeks), cesarean delivery, and pre-eclampsia (a condition defined by high blood pressure during pregnancy). Two studies had autistic and nonautistic adults fill out online surveys about their experiences, and found that autistic adults are more likely to have depression during and after pregnancy, have more difficulty interacting with health care professionals at pregnancy appointments and during the birth process, and feel that information and support services for pregnancy do not always meet their needs. Autistic women also reported that sensory differences can make health care visits during pregnancy especially difficult, and described that they may experience anxiety and confusion when interacting with health care staff.What did the authors find about parenthood among autistic adults?: The research we reviewed showed that autistic adults experience strengths and difficulties in parenting. Many autistic adults found parenthood rewarding, but also felt isolated as parents and had difficulty communicating with health care professionals about their children. Autistic adults also had high rates of interacting with child protective services (CPS). Some research also found that autistic adults had lower self-confidence in parenting, although findings are mixed.What are the recommendations for future research and practice?: We need to develop support strategies to promote pregnancy health and parenting satisfaction in partnership with autistic adults. For example, it may be helpful to develop communication tools that can support autistic adults during pregnancy, labor, and birth. We also recommend that future research develop questionnaires to ask autistic adults about their pregnancy and parenting experiences in sensitive ways, so that in the future providers can regularly ask autistic adults about their support needs. Most importantly, it is critical that future research also include more diverse autistic participants in their research, including racial/ethnic and sexual and gender minorities.How will these findings help autistic adults now or in the future?: We hope that this article will help guide future research that strives to better understand how autistic adults experience pregnancy and parenthood. Ultimately, we believe this research can lead to supports and intervention strategies that can improve pregnancy health and parental well-being for autistic adults.
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Affiliation(s)
- Christina G. McDonnell
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA.,Address correspondence to: Christina G. McDonnell, PhD, Department of Psychology, Virginia Polytechnic Institute and State University, Williams Hall, Virginia Tech, Blacksburg, VA 24061, USA
| | - Elizabeth A. DeLucia
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
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23
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Dubreucq M, Dubreucq J. Toward a Gender-Sensitive Approach of Psychiatric Rehabilitation in Autism Spectrum Disorder (ASD): A Systematic Review of Women Needs in the Domains of Romantic Relationships and Reproductive Health. Front Psychiatry 2021; 12:630029. [PMID: 33995144 PMCID: PMC8113637 DOI: 10.3389/fpsyt.2021.630029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/15/2021] [Indexed: 01/18/2023] Open
Abstract
Later age of diagnosis, better expressive behaviors, increased use of camouflage strategies but also increased psychiatric symptoms, more unmet needs, and a general lower quality of life are characteristics often associated with female gender in autism spectrum disorder (ASD). Psychiatric rehabilitation has shown small to moderate effectiveness in improving patients' outcomes in ASD. Few gender differences have been found in the response to psychiatric rehabilitation. This might be related to the predominance of males in research samples, but also to the lack of programs directly addressing women's unmet needs. The objectives of the present paper were: (i) to review the needs for care of autistic women in romantic relationships and reproductive health; (ii) to review the existing psychosocial treatments in these domains; and (iii) to evaluate the strengths and limitations of the current body of evidence to guide future research. A systematic electronic database search (PubMed and PsycINFO), following PRISMA guidelines, was conducted on autistic women's needs for care relating to psychiatric rehabilitation in romantic relationships and reproductive health. Out of 27 articles, 22 reported on romantic relationships and 16 used a quantitative design. Most studies were cross-sectional (n = 21) and conducted in North America or Europe. Eight studies reported on interventions addressing romantic relationships; no published study reported on interventions on reproductive health or parenting. Most interventions did not include gender-sensitive content (i.e., gender variance and gender-related social norms, roles, and expectations). Autistic women and autistic gender-diverse individuals may face unique challenges in the domains of romantic relationships and reproductive health (high levels of stigma, high risk of sexual abuse, increased psychiatric symptoms, and more unmet needs). We discussed the potential implications for improving women's access to psychiatric and psychosocial treatment, for designing gender-sensitive recovery-oriented interventions, and for future research.
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Affiliation(s)
- Marine Dubreucq
- Centre référent de réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France.,Fondation FondaMental, Créteil, France
| | - Julien Dubreucq
- Centre référent de réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France.,Fondation FondaMental, Créteil, France.,Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, Lyon, France.,Réseau Handicap Psychique, Grenoble, France
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24
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Childbirth Experiences of Women With Autism Spectrum Disorder in an Acute Care Setting. Nurs Womens Health 2020; 24:165-174. [PMID: 32389581 DOI: 10.1016/j.nwh.2020.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/26/2020] [Accepted: 03/01/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the childbirth experiences of women with autism spectrum disorder. DESIGN Qualitative interpretive description design and data analysis using Knafl and Webster. SETTING Women were interviewed in the environment of their choosing: in the home, over the telephone, or via Skype or Facebook Messenger. PARTICIPANTS Twenty-four women ages 29 to 65 years from the United States, United Kingdom, and Australia, all of whom gave birth to healthy newborns in an acute care setting. METHOD Interviews were conducted using a semistructured interview guide. RESULTS Three main themes emerged from the data: Having Difficulty Communicating, Feeling Stressed in an Uncertain Environment, and Being an Autistic Mother. Each of these themes also included several subthemes. CONCLUSION Study participants expressed difficulty communicating with nurses in a variety of ways. The degree of difficulty in communication varied among participants. Problems in communication included trouble conveying needs, alerting nurses when they felt ill, or not understanding what was said to them. Ineffective communication with nurses resulted in feelings of anxiety and being scared and inhibited participants in further attempts at communication. Nurses caring for women with ASD through the childbirth period should be aware that communication needs will vary for each woman, and interventions to facilitate safe and effective communication in labor should be individualized to each woman.
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25
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Pohl AL, Crockford SK, Blakemore M, Allison C, Baron-Cohen S. A comparative study of autistic and non-autistic women's experience of motherhood. Mol Autism 2020; 11:3. [PMID: 31911826 PMCID: PMC6945630 DOI: 10.1186/s13229-019-0304-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 12/09/2019] [Indexed: 12/22/2022] Open
Abstract
Background Autism is a lifelong neurodevelopmental difference and disability, yet there is limited research examining parenting in autistic mothers. Objective To explore autistic mothers' experience of the perinatal period and parenthood. This includes pregnancy, childbirth, the postpartum period, self-perception of parenting strengths and weaknesses, communication with professionals in relation to one's child, mental health difficulties and the social experience of motherhood. It also includes disclosing one's diagnosis of autism in parenting contexts. Methods We used a community-based participatory research model, and recruited an advisory panel, with whom we co-developed an anonymous, online survey for autistic mothers. The online survey was completed by autistic and non-autistic mothers, and we compared their responses using Chi-squared analysis. Sample Autistic mothers (n = 355), and non-autistic mothers (n = 132), each of whom had at least one autistic child, were included in our final analysis. Results There were differences in education, gender identity and age of mother at birth of first child. Autistic mothers were more likely to have experienced additional psychiatric conditions, including pre- or post-partum depression, and reported greater difficulties in areas such as multi-tasking, coping with domestic responsibilities and creating social opportunities for their child. They were also more likely to report feeling misunderstood by professionals, and reported greater anxiety, higher rates of selective mutism, and not knowing which details were appropriate to share with professionals. They were also more likely to find motherhood an isolating experience, to worry about others judging their parenting, or feel unable to turn to others for support in parenting. However, despite these challenges, autistic mothers were able to act in the best interest of their child, putting their child's needs first. Conclusions Autistic mothers face unique challenges and the stigma associated with autism may further exacerbate communication difficulties. Greater understanding and acceptance amongst individuals who interact with autistic mothers is needed, and autistic mothers would benefit from additional and better-tailored support.
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Affiliation(s)
- A L Pohl
- 1Autism Research Centre, Department of Psychiatry, Cambridge University, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH UK
| | - S K Crockford
- 1Autism Research Centre, Department of Psychiatry, Cambridge University, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH UK
| | - M Blakemore
- Autism Asperger Advocacy Australia (A4), Sydney, Australia
| | - C Allison
- 1Autism Research Centre, Department of Psychiatry, Cambridge University, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH UK
| | - S Baron-Cohen
- 1Autism Research Centre, Department of Psychiatry, Cambridge University, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH UK
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Sundelin HE, Stephansson O, Hultman CM, Ludvigsson JF. Pregnancy outcomes in women with autism: a nationwide population-based cohort study. Clin Epidemiol 2018; 10:1817-1826. [PMID: 30555264 PMCID: PMC6280895 DOI: 10.2147/clep.s176910] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background The consequences of autism in pregnancy outcomes have not been explored before, although it is of crucial importance because of the frequent comorbidities and medication in this group of women. Objectives To estimate the risk of adverse pregnancy outcomes in women diagnosed with autism. Design Nationwide population-based cohort study. Setting Sweden. Participants Singleton births identified in the Swedish Medical Birth Registry, 2006–2014. A total of 2,198 births to women diagnosed with autism registered in the Swedish National Patient Registry were compared to 877,742 singleton births to women without such a diagnosis. Main outcome and measures Preterm delivery. Secondary measures were cesarean delivery (emergency and elective), Apgar score <7 at 5 minutes, small for gestational age, large for gestational age, stillbirth, gestational diabetes, and preeclampsia. ORs were calculated through logistic regression, adjusted for maternal age at delivery, maternal country of birth, smoking, maternal body mass index, parity, calendar year of birth, and psychotropic and antiepileptic medication during pregnancy. Results Women with autism were at increased risk of preterm birth (OR=1.30; 95% CI=1.10–1.54), especially medically indicated preterm birth (OR=1.41; 95% CI=1.08–1.82), but not with spontaneous preterm birth. Maternal autism was also associated with an increased risk of elective cesarean delivery (OR=1.44; 95% CI=1.25–1.66) and preeclampsia (OR=1.34; 95% CI=1.08–1.66), but not with emergency cesarean delivery, low Apgar score (<7), large for gestational age, gestational diabetes, and stillbirth. In women with medication during pregnancy, there was no increased risk of adverse pregnancy outcome except for induction of delivery (OR=1.33; 95% CI=1.14–1.55). Conclusion and relevance Maternal autism is associated with preterm birth, likely due to an increased frequency of medically indicated preterm births, but also with other adverse pregnancy outcomes, suggesting a need for extra surveillance during prenatal care.
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Affiliation(s)
- Heléne Ek Sundelin
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden, .,Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden,
| | - Olof Stephansson
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska University Hospital and Institutet, Stockholm, Sweden.,Department of epidemiology and biostatistics, School of Public Health, University of California, Berkeley, CA, USA
| | - Christina M Hultman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Icahn School of Medicine at Mt Sinai, New York, NY, USA
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
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