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Westby C, Chen KM, Cheng L, Jithavech P, Maroonroge S. Autism in Taiwan and Thailand: Influences of Culture. Neuropsychiatr Dis Treat 2024; 20:1523-1538. [PMID: 39113831 PMCID: PMC11303671 DOI: 10.2147/ndt.s462864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 07/11/2024] [Indexed: 08/10/2024] Open
Abstract
The prevalence of autism is increasing worldwide. The majority of autism research and development of autism assessments and interventions has been conducted in Western cultures. The prevalence of autism is reportedly lower in Asian versus Western cultures, but this is likely due to lack of personnel and uniform criteria for diagnosing autism. This article describes how two Asian cultures, Taiwan and Thailand, are dealing with the increasing identification of autistic children. National universal healthcare in both Taiwan and Thailand provides a mechanism for assessment and diagnosis of young children, but a lack of a sufficient number of trained professionals limits the availability of intervention services. A focus of research in these cultures has been on parents' experiences and coping with the stigma and stress of having an autistic child. Cultural values associated with Confucianism and Buddhism influence attitudes toward persons with disability and how parents of autistic children experience and cope with stigma and stress. Both areas have national laws that provide a range of educational opportunities for autistic children, including inclusion into general education classrooms. Special education and general education teachers, however, have little specific training in autism. Speech and language services are rarely offered in public school programs. Available speech and language services are limited to consultation with teachers a few times a year. In general, parents of autistic children are supportive of inclusion programs, but teachers and parents of both autistic and typically developing children express concerns about the ability to implement such programs in ways that are beneficial to all children.
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Affiliation(s)
- Carol Westby
- Bilingual Multicultural Services, Albuquerque, NM, USA
| | - Kai-Mei Chen
- Muen Speech-Language Clinic, Taichung City, Taiwan
| | - Lilly Cheng
- Chinese Cultural Center, San Diego State University, San Diego, CA, USA
| | - Ponjit Jithavech
- Department of Communication Sciences and Disorders, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sumalai Maroonroge
- Communication Sciences and Disorders, Texas A&M International University, Laredo, TX, USA
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Chen YWR, Ng DY, Tseng MH, Bundy A, Cordier R. The impact of coping behaviors on perceived competence and social anxiety in the everyday social engagement of autistic adolescents. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1268-1279. [PMID: 37776008 DOI: 10.1177/13623613231196773] [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: 10/01/2023]
Abstract
LAY ABSTRACT Individuals who cope well with challenges may engage in social situations more successfully. We examined how well autistic adolescents coped, depending on how competent they felt and how much anxiety they experienced during social activities. We included 133 individuals (82 autistic, 51 neurotypical) between the ages of 10 and 16 years. Participants carried a mobile device that prompted them seven times a day for 7 days to record what they were doing, how competent they felt and how much anxiety they experienced. We used the Coping Inventory to understand how well participants coped with environmental challenges and met their needs for growth. Autistic adolescents were more likely than neurotypical peers to feel anxious while doing activities with adults. Autistic adolescents who had more difficulty coping with challenges were more likely to feel anxious when doing leisure activities with peers. Interestingly, autistic adolescents who coped better with challenges tended to feel less competent in social situations. However, those better able to meet their needs for growth tended to perceive their social competence positively. These findings can help practitioners develop strategies and programs to reduce the negative social experiences of autistic adolescents by helping them cope better.
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Affiliation(s)
| | | | - Mei-Hui Tseng
- National Taiwan University, Taiwan
- National Taiwan University Hospital, Taiwan
| | | | - Reinie Cordier
- Northumbria University, UK
- Curtin University, Australia
- University of Cape Town, South Africa
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Chin WC, Chang HL, Chao KY. Exploring Coping Strategies of Parents of Children With Autism Spectrum Disorder in Taiwan: A Qualitative Study. J Nurs Res 2023; 31:e278. [PMID: 37097915 DOI: 10.1097/jnr.0000000000000553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Children with autism spectrum disorder (ASD) experience impairments in their social interactions, language communication, and stereotypical patterns of behavior. Parents of children with ASD experience higher levels of stress and more depression and anxiety than parents of children with other disabilities or typically developing children. Parents of children with disabilities develop coping strategies to counteract the stresses associated with raising a child with special needs. Understanding coping strategies to help counteract the stresses associated with parenting a child with ASD may enhance well-being in parents of children with ASD, improve the quality of care provided to these children, and foster better parent-child relationships. PURPOSE The purpose of this study was to explore the coping strategies used by parents in Taiwan parenting a child with ASD. METHODS In this descriptive qualitative study, thematic analysis was conducted on data collected during face-to-face interviews. Fourteen parents of children with ASD were recruited using purposive sampling. Researchers employed a teamwork approach for data analysis to increase the dependability and consistency of the transcribed interviews. Team members discussed coding and identified the themes collaboratively. RESULTS Taiwanese parents of children with ASD coped with the psychological impacts of parenting by employing problem-focused and emotion-focused strategies. Problem-focused strategies included communication, support, and management, whereas emotion-focused strategies included acceptance and adaptation. Findings showed that both coping strategies were useful in addressing specific situations and circumstances. Social and clinical support improved parents' mental health and children's external behaviors. CONCLUSIONS/IMPLICATION FOR PRACTICE Healthcare providers should evaluate how parents are coping with the stresses related to raising a child with ASD and consider the cultural factors that might influence how they accept and adapt to parenting children with ASD. Understanding these variables may be used to tailor strategies appropriate to reducing stress and improving the well-being of parents and their children. Support and resource referrals should be considered, including parent support groups, books, web-based services, and recommendations for professional consultations with social workers or therapists.
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Affiliation(s)
- Wei-Chih Chin
- MD, Attending Physician, and Assistant Professor, Department of Child Psychiatry and Sleep Center, Linkou Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsueh-Ling Chang
- MD, Attending Physician, and Assistant Professor, Neo-psych Clinic, Taipei, Taiwan
| | - Kuo-Yu Chao
- PhD, RN, Associate Professor, Department of Nursing, Chang Gung University of Science and Technology, and Division of Colon and Rectal Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Wang F, Memis I, Durocher JS, Furar E, Cavalcante L, Eshraghi RS, Samson AC, Van Herwegen J, Dukes D, Alessandri M, Mittal R, Eshraghi AA. Efficacy of coping mechanisms used during COVID-19 as reported by parents of children with autism. PLoS One 2023; 18:e0283494. [PMID: 37053138 PMCID: PMC10101447 DOI: 10.1371/journal.pone.0283494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 03/11/2023] [Indexed: 04/14/2023] Open
Abstract
The COVID-19 pandemic's alterations to daily life have been especially challenging for families with Autism Spectrum Disorder (ASD), worsening the core features of ASD and overall mental health. With the increased need for effective coping, the current retrospective study used data from a survey regarding parent reports of how often their child with ASD used certain coping strategies (frequency), as well as the extent to which they felt their child benefitted from their use (efficacy) in mitigating stress during the pandemic. This retrospective study Repeated measures ANOVAs were conducted to evaluate whether there were significant differences in both frequency and efficacy ratings for each coping strategy, for the entire sample as well as for three children's age groups. Using Spearman's rank-order correlations, correlation coefficients between the frequency and efficacy of each coping strategy were explored. Results revealed that maladaptive strategies were used more frequently than adaptive strategies, while parent routine as the most frequently used and efficacious for all age groups. Additionally, for adaptive strategies, humor and focusing on the positive had the strongest correlations between frequency and efficacy ratings amongst all age groups. Of the maladaptive strategies, repetitive behaviors, rumination, and isolation had the strongest correlations for the youngest, middle, and oldest age groups, respectively. Further, for each age group, the adaptive coping strategies had stronger correlations between frequency and efficacy than the maladaptive ones. It is our hope that the results of this study will lay the foundation for developing adaptive coping strategies to alleviate stress in children with ASD. Further investigations using a larger cohort are warranted to determine effective coping strategies for individuals with ASD across a range of situations, including acute stressors (such as future public health emergencies and natural disasters), as well as common daily stressors.
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Affiliation(s)
- Florence Wang
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Idil Memis
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Jennifer S. Durocher
- Department of Psychology, University of Miami, Coral Gables, Florida, United States of America
| | - Emily Furar
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Leylane Cavalcante
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Rebecca S. Eshraghi
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Andrea C. Samson
- Institute of Special Education, University of Fribourg, Fribourg, Switzerland
- Faculty of Psychology, Unidistance Suisse, Brig, Switzerland
| | - Jo Van Herwegen
- Department of Psychology and Human Development, UCL, Institute of Education, University College London, London, United Kingdom
| | - Daniel Dukes
- Institute of Special Education, University of Fribourg, Fribourg, Switzerland
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Michael Alessandri
- Department of Psychology, University of Miami, Coral Gables, Florida, United States of America
| | - Rahul Mittal
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Adrien A. Eshraghi
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
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Stress, Coping, and Resiliency Among Families of Individuals with Autism: a Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00245-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hilton CL, Ratcliff K, Collins DM, Flanagan J, Hong I. Flourishing in children with autism spectrum disorders. Autism Res 2019; 12:952-966. [PMID: 30912315 PMCID: PMC6684035 DOI: 10.1002/aur.2097] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 03/01/2019] [Accepted: 03/06/2019] [Indexed: 01/01/2023]
Abstract
Flourishing is an indicator of positive mental health and is important for children's development and well-being. We used variables from the National Survey of Children's Health 2016 as indicators of flourishing (difficulty making friends, is bullied, bullies others, shares ideas with family, argues, finishes tasks, does all homework, shows curiosity, stays calm, and cares about doing well in school) to compare differences in parent perceptions of their children with and without autism spectrum disorder (ASD). We anticipate that these findings will help identify intervention targets to support the well-being of individuals with ASD. Children between 6 and 17 years of age, without intellectual disability, brain injury, cerebral palsy, or Down syndrome were included. Total participants were 34,171 controls (male/female = 17,116/17,155) and 812 with ASD (male/female = 668/144). Factor analysis resulted in three-factor structures (social competence, behavioral control, and school motivation) with good model fit (root mean square error of approximation = 0.08, comparative fit index = 0.92, Tucker-Lewis index = 0.89). The multivariate regression model and propensity score with inverse probability of treatment weighting (PS-IPTW) method revealed that children with ASD had lower scores in the social competence and behavioral control factors compared to the control group (all P < 0.05). However, no significant differences were found in the school motivation factor between the two groups (P > 0.05) in both multivariate regression model and PS-IPTW method. Findings suggest that social competence and behavioral control are indicators of flourishing and are important intervention targets to increase flourishing among children with ASD. Autism Res 2019, 12: 952-966. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Flourishing is an indicator of positive mental health and is important for children's development and well-being. We used variables from The National Survey of Children's Health 2016 to examine differences in parent perceptions of the indicators of flourishing (difficulty making friends, is bullied, bullies others, shares ideas with family, argues, finishes tasks, does all homework, shows curiosity, stays calm, and cares about doing well in school) between children with and without autism spectrum disorders (ASD). We anticipate that this information will help to identify therapeutic targets to support the well-being of individuals with ASD. Children between 6 and 17 years old, without intellectual disability (ID), brain injury (BI), cerebral palsy (CP), or Down syndrome (DS) were included. From the total (N = 50,212), we excluded children under age 6 (n = 14,494), those who once, but do not currently have ASD (n = 81), and those with ID (n = 432), BI (n = 170), CP (n = 35), and DS (n = 17), resulting in 34,983 records used. Total participants, age 6-17 years, were 34,171 controls (male/female = 17,116/17,155) and 812 with ASD (male/female = 668/144). Factor analysis resulted in the identification of three flourishing categories among the indicator variables (social competence, behavioral control, and school motivation). Children with ASD had lower scores in the social competence and behavioral control factors compared to the control group. However, there were no significant differences in the school motivation factor between the two groups. Findings suggest that social competence and behavioral control are indicators of flourishing and are important intervention targets to increase flourishing among children with ASD.
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Affiliation(s)
- Claudia L Hilton
- Occupational Therapy Department, University of Texas Medical Branch, School of Health Professions, 301 University Boulevard, Galveston, Texas, 77555-1142
| | - Karen Ratcliff
- Occupational Therapy Department, University of Texas Medical Branch, School of Health Professions, 301 University Boulevard, Galveston, Texas, 77555-1142
| | - Diane M Collins
- Occupational Therapy Department, University of Texas Medical Branch, School of Health Professions, 301 University Boulevard, Galveston, Texas, 77555-1142
| | - Joanne Flanagan
- Occupational Therapy Department, University of Texas Medical Branch, School of Health Professions, 301 University Boulevard, Galveston, Texas, 77555-1142
| | - Ickpyo Hong
- Occupational Therapy Department, University of Texas Medical Branch, School of Health Professions, 301 University Boulevard, Galveston, Texas, 77555-1142
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Chin WC, Li HM, Chao KY, Chang HL. Stressors experienced by children with autism spectrum disorder in Taiwan: Perspectives of children and their parents. Nurs Health Sci 2018; 21:206-213. [PMID: 30548420 DOI: 10.1111/nhs.12583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 09/13/2018] [Accepted: 10/21/2018] [Indexed: 02/06/2023]
Abstract
Autism spectrum disorder has only recently been recognized as a developmental disability in Taiwan. We conducted an exploratory qualitative descriptive study with children (n = 14, mean age = 13.57 years) and their parents to understand stressors experienced by children with autism spectrum disorder in Taiwan. An analysis of face-to-face interviews revealed that children with autism spectrum disorder experienced stressors of daily living, which included environmental stimuli, academic and behavioral expectations, deviations in routine, behavioral expectations, and emotional control, and stressors of socializing, which included bullying, communication, personal interactions, conflict resolution, and difficulty understanding others' emotions. Stressors resulted from the core symptoms and characteristic behaviors of autism spectrum disorders, and also Taiwanese cultural expectations. Our findings could help develop individualized educational plans and culturally-sensitive behavioral interventions. Facilitation of these interventions could be used by nurses and health-care professionals to help facilitate problem solving and communication skills, which could reduce the stress for children with autism spectrum disorder in Taiwan.
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Affiliation(s)
- Wei-Chih Chin
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hsin-Mei Li
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Kuo-Yu Chao
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
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Kao YC, Lien YJ, Chang HA, Tzeng NS, Yeh CB, Loh CH. Stigma Resistance in Stable Schizophrenia: The Relative Contributions of Stereotype Endorsement, Self-Reflection, Self-Esteem, and Coping Styles. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:735-744. [PMID: 28884606 PMCID: PMC5638194 DOI: 10.1177/0706743717730827] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Stigma resistance (SR) has recently emerged as a prominent aspect of research on recovery from schizophrenia, partly because studies have suggested that the development of stigma-resisting beliefs may help individuals lead a fulfilling life and recover from their mental illness. The present study assessed the relationship between personal SR ability and prediction variables such as self-stigma, self-esteem, self-reflection, coping styles, and psychotic symptomatology. METHOD We performed an exploratory cross-sectional study of 170 community-dwelling patients with schizophrenia. Self-stigma, self-esteem, self-reflection, coping skills, and SR were assessed through self-report. Psychotic symptom severity was rated by the interviewers. Factors showing significant association in univariate analyses were included in a stepwise backward regression model. RESULTS Stepwise regressions revealed that acceptance of stereotypes of mental illness, self-esteem, self-reflection, and only 2 adaptive coping strategies (positive reinterpretation and religious coping) were significant predictors of SR. The prediction model accounted for 27.1% of the variance in the SR subscale score in our sample. CONCLUSIONS Greater reflective capacity, greater self-esteem, greater preferences for positive reinterpretation and religious coping, and fewer endorsements of the stereotypes of mental illness may be key factors that relate to higher levels of SR. These factors are potentially modifiable in tailored interventions, and such modification may produce considerable improvements in the SR of the investigated population. This study has implications for psychosocial rehabilitation and emerging views of recovery from mental illness.
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Affiliation(s)
- Yu-Chen Kao
- 1 Department of Psychiatry, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan.,2 Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan
| | - Yin-Ju Lien
- 3 Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Hsin-An Chang
- 2 Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan.,4 Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- 2 Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan.,4 Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan
| | - Chin-Bin Yeh
- 2 Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan.,4 Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan
| | - Ching-Hui Loh
- 5 School of Medicine, National Defense Medical Center, Taipei, Taiwan
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