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Pang RCC, Ho MSH, Wong PWC. A Review of the Literature on the Multiple Forms of Stigmatization of Caregivers of Children with Autism Among Ethnic Minority Groups. J Racial Ethn Health Disparities 2024; 11:545-559. [PMID: 36877377 DOI: 10.1007/s40615-023-01540-6] [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] [Received: 03/03/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 03/07/2023]
Abstract
Multiple forms of stigmatization are experienced by caregivers of children with autism among ethnic minority (EM) groups in various countries. Such forms of stigmatization can lead to delayed assessment and services for mental health among children and caregivers. This review identified the research literature on the types of stigmatization experienced by caregivers of children with autism with an EM background. A total of 19 studies published after 2010 (i.e., 12 from the USA, 2 from the UK, 1 from Canada, and 1 from New Zealand) of caregivers of 20 ethnicities were identified and reviewed, and their reporting qualities systematically also assessed. Four main themes: (1) self-stigma, (2) social stigma, (3) stigma towards EM parents of children on the autism spectrum, and (4) service utilization stigma, and nine sub-themes were identified. The discrimination experienced by caregivers were extracted, synthesized, and further discussed. While the reporting quality of the studies included is good, the depth of the understanding of this under-researched yet important phenomenon is very limited. The multiple forms of stigmatization experiences are complex, and it may be difficult to disentangle whether the causes of stigmatization were autism and/or EM related, and the types of stigmatization can vary enormously among different ethnic groups in different societies. More quantitative studies are needed to quantify the impacts of multiple forms of stigmatization on families of children with autism in EM groups so that more socially inclusive support for caregivers with an EM background in host countries can be developed.
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Affiliation(s)
| | - Mimi S H Ho
- Department of Special Education and Counselling, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, Hong Kong
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2
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Grigore B, Peters J, Williams J, Russell G, Coles P, Visintin C, Rogers M, Hayward R, Zhelev Z, Logan S, Hyde C. Screening for Autism Spectrum Disorder in Young Children: Still Not Enough Evidence. J Prim Care Community Health 2024; 15:21501319241263223. [PMID: 39077980 PMCID: PMC11289826 DOI: 10.1177/21501319241263223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/16/2024] [Accepted: 06/01/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Early detection of autism spectrum disorder (ASD) has the potential to significantly reduce the impact of the condition, however previous reviews have found little evidence to support screening programs for ASD in young children. METHODS We conducted a review with the aim of updating evidence on 3 aspects: (a) diagnostic stability of ASD in young children; (b) accuracy of ASD screening tools in young children; and (c) the benefits of early interventions in screen-detected young children with ASD. RESULTS A total of 33 studies were included in our review. Five studies looking at diagnostic stability reported estimates ranging from 71.9% to 100%, however the majority only included a follow-up of 24 months and all studies raised concerns regarding the risk of bias due particularly to lack of blinding, sample size, and patient flow. A total of 25 studies, reported in 26 articles, were identified that reported accuracy data on 11 screening tools. Most of the reports were concerned with versions of M-CHAT, reporting sensitivity estimates from 0.67 to 1.0; however, many of these were deemed to be of high risk of bias due to lack of blinding and follow-up. Four studies reported on early interventions in screen-detected children; however, the majority did not find significant improvements on the relevant outcomes. CONCLUSIONS Overall, the evidence on screening for ASD in young children captured by this review is not conclusive regarding the 3 aspects of screening in this population. Future studies should attempt to ensure blinded diagnostic assessments, include longer follow-up periods and limit attrition.
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Carpita B, Nardi B, Pronestì C, Parri F, Giovannoni F, Cremone IM, Pini S, Dell’Osso L. May Female Autism Spectrum Be Masked by Eating Disorders, Borderline Personality Disorder, or Complex PTSD Symptoms? A Case Series. Brain Sci 2023; 14:37. [PMID: 38248252 PMCID: PMC10813290 DOI: 10.3390/brainsci14010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/15/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction: The prevalence of Autism Spectrum Disorder (ASD) is four times higher in males than females; however, females are significantly more likely to go undiagnosed due to the existence of a "female autistic phenotype", a manifestation unique to females that conflicts with conventional, masculine conceptualizations of ASD. Furthermore, subthreshold autistic traits, which exert a significantly negative impact on quality of life and represent a vulnerability factor for the development of other psychopathological conditions, may remain even more under-recognized. Subsequently, many women with ASD may never receive a diagnosis or any resulting care, with serious consequences for their health. Aims: We aimed to describe two brief cases in order to confirm the diagnostic difficulties that ASD female undergo during their clinical evaluation and the possible alternative phenotype that they can manifest. Methods: We reported the cases of two young women on the autism spectrum that came to clinical attention only after the development of severe symptomatology attributed to other mental disorders, overlooking the presence of underlying autism spectrum features and a brief résumé of the literature on this topic. Results: These cases confirm the need for a timely and proper identification of females on the autism spectrum in order to prevent complications and improve the outcome. Conclusions: Research on gender differences could lead to a reexamination of the sex ratio in the prevalence of ASD and provide a better understanding of several psychiatric conditions that are frequently diagnosed in women, supporting the neurodevelopmental approach to psychopathology.
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Affiliation(s)
| | - Benedetta Nardi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (B.C.); (C.P.); (F.P.); (F.G.); (S.P.); (L.D.)
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Jacobs D. Experiences of children and adolescents with attention-deficit/hyperactivity disorder taking methylphenidate. Dev Med Child Neurol 2023; 65:1587-1595. [PMID: 37154566 DOI: 10.1111/dmcn.15636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
To improve clinical counselling for adolescents about the use of stimulant medication, it is crucial to understand the experiences of young people diagnosed with attention-deficit/hyperactivity disorder (ADHD) who are taking such treatment. For this narrative review, five databases were searched for studies investigating the personal experiences of control issues in adolescents diagnosed with ADHD taking methylphenidate. We extracted the data using NVivo 12 and interpretatively synthesized them according to the procedures of thematic analysis. Interviewed youngsters spontaneously put forward self-experiences about self-esteem and sense of control, although these issues were rarely explicitly addressed in the research question. The overarching theme in these studies was 'improving the self'. Two subthemes emerged: (1) medication sometimes delivered on its promise to improve the self, but regularly it did not; and (2) youngsters felt pressurized to conform to behavioural norms and comply with the medication use that adults had decided on. To genuinely involve youngsters diagnosed with ADHD for whom stimulant medication is prescribed in the shared decision-making process, we recommend to specifically involve them in a dialogue on the medication's potential effects on their self-experiences. This will allow them to feel at least partly in control of their body and life, and less pressurized to conform to others' norms.
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Affiliation(s)
- Delphine Jacobs
- Psychiatrie Infanto-Juvénile, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
- UCLouvain, Institut de Recherche Santé et Société, Bruxelles, Belgium
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Gibbs V, Hudson JL, Pellicano E. Poly-victimization of autistic adults: An investigation of individual-level correlates. Autism Res 2023; 16:2336-2349. [PMID: 37737378 DOI: 10.1002/aur.3031] [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] [Received: 01/05/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023]
Abstract
Autistic people experience high rates of violence and victimization which is largely due to structural injustices, including stigma and social attitudes. Identifying and addressing systemic and structural factors is vitally important, however effecting change in embedded social structures is likely to take some time, even with concerted efforts. In the meantime, it is important to understand whether there are other individual-level factors that may assist in developing preventative and protective strategies for autistic people. The current study investigated the role of individual-level risk factors in the victimization of autistic people. Specifically, we examined whether characteristics that are common among autistic people that is, lower social competence, higher compliance and emotion regulation difficulties or more ADHD features (inattention, impulsiveness and hyperactivity) were associated with poly-victimization in a community sample of 228 adults (118 autistic, 110 non-autistic). Our results show that only ADHD features were predictive of poly-victimization once socio-demographic background variables (age, sexual orientation) were adjusted for. Group status was not a significant predictor in the model and there were no interaction effects between any of the characteristics and group status. These findings suggest that, regardless of whether a person is autistic, ADHD features may place individuals at higher risk of experiencing multiple forms of violence in adulthood. Further research using longitudinal designs and larger, diverse samples is needed. Furthermore, the regression model only accounted for about one-third of the variance in poly-victimization which highlights the importance of looking beyond individual-level risk factors to structural and systemic factors that contribute to disproportionate victimization of autistic people.
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Affiliation(s)
- Vicki Gibbs
- Macquarie School of Education, Macquarie University, Macquarie Park, New South Wales, Australia
| | | | - Elizabeth Pellicano
- Macquarie School of Education, Macquarie University, Macquarie Park, New South Wales, Australia
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Kilmer M, Hong M, Shah E. Relationship between caregiver adverse childhood events and age of autism spectrum diagnosis. J Pediatr Nurs 2023; 73:e266-e272. [PMID: 37798211 DOI: 10.1016/j.pedn.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND The age at which children are diagnosed with autism spectrum disorder (ASD) has not significantly decreased in the past 20 years. Adverse childhood events (ACEs) experienced by caregivers of autistic children may predict delays in caregivers attending ASD diagnostic evaluations, negatively impacting the age at which the child is diagnosed with ASD. The purpose of this study was to further explore the caregiver delay response by analyzing recurring events common in caregivers of children at risk for ASD. METHODS We used a quantitative research design with convenience sampling to categorize caregivers of children referred for an ASD diagnostic evaluation into three groups based on their ACEs score and medical history. FINDINGS A higher percentage of caregivers with four or more ACEs compared to the national average was noted. Parental separation or divorce, verbal aggression, emotional abuse, and parental alcohol or substance abuse occurred most frequently, and the latter predicted a prolonged time in attending the diagnostic evaluation. DISCUSSION ACEs experienced by caregivers of children with ASD may delay the age of ASD diagnosis. Further investigation into the effect of ACEs on caregivers' mental health status and executive functioning is warranted to develop best practice for assisting caregivers in ASD recognition, diagnosis, and care management. APPLICATION TO PRACTICE Clinicians should consider caregiver ACEs score when referring a child for a diagnostic developmental evaluation. Resources to address caregiver mental health needs should be provided at the onset of the referral process to increase the likelihood of caregiver adherence.
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Affiliation(s)
| | - Minju Hong
- The University of Arkansas, United States of America
| | - Emily Shah
- The University of Arkansas, United States of America
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Vanaken GJ, Noens I, Steyaert J, van Esch L, Warreyn P, Hens K. The Earlier, the Better? An In-Depth Interview Study on the Ethics of Early Detection with Parents of Children at an Elevated Likelihood for Autism. J Autism Dev Disord 2023:10.1007/s10803-023-06139-8. [PMID: 37751101 DOI: 10.1007/s10803-023-06139-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 09/27/2023]
Abstract
Autism is increasingly viewed as an expression of neurodiversity deserving accommodation, rather than merely as a disorder in need of remediation or even prevention. This reconceptualization has inspired calls to broaden the ethical debate on early autism care beyond matters of efficient screenings and effective interventions. We conducted 14 in-depth interviews with 26 parents of infants at an increased likelihood for autism (siblings, preterms and children with persistent feeding difficulties) to understand which benefits and risks these parents see for the implementation of a systematic, early autism detection program in our region. With this study, we aim to contribute empirically to the ethical debate on good and just early autism care in the age of neurodiversity. Data were analyzed according to the QUAGOL-methodology. Three main themes emerged from our analysis. In their evaluation of early autism detection, parents discussed how a diagnosis helps gain a different perspective fostering understanding and recognition for both child and parent. Second, a diagnosis supports parents in adjusting their parenting practices, to justify this deviation from "normal" parenting and to strive for such adjusted environments beyond the nuclear family. Third, an autism diagnosis induces ambiguities parents need to navigate, involving questions on whether and when to mobilize the diagnostic label and which language to use to talk about autism. We discuss the complex position of parents of a (potentially) autistic child in terms of moving back and forth across the ab/normal binary and describe implications for the ethical debate on early autism detection.
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Affiliation(s)
- Gert-Jan Vanaken
- Centre for Ethics, Department of Philosophy, University of Antwerp, Antwerp, Belgium.
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leopold Vanderkelenstraat 32, Leuven, 3000, Belgium.
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium.
| | - Ilse Noens
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leopold Vanderkelenstraat 32, Leuven, 3000, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
| | - Jean Steyaert
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
- Centre for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Lotte van Esch
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leopold Vanderkelenstraat 32, Leuven, 3000, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
| | - Petra Warreyn
- Research in Developmental Disorders Lab, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Kristien Hens
- Centre for Ethics, Department of Philosophy, University of Antwerp, Antwerp, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
- Institute of Philosophy, KU Leuven, Leuven, Belgium
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Rivera RA, Bennetto L. Applications of identity-based theories to understand the impact of stigma and camouflaging on mental health outcomes for autistic people. Front Psychiatry 2023; 14:1243657. [PMID: 37743980 PMCID: PMC10511883 DOI: 10.3389/fpsyt.2023.1243657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
Autistic people have long been conceptualized from a deficit-based model of disability, but recent self-advocates and scholars have asserted the importance of recognizing autism as both a disability and an important part of a person's social identity. The autistic identity is subject to specific stigma and stressors beyond everyday discrimination and prejudice, which can have many downstream implications on mental health and well-being. Prior research on camouflaging has explained both quantitatively and qualitatively how autistic people conform to norms and mask their autistic traits to better fit in with non-autistic societal standards. Given this paradigm shift in understanding autistic peoples' lived experiences, researchers must also begin to reshape the theories guiding their work in order to improve diagnosis, intervention, and supports. This review examines the extant research on identity-related stigma and camouflaging and their subsequent impacts on mental health outcomes in autism. A model is proposed integrating identity-based theories-specifically the social model of disability, social identity theory, and minority stress model-to explain relationships across research areas and better explain the experiences of autistic people. We discuss how identity-based theories can be applied in autism research to better understand the impacts of stigma and camouflaging on autistic peoples' lived experiences and reduce disparities in their mental health outcomes.
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Affiliation(s)
- Rachel A. Rivera
- Department of Psychology, University of Rochester, Rochester, NY, United States
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Hyassat M, Al-Makahleh A, Rahahleh Z, Al-Zyoud N. The Diagnostic Process for Children with Autism Spectrum Disorder: A Preliminary Study of Jordanian Parents' Perspectives. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1394. [PMID: 37628393 PMCID: PMC10453648 DOI: 10.3390/children10081394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023]
Abstract
Although extensive research has been conducted worldwide to investigate the diagnostic process of Autism Spectrum Disorder (ASD), Jordanian parents' experiences have been overlooked. This study explored parents' journeys toward receiving diagnoses for their children with ASD. In particular, it aimed to provide a clear picture of the process for obtaining these diagnoses for children in Jordan. METHODS Eighteen semi-structured interviews were carried out with 12 mothers and six fathers of children with ASD aged 5 to 11 years old. RESULTS The coding process was based on a thematic analysis method and resulted in the identification of three overlapping themes: dissatisfaction with professionals' abilities to approach parents, an unstructured diagnostic process, and perspectives on diagnosis tools. CONCLUSIONS Our data upheld the idea that parental satisfaction with the diagnostic process is influenced by the duration of the process, the information provided, the support offered, and the communication approach used by professionals. Within the local cultural context, parents were significantly impacted by the societal stigma associated with disability when they sought diagnoses for their children with ASD.
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Affiliation(s)
- Mizyed Hyassat
- Department of Special Education, Princess Rahma University College, Al-Balqa Applied University, Salt 19117, Jordan; (A.A.-M.); (Z.R.)
| | - Ahmad Al-Makahleh
- Department of Special Education, Princess Rahma University College, Al-Balqa Applied University, Salt 19117, Jordan; (A.A.-M.); (Z.R.)
| | - Zahraa Rahahleh
- Department of Special Education, Princess Rahma University College, Al-Balqa Applied University, Salt 19117, Jordan; (A.A.-M.); (Z.R.)
| | - Nawaf Al-Zyoud
- Department of Psychological Sciences, College of Education, Qatar University, Doha 93001, Qatar;
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Abstract
Autism is often considered to reflect categorically 'different brains'. Neuropsychological research on autism spectrum disorder (ASD) however, has struggled to define this difference, or derive clear-cut boundaries between autism and non-autism. Consequently, restructuring or disbanding the ASD diagnosis is becoming increasingly advocated within research. Nonetheless, autism now exists as a salient social construction, of which 'difference' is a key facet. Clinical and educational professionals must influence this cautiously, as changes to autism's social construction may counterproductively affect the quality of life of autistic people. This paper therefore reviews ASD's value as both neuropsychological and social constructs. Although lacking neuropsychological validity, the autism label may be beneficial for autistic self-identity, reduction of stigma, and administering support. Whilst a shift away from case-control ASD research is warranted, lay notions of 'different brains' may be preserved.
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Affiliation(s)
- Daniel Crawshaw
- School of Psychology, University of Nottingham, University Park, Nottingham, UK
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Almasoud H, Alqahtani S. Potential impact of autism services on the quality of life of individuals with autism spectrum disorder and their families. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 136:104492. [PMID: 36958127 DOI: 10.1016/j.ridd.2023.104492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 06/18/2023]
Abstract
Autism spectrum disorder (ASD) is a lifelong condition that requires autism-specific services. However, the quality of autism services in Saudi Arabia has rarely been examined. Therefore, exploring issues from the parents' perspective is crucial to improve the quality of life (QOL) outcomes for such a population. Semi-structured interviews were administered to nine parents of individuals with ASD, and thematic analysis was used for data analysis. Results showed that parents' experiences regarding the quality of autism services varied. In addition, the quality of autism services must be further developed to meet the diverse needs of individuals with ASD and their families, in line with the 2030 vision of Saudi Arabia, which prioritises the QOL of individuals with a disability and their families. This study highlighted some influencing factors of the quality of autism services and QOL of individuals with ASD and their families from the parents' perspective. This study concluded that further research is necessary to gain in-depth understanding of the influencing factors of the quality of national autism services. Overall, the reasons behind the diversity in experiences amongst parents of individuals with ASD regarding the quality of autism services must be further explored.
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Affiliation(s)
- Hanan Almasoud
- Special Education Department, King Saud University, Riyadh 11451, Saudi Arabia.
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Tan WY, Hamzaid NH, Ibrahim N. Parental Perceptions on the Importance of Nutrients for Children with Autism Spectrum Disorder (ASD) and the Coping Strategies: A Qualitative Study. Nutrients 2023; 15:nu15071608. [PMID: 37049449 PMCID: PMC10096955 DOI: 10.3390/nu15071608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/08/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
Autism Spectrum Disorder (ASD) is a developmental disorder that comes with co-occurring eating behavior such as limited food varieties, selective food intake, and repetitive eating patterns, contributing to significant challenges for their parents. Many parents find mealtimes difficult and develop anxiety or stress about their child’s nutrition, health, and overall well-being. Hence, parents must equip themselves with the correct awareness and nutrition knowledge. An online open-ended semi-structured interview was conducted among fifteen parents from the community-rehabilitation program center to explore their understanding of nutrition’s importance and the possible coping strategies when facing challenges. The interview sessions were recorded, followed by three researchers’ coding processes. Data were then subjected to thematic analysis. The interview sessions suggested that the parents were aware of the autism trait eating behavior and had a general knowledge about nutrition. However, it was quite challenging when it came to preparation. Nevertheless, the parents are able to manage the challenges with unique kinds of coping strategies. In addition, a complete educational dietary intervention program including psychosocial aspects for parents is recommended for better effectiveness.
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Foster-Cohen S, Macrae T, Newbury J. Variation in morpho-lexical development within and between diagnoses in children with neurodevelopmental disorders. Front Psychol 2023; 13:968408. [PMID: 36710780 PMCID: PMC9878158 DOI: 10.3389/fpsyg.2022.968408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
While primary diagnosis is only one aspect of the presentation of a child with neurodevelopmental delay/disorder, the degree to which early expressive language reflects diagnostic divisions must be understood in order to reduce the risk of obscuring clinically important differences and similarities across diagnoses. We present original data from the New Zealand MacArthur-Bates Communicative Development Inventory (NZCDI) from 88 English-speaking children aged 2;6 to 5;6 years receiving multidisciplinary intervention within a single family-centered program. The children had one of six pediatrician-assigned genetic or behaviorally determined diagnoses: Down syndrome (DS); motor disorders (cerebral palsy and developmental coordination disorder); global development delay; disorders of relating and communicating (R&C); other genetically defined diagnoses; or language delay due to premature (PREM) birth. Morphological and lexical development were compared within and across diagnostic groups, using both data visualization and mixed-effects modeling. Groups varied in the amount of variation within and between them, but only prematurity reached significance, in interaction with age, as a predictor of morpho-lexical scores. Further analysis of longitudinal data available from a subset of the sample (n = 62) suggested that individual trajectories of vocabulary growth could not be reliably predicted by diagnosis. Moreover, the distribution of word types (nouns, predicates, etc.) only distinguished PREM children with language delay from those with DS and those in the R&C group. There were strong similarities in early morpho-lexical development across these clinical populations, with some differences. These findings align with research and clinical approaches which accommodate individual variation within diagnosis, and broad similarities across diagnostic groups.
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Affiliation(s)
- Susan Foster-Cohen
- Department of Linguistics, University of Canterbury, Christchurch, New Zealand
- New Zealand Institute of Language, Brain and Behaviour, University of Canterbury, Christchurch, New Zealand
- Christchurch Early Intervention Trust, The Champion Centre, Christchurch, New Zealand
| | - Toby Macrae
- New Zealand Institute of Language, Brain and Behaviour, University of Canterbury, Christchurch, New Zealand
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Jayne Newbury
- New Zealand Institute of Language, Brain and Behaviour, University of Canterbury, Christchurch, New Zealand
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
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Legg H, Tickle A, Gillott A, Wilde S. Exploring the Experiences of Parents Whose Child has Received a Diagnosis of Autistic Spectrum Disorder in Adulthood. J Autism Dev Disord 2023; 53:205-215. [PMID: 34997881 PMCID: PMC9889483 DOI: 10.1007/s10803-021-05296-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 02/04/2023]
Abstract
There is a growing trend of adult diagnosis of Autism Spectrum Disorder (ASD). Research has found that diagnosis can prompt a process of sense-making which may be disrupted by lack of post-diagnostic support. Given the continued involvement of many parents in supporting their adult son or daughter with ASD, it is vital to understand their experiences to meet their needs in adapting to the diagnosis. Eleven parents of recently diagnosed adults participated in semi-structured interviews which were analysed thematically. Findings demonstrate that the new knowledge of diagnosis facilitates changes in attributions, interactions and relationships, but can result in unmet emotional and relational support needs. Findings are relevant to those involved in adult diagnosis, and the provision of post-diagnostic support.
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Affiliation(s)
- Hannah Legg
- Trent Doctorate in Clinical Psychology, Division of Psychiatry and Applied Psychology, University of Nottingham, YANG Fujia Building, B Floor, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK.
- The Ryegate Children's Centre, Sheffield Children's NHS Foundation Trust, Tapton Hill Rd, Sheffield, S10 5DP, UK.
| | - Anna Tickle
- Trent Doctorate in Clinical Psychology, Division of Psychiatry and Applied Psychology, University of Nottingham, YANG Fujia Building, B Floor, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK
| | - Alinda Gillott
- Neurodevelopmental Specialist Service, Nottinghamshire Healthcare NHS Foundation Trust, The Pines, Highbury Hospital, Bulwell, Nottingham, NG6 9DR, UK
| | - Sarah Wilde
- Trent Doctorate in Clinical Psychology, Sarah Swift Building, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS, UK
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Psychophysiological aspects of autism spectrum disorder. Int J Health Sci (Qassim) 2022. [DOI: 10.53730/ijhs.v6ns1.6096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Autism spectrum disorder is a neurodevelopmental illness marked by chronic difficulties with mutual social interaction and communication, as well as restricted or repetitive patterns of behavior, interests, or activities. ASD symptoms commonly appear in early childhood and can be identified by the age of 2 years. Early detection of ASD allows for better therapeutic interventions and management, which has been shown to lessen children's long-term intellectual, behavioral, and functional deficits while also improving family consequences. In the present review, we are focusing on important psychophysiological aspects of autism spectrum disorders.
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Turnock A, Langley K, Jones CR. Understanding Stigma in Autism: A Narrative Review and Theoretical Model. AUTISM IN ADULTHOOD 2022; 4:76-91. [PMID: 36605561 PMCID: PMC8992913 DOI: 10.1089/aut.2021.0005] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The experience of stigma by autistic people is relatively understudied, despite contributing to a range of poor outcomes and having an overarching impact on well-being. The current review of the literature synthesizes research to determine what is currently known and presents a theoretical model of autism stigma. Autism stigma is primarily influenced by a public and professional understanding of autism in combination with interpretation of visible autistic traits. Moderating factors include the quality and quantity of contact with autistic people, cultural factors, sex and gender, individual differences, and diagnostic disclosure. Stigma can reduce well-being as well as increase the presence of camouflaging behaviors, which mask autistic traits. Caregivers of autistic people can experience stigma by association, that is, affiliate stigma, which can impact their own well-being. A variety of interventions and approaches to reduce stigma are discussed, including "autism friendly" spaces, positive media representation, educational and psychosocial training for the public and professionals, as well as cultural and systemic shifts that foster inclusivity and recognize neurodiversity.
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Affiliation(s)
- Alice Turnock
- School of Medicine, Cardiff University, University Hospital of Wales, Cardiff, United Kingdom
| | - Kate Langley
- Wales Autism Research Centre, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Catherine R.G. Jones
- Wales Autism Research Centre, School of Psychology, Cardiff University, Cardiff, United Kingdom.,Address correspondence to: Catherine R.G. Jones, PhD, School of Psychology, Cardiff University, Park Place, Cardiff CF10 3AT, United Kingdom
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17
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Pivotal Response Treatment (PRT) - Parent Group Training for Young Children with Autism Spectrum Disorder: A Qualitative Study on Perspectives of Parents. J Autism Dev Disord 2022; 52:5414-5427. [PMID: 35083605 PMCID: PMC8791680 DOI: 10.1007/s10803-021-05397-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2021] [Indexed: 01/31/2023]
Abstract
Pivotal Response Treatment (PRT) is considered to be an empirically supported parent-mediated treatment for children with autism spectrum disorder (ASD), but research on parental experiences is lacking. This qualitative study examined the perspectives of parents of young children with ASD who participated in a 14-week PRT with parent group training (PRT-PG). Semi-structured interviews (n = 12) were carried out, based on Grounded Theory principles. Results indicated that facilitators and barriers were related to timing and expectations, training setting and characteristics, and participant characteristics. Perceived effects were related to improved child’s social-communication skills and well-being, parental insights into their child’s needs and own habitual patterns in communication and behavior, and positive changes in family cohesion. The findings indicate that in general parents value PRT-PG as feasible and effective.
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18
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Han E, Scior K, Avramides K, Crane L. A systematic review on autistic people's experiences of stigma and coping strategies. Autism Res 2021; 15:12-26. [PMID: 34881514 DOI: 10.1002/aur.2652] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/17/2021] [Accepted: 11/28/2021] [Indexed: 11/08/2022]
Abstract
Autism can be understood as a concealable stigmatized identity. This is the first systematic review to synthesize the literature on autistic people's experiences of stigma and coping strategies. 2877 studies were screened and 27 were included in this review. The reviewed literature demonstrates that autistic individuals are acutely aware of being stereotyped, judged, and discriminated by others. Autistic people also show signs of internalizing stigma, rendering them more vulnerable to low self-worth and poorer mental health. To manage the impact of stigma, the included studies suggest that autistic individuals may use these strategies: concealment and camouflaging, selective disclosure and self-advocacy, as well as positive reframing and reconstructing identity. However, the evidence is limited and mixed in terms of how helpful and effective these strategies are. Future studies should include autistic populations with a wider range of intellectual abilities and explore interventions that can support autistic people in managing stigma to supplement interventions that seek to reduce stigma towards autistic people. The power of language in perpetuating and challenging stigma also has important implications for research and practice, underscoring the need for researchers and practitioners to reflect carefully on the messages they are communicating about autism.
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Affiliation(s)
- Emeline Han
- Centre for Research in Autism and Education (CRAE), UCL Institute of Education, London, UK
| | - Katrina Scior
- Research Department of Clinical, Educational and Health Psychology, UCL Division of Psychology and Language Sciences, London, UK
| | - Katerina Avramides
- Department of Psychology and Human Development, UCL Institute of Education, London, UK
| | - Laura Crane
- Centre for Research in Autism and Education (CRAE), UCL Institute of Education, London, UK
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19
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Hayes J, Ford T, McCabe R, Russell G. Autism diagnosis as a social process. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:488-498. [PMID: 34243682 PMCID: PMC8814948 DOI: 10.1177/13623613211030392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT When a child or adult is referred for an autism diagnosis, clinicians from different backgrounds work together to make a diagnostic decision. A few studies have asked clinicians in interview how they feel about diagnosis and what the challenges are. We interviewed clinicians in child and adult assessment services in England, and from different professional backgrounds, about the challenges of autism diagnosis and the factors that might influence the assessment process. We found that there were a number of challenges in autism diagnosis, especially when someone coming for diagnosis was considered to be near the diagnostic threshold. Clinicians told us that making a diagnosis was like creating a 'narrative': looking at many different factors that told a story about a person, rather than just looking at the results of diagnostic tests. Clinicians do not always agree with the results of those tests and have to use their specialist clinical judgement to make decisions. Clinicians were concerned about the amount of time people have to wait for an autism assessment, and the resulting pressure on the assessment process. The findings of this work can help us to understand how diagnosis happens and consider ways in which it can be improved for adults, children and families coming for assessment, as well as clinicians.
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20
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Wright Stein S, Alexander R, Mann J, Schneider C, Zhang S, Gibson BE, Gabison S, Jachyra P, Mosleh D. Understanding disability in healthcare: exploring the perceptions of parents of young people with autism spectrum disorder. Disabil Rehabil 2021; 44:5623-5630. [PMID: 34232798 DOI: 10.1080/09638288.2021.1948114] [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: 10/20/2022]
Abstract
Purpose: How autism spectrum disorder (ASD) is understood (i.e., as a medical problem or natural human variation) has profound implications for how healthcare services are designed and delivered. As the recipients of these services, children and families are highly invested in these debates, yet little research has sought to investigate their views. The purpose of this study was to explore parents' conceptualizations of ASD in relation to disability, and how they align with, or diverge from, conceptualizations they encounter within healthcare.Materials and methods: Nine semi-structured qualitative interviews were conducted with parents of children with ASD and thematically analyzed.Results: The accounts suggested that participants integrated multiple and sometimes contradictory conceptualizations of disability that reflected both "medical" and "social" models and sources of disablement. While the participants often advocated for acceptance and inclusion of their child, the label of "neurodiversity" was commonly rejected due to the concern for potential loss of funding for services.Conclusions: Study findings highlight the relationship between how parents conceptualize ASD and their experiences accessing supportive services within current delivery structures. Implications for ASD service providers emphasize accommodating parents' unique and evolving values and priorities for healthcare and their relation to current service systems.Implications for RehabilitationParents conceptualizations of ASD both inform and are influenced by their experiences of accessing supportive services.This study highlights that parents' perspectives are fluid, context-dependent, and do not exclusively represent a single model or perspective of disability.To meet family needs, service providers including healthcare professionals must recognize parents' unique understandings of their child's ASD and appreciate how healthcare shapes these perceptions.
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Affiliation(s)
| | | | - Jotvarinder Mann
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Cory Schneider
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Sophie Zhang
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Barbara E Gibson
- Department of Physical Therapy, University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Sharon Gabison
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Patrick Jachyra
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Sport and Exercise Science, Durham University, Durham, UK
| | - Donya Mosleh
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
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21
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The Effect of Acceptance and Commitment Therapy for Improving Psychological Well-Being in Parents of Individuals with Autism Spectrum Disorders: A Randomized Controlled Trial. Brain Sci 2021; 11:brainsci11070880. [PMID: 34209171 PMCID: PMC8301771 DOI: 10.3390/brainsci11070880] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/19/2021] [Accepted: 06/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Acceptance and Commitment Therapy (ACT) has been demonstrated as effective in improving psychological well-being in several clinical domains, but there is no evidence regarding the parents of children with Autism Spectrum Disorder (ASD). Methods: In this randomized controlled trial, we evaluated the efficacy of the ACT matrix behavioral protocol in comparison to the Parent Training (PT) program, measuring several primary and secondary outcomes prior to and following treatments. Twelve parents were randomly and equally assigned to two demographically matched groups wherein individuals underwent 24 weekly meetings of ACT protocol (experimental group) or conventional PT (control group). Results: Parents enrolled in the ACT protocol demonstrated significant improvement in psychological flexibility, awareness states, personal values in everyday life, and parental stress, whereas reduced scores were elicited in parents’ perceptions of their child’s disruptive behaviors. Conclusions: The results of this randomized controlled trial, if repeated with a large number of subjects, could open the way to include ACT protocols in daily practice to support the development of new parenting skills.
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22
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O'Connor C, Brassil M, O'Sullivan S, Seery C, Nearchou F. How does diagnostic labelling affect social responses to people with mental illness? A systematic review of experimental studies using vignette-based designs. J Ment Health 2021; 31:115-130. [PMID: 34008456 DOI: 10.1080/09638237.2021.1922653] [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: 12/22/2022]
Abstract
BACKGROUND An outstanding question in the stigma literature is the extent to which negative responses are provoked by diagnostic labels, rather than observable symptoms of mental illness. Experimental studies frequently use vignettes to identify the unique effects of diagnostic labels on social responses to people with mental illness, independent of their behaviour or socio-demographic characteristics. AIMS The current article identifies, evaluates, and synthesises the body of experimental vignette studies of labelling effects. METHODS A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies were subjected to quality evaluation and narrative synthesis. RESULTS Of 1511 articles screened, 22 met inclusion criteria. Most studies focused on the diagnostic categories of attention deficit hyperactivity disorder, schizophrenia spectrum disorders, and autism spectrum disorder. The literature reported diverse effects, with diagnostic disclosure either exacerbating, mitigating, or not affecting stigma. The quality of studies was generally acceptable but the review identified an over-reliance on convenience sampling and unvalidated measures. CONCLUSIONS Results highlight the complexity of labelling effects, which diverge across diagnostic categories and social contexts. The review emphasises the need for expansion of diagnostic labels and contexts studied, standardisation of validated attitude scales, incorporation of behavioural outcomes, and diversification of samples.
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Affiliation(s)
| | - Maryanne Brassil
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Sadhbh O'Sullivan
- School of Medicine, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Christina Seery
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Finiki Nearchou
- School of Psychology, University College Dublin, Dublin, Ireland
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23
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Mackie TI, Schaefer AJ, Ramella L, Carter AS, Eisenhower A, Jimenez ME, Fettig A, Sheldrick RC. Understanding How Parents Make Meaning of Their Child's Behaviors During Screening for Autism Spectrum Disorders: A Longitudinal Qualitative Investigation. J Autism Dev Disord 2021; 51:906-921. [PMID: 32328857 PMCID: PMC7954750 DOI: 10.1007/s10803-020-04502-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A family's journey in understanding their child's behaviors in relation to Autism Spectrum Disorders (ASD) frequently begins with screening. This study aimed to characterize the interpretive processes that unfold for parents. We employed longitudinal interviews with 19 families engaged in a community-based multi-stage screening protocol. Parents participated in 1-6 interviews dependent upon children's length of engagement in the screening protocol; data were analyzed through modified grounded theory. Parents who moved towards understanding their child's behaviors as ASD expressed (1) sensitization to ASD symptoms, (2) differentiation from other developmental conditions, and (3) use of the ASD diagnosis to explain the etiology of concerning behaviors. Identifying interpretive processes involved during ASD screening provides new opportunities for shared decision-making.
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Affiliation(s)
- Thomas I Mackie
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, USA.
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson Ave, New Brunswick, NJ, 08901, USA.
| | - Ana J Schaefer
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, USA
| | - Leah Ramella
- Department of Health Law, Policy and Management, School of Public Health, Boston University, One Silber Way, Boston, MA, 02215, USA
| | - Alice S Carter
- Department of Psychology, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, USA
| | - Abbey Eisenhower
- Department of Psychology, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, USA
| | - Manuel E Jimenez
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, 89 French Street, New Brunswick, NJ, 08901, USA
| | - Angel Fettig
- College of Education - Special Education, University of Washington, 2012 Skagit Lane, Box 353600, Seattle, WA, 98195, USA
| | - R Christopher Sheldrick
- Department of Health Law, Policy and Management, School of Public Health, Boston University, One Silber Way, Boston, MA, 02215, USA
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24
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Ismail MF, Safii R, Saimon R, Rahman MM. Quality of Life Among Malaysian Parents with Autism Spectrum Disorder Child: The Double ABCX Model Approach. J Autism Dev Disord 2021; 52:113-123. [PMID: 33635421 DOI: 10.1007/s10803-021-04929-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 01/18/2023]
Abstract
This paper reported the quality of life (QoL) of 260 Malaysian parents with autism spectrum disorder (ASD) and factors which influencing it. About half of these parents reported to having good QoL. The factors identified in the double ABCX model showed that perceived social support and sense of coherence (SOC) were mediated by coping strategies and had a positive direct and indirect effect on parents' QoL. These finding reiterate the importance of social support, coping skills, and strong SOC reflection skills in influencing the QoL of parents with ASD child. We therefore suggest parents to utilize the widely available social and organization supports to gain good QoL, which is also important for the wellbeing of their child.
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Affiliation(s)
- Mohd Fahmi Ismail
- Department of Community Medicine and Public Health, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak (UNIMAS), 94300, Kota Samarahan, Sarawak, Malaysia.
| | - Razitasham Safii
- Department of Community Medicine and Public Health, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak (UNIMAS), 94300, Kota Samarahan, Sarawak, Malaysia
| | - Rosalia Saimon
- Department of Community Medicine and Public Health, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak (UNIMAS), 94300, Kota Samarahan, Sarawak, Malaysia
| | - Md Mizanur Rahman
- Department of Community Medicine and Public Health, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak (UNIMAS), 94300, Kota Samarahan, Sarawak, Malaysia
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25
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Makino A, Hartman L, King G, Wong PY, Penner M. Parent Experiences of Autism Spectrum Disorder Diagnosis: a Scoping Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00237-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AbstractThe purpose of this review was to identify the quantity, breadth, and methodological characteristics of literature examining parent perspectives of autism spectrum disorder diagnosis, synthesize key research findings, and highlight gaps in the current literature. A systematic search was conducted for the period January 1994–February 2020. One hundred and twenty-two articles underwent data extraction. The majority of studies took place in Europe and North America in high-income countries. Over half of the studies used qualitative methodology. Four key components of the diagnostic experience were identified: journey to assessment, assessment process, delivery of the diagnosis and feedback session, and provision of information, resources, and support. Themes of parental emotions and parental satisfaction with the diagnostic process were also found.
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26
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Self-Stigma of Families of Persons with Autism Spectrum Disorder: a Scoping Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-020-00228-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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27
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Hayes J, McCabe R, Ford T, Parker D, Russell G. 'Not at the diagnosis point': Dealing with contradiction in autism assessment teams. Soc Sci Med 2021; 268:113462. [PMID: 33253991 PMCID: PMC7814339 DOI: 10.1016/j.socscimed.2020.113462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/25/2020] [Accepted: 10/15/2020] [Indexed: 11/29/2022]
Abstract
Social science literature has documented how the concept of diagnosis can be seen as an interactive process, imbued with uncertainty and contradiction, which undermines a straightforward notion of diagnosis as a way to identify underlying biological problems that cause disease. We contribute to this body of work by examining the process of resolving contradiction in autism diagnosis for adults and adolescents. Autism is a useful case study as diagnosis can be a complex and protracted process due to the heterogeneity of symptoms and the necessity to interpret behaviours that may be ambiguous. We audio-recorded and transcribed 18 specialist clinical assessment meetings in four teams in England, covering 88 cases in two adult, one child and one adolescent (14+) setting. We undertook a qualitative analysis of discursive processes and narrative case-building structure utilised by clinicians to counteract contradiction.We identified a three-part interactional pattern which allows clinicians to forward evidence for and against a diagnosis, facilitates their collaborative decision-making process and enables them to build a plausible narrative which accounts for the diagnostic decision. Pragmatism was found to operate as a strategy to help assign diagnosis within a condition which, diagnostically, is permeated by uncertainty and contradiction. Resolution of contradiction from different aspects of the assessment serves to create a narratively-coherent, intelligible clinical entity that is autism.
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Affiliation(s)
- Jennie Hayes
- University of Exeter, College of Medicine and Health, EX1 2LU, UK.
| | - Rose McCabe
- School of Health Sciences, City, University of London, Myddelton Street Building, 1 Myddelton Street, London, EC1R 1UW, UK.
| | - Tamsin Ford
- University of Cambridge, Department of Psychiatry, Douglas House, 18b Trumpington Road, Cambridge, CB2 2AH, UK.
| | - Daisy Parker
- University of Exeter, College of Medicine and Health, EX1 2LU, UK.
| | - Ginny Russell
- University of Exeter, College of Medicine and Health, EX1 2LU, UK.
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28
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Como DH, Stein Duker LI, Polido JC, Cermak SA. Oral Health and Autism Spectrum Disorders: A Unique Collaboration between Dentistry and Occupational Therapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E135. [PMID: 33375475 PMCID: PMC7795681 DOI: 10.3390/ijerph18010135] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 12/16/2022]
Abstract
Children with autism spectrum disorders (ASD) are at risk for oral health disparities. With the dramatic rise in ASD prevalence to 1 in 54 children, it is likely that an increasing number of dental practitioners will encounter or be asked to treat children with ASD. This paper reviews explanations related to the increasing prevalence of ASD, provides reasons why children with ASD are at increased risk for poor oral health, and discusses unique interprofessional collaborations between dental practitioners and occupational therapists. Occupational therapists and dentists can work together to plan modifications to the dental environment or adapt dental protocols to reduce some of the barriers encountered by those with ASD, provide desensitization strategies before the clinic visit, or help a child with emotional regulation during clinical treatments.
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Affiliation(s)
- Dominique H. Como
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA; (L.I.S.D.); (S.A.C.)
| | - Leah I. Stein Duker
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA; (L.I.S.D.); (S.A.C.)
| | - José C. Polido
- Children’s Hospital Los Angeles and Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA;
| | - Sharon A. Cermak
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA; (L.I.S.D.); (S.A.C.)
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29
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Riccio A, Kapp SK, Jordan A, Dorelien AM, Gillespie-Lynch K. How is autistic identity in adolescence influenced by parental disclosure decisions and perceptions of autism? AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 25:374-388. [PMID: 32969254 DOI: 10.1177/1362361320958214] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT There is a lot of research about how parents think about their child's autism but we don't know much about how parents talk with their kids about autism. How parents talk with their kids about autism may shape how kids see autism. A team of autistic and non-autistic people (including a mother of an autistic person) did a study. We wanted to know if how parents talk with their kids about autism shapes how their kids see autism. Nineteen teens from a summer camp did interviews and surveys. Their mothers did surveys. Teens learned about if they had autism in different ways. Some teens still didn't know they were autistic. Teens whose moms chose to tell them about their autism talked about autism and themselves more positively than teens whose moms didn't choose to talk with them about autism. Only teens whose moms chose to talk with them about autism described themselves as having social strengths. Teens had a harder time defining autism than moms. However, teens and moms talked about autism in similar ways. Our study shows that parents can help their kids see autism and themselves more positively by talking with their kids about autism early in development.
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30
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Jacobs D, Steyaert J, Dierickx K, Hens K. Parents' multi-layered expectations when requesting an Autism Spectrum Disorder assessment of their young child: an in-depth interview study. BMC Psychiatry 2020; 20:440. [PMID: 32912176 PMCID: PMC7488345 DOI: 10.1186/s12888-020-02806-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 08/03/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Parents are valued stakeholders in research, clinical practice and policy development concerning autism spectrum disorder (ASD). However, little is known about what drives and moves parents besides their obvious worries and help request when they ask for a diagnostic ASD assessment of their child. METHODS Seventeen Flemish parents of 11 young children participated in a longitudinal study consisting of three in-depth interviews before and after their child's diagnostic ASD assessment. Data were analysed in Nvivo 11 according to the procedures of Interpretative Phenomenological Analysis. RESULTS In this paper we report the results of the first series of interviews which were conducted after parents had asked for an ASD assessment of their young child, and before this assessment started. The pre-assessment experiences of the parents were dominated by the anticipation of various implications of an ASD diagnosis, comprising both positive and negative expectations. The theme of positive expectations consisted of two equally prominent subthemes: treatment-related implications but also expectations pertaining to their psychological and relational experiences. CONCLUSIONS This study suggests important issues for clinicians to bear in mind during a consultation with parents who request an ASD assessment of their young child. We argue that attending to and communicating about parents' expectations prior to their child's ASD assessment may help clinicians to better understand parents' requests for help, and to address their needs more effectively.
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Affiliation(s)
- Delphine Jacobs
- Faculty of Medicine, Centre for Biomedical Ethics and Law - KU Leuven, Kapucijnenvoer 35 box 7001, 3000, Leuven, Belgium.
| | - Jean Steyaert
- Centre for Autism Expertise, Child and Youth Psychiatry - University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Kris Dierickx
- Faculty of Medicine, Centre for Biomedical Ethics and Law - KU Leuven, Kapucijnenvoer 35 box 7001, 3000, Leuven, Belgium
| | - Kristien Hens
- Department of Philosophy, Faculty of Arts, University of Antwerp, Prinsstraat 13, 2000, Antwerpen, Belgium
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31
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Liu XY, To SM. Personal Growth Experience among Parents of Children with Autism Participating in Intervention. J Autism Dev Disord 2020; 51:1883-1893. [PMID: 32875454 DOI: 10.1007/s10803-020-04681-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Guided by Pals' (in: McStay (ed) Identity and story: Creating self in narrative, American Psychological Association, Washington DC, 2006) model of self-making through a narrative lens in the context of adversity, this study investigated not only the difficulties but also the personal growth that parents have experienced while participating in the interventions with their children with autism spectrum disorder (ASD) in mainland China. Based on interviews with 16 purposively sampled parents, thematic analysis revealed themes concerning the parents' acknowledgment of stressful events and their emotional reactions, meanings of their experiences constructed through causal connections, and outcomes of their perceived improvement in self-understanding, parent-child relationships, and philosophies on life. Largely consistent with this theoretical model, such findings highlight the uniqueness of the personal growth process of parents of children with ASD in China's sociocultural context.
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Affiliation(s)
- Xiao-Yu Liu
- The Chinese University of Hong Kong, New Territory, Hong Kong.
- Chung Chi College, The Chinese University of Hong Kong, Rm. 613, Sino Building, Sha Tin, New Territory, Hong Kong.
| | - Siu-Ming To
- The Chinese University of Hong Kong, New Territory, Hong Kong
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32
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Parents' views and experiences of the autism spectrum disorder diagnosis of their young child: a longitudinal interview study. Eur Child Adolesc Psychiatry 2020; 29:1143-1154. [PMID: 31686239 DOI: 10.1007/s00787-019-01431-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/24/2019] [Indexed: 01/16/2023]
Abstract
Parents are valuable stakeholders in research, clinical practice and policy development concerning autism spectrum disorder (ASD). Little is known, however, about how parents view and experience an ASD diagnosis. We investigated the evolution of parents' views and experiences of the ASD diagnosis before, right after and 12 months after their child was diagnosed. Seventeen Flemish parents waiting for their young child's diagnostic ASD assessment participated in a longitudinal study consisting of three in-depth interviews. They described their views and experiences concerning their child's ASD diagnosis at three separate moments: (T1) prior to a diagnostic ASD assessment; (T2) immediately after their final feedback session at the end of the assessment; and (T3) 12 months later. Interviews were digitally recorded, transcribed and analysed in Nvivo 11 according to the procedures of interpretative phenomenological analysis. We extracted three themes from the interview material throughout the parental journey: (T1) expecting certainty and exculpation; (T2) vulnerabilisation of the child; and (T3) pragmatic attitude and some disappointment. At T3, the parents overall had come to value the diagnosis because of two reasons: they were satisfied with their child's entitlement to ASD-related support at school, and with the diagnosis' impact on the child's relationships with parents and teachers. Many parents experienced their child with an ASD diagnosis as vulnerable, and themselves as acutely responsible for his development and future. Our findings may lead to a higher satisfaction with the clinical trajectory in both clinician and parents by inspiring a conversation between them about parents' evolving views, hopes and concerns related to their child's ASD diagnosis.
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Garcia Primo P, Weber C, Posada de la Paz M, Fellinger J, Dirmhirn A, Holzinger D. Explaining Age at Autism Spectrum Diagnosis in Children with Migrant and Non-Migrant Background in Austria. Brain Sci 2020; 10:brainsci10070448. [PMID: 32674382 PMCID: PMC7407505 DOI: 10.3390/brainsci10070448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/31/2022] Open
Abstract
This study explored (i) differences in age at Autism Spectrum Disorder (ASD) diagnosis between children with and without a migrant background in the main diagnostic centre for ASD in Upper Austria (ii) factors related to the age at diagnosis and (iii) whether specific factors differed between the two groups. A retrospective chart analysis included all children who received their first diagnosis before the age of 10 years (n = 211) between 2013 and 2018. Children with a migrant background were diagnosed 13 months earlier than those without (r = 0.278, p < 0.001), and had more severe delays in language, more severe autism, no Asperger’s syndrome, lower parental educational level and more frequent referrals by paediatricians. For the total sample, expressive language delay, severity of restricted and repetitive behaviours, higher nonverbal development, and paediatric referrals explained earlier diagnoses. There was a stronger effect of parental education and weaker effect of language impairment on age at ASD diagnosis in children with a migrant background. In conclusion, no delay in diagnosing ASD in children with a migrant background in a country with universal health care and an established system of paediatric developmental surveillance was found. Awareness of ASD, including Asperger’s syndrome, should be raised among families and healthcare professionals.
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Affiliation(s)
- Patricia Garcia Primo
- Research Institute of Developmental Medicine, Johannes Kepler University, 4020 Linz, Austria; (P.G.P.); (C.W.); (J.F.); (D.H.)
| | - Christoph Weber
- Research Institute of Developmental Medicine, Johannes Kepler University, 4020 Linz, Austria; (P.G.P.); (C.W.); (J.F.); (D.H.)
- Department for Inclusive Education, University of Education Upper Austria, 4020 Linz, Austria
| | - Manuel Posada de la Paz
- Institute of Rare Diseases Research (IIER) & CIBERER, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence:
| | - Johannes Fellinger
- Research Institute of Developmental Medicine, Johannes Kepler University, 4020 Linz, Austria; (P.G.P.); (C.W.); (J.F.); (D.H.)
- Institut für Sinnes- und Sprachneurologie, Konventhospital Barmherzige Brüder, 4020 Linz, Austria;
- Division of Social Psychiatry, Medical University of Vienna, 1010 Vienna, Austria
| | - Anna Dirmhirn
- Institut für Sinnes- und Sprachneurologie, Konventhospital Barmherzige Brüder, 4020 Linz, Austria;
| | - Daniel Holzinger
- Research Institute of Developmental Medicine, Johannes Kepler University, 4020 Linz, Austria; (P.G.P.); (C.W.); (J.F.); (D.H.)
- Institut für Sinnes- und Sprachneurologie, Konventhospital Barmherzige Brüder, 4020 Linz, Austria;
- Institute of Linguistics, Karl-Franzens University of Graz, 8010 Graz, Austria
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Lived Experiences of Diagnostic Shifts in Child and Adolescent Mental Health Contexts: a Qualitative Interview Study with Young People and Parents. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:979-993. [PMID: 32447487 DOI: 10.1007/s10802-020-00657-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Psychiatric diagnoses are important resources in helping young people and families make sense of emotional or behavioural difficulties. However, the poor reliability of diagnoses in childhood means many young service-users experience their diagnosis being removed, revised or supplemented over time. No previous research has investigated how young service-users experience, understand or respond to alteration of their original diagnosis. The current study adopted a qualitative approach to explore the lived experience of diagnostic shifts in youth mental health contexts. Narrative interviews were conducted with families living in Ireland, who had direct experience of diagnostic shifts. Participants included 21 parents (19 female) and 14 young people (8 female, mean age = 14). Thematic analysis explored the range of interpretations and implications of diagnostic shifts in families' lives, identifying three themes that underpinned participants' narratives. Diverse Trajectories & Experiences outlined the variety of contexts for diagnostic shifts, ways they were communicated to parents and young people, and their clinical consequences. A Process of Readjustment captured processes of emotional and conceptual adaptation that followed a diagnostic shift. Finally, Social Repositioning explored how diagnostic shifts could prompt changes to interpersonal relations, social identity and stigma experiences. The study shows that diagnostic shifts carry significant emotional, social and practical repercussions. While diagnostic shifts may threaten the therapeutic relationship and service-user understanding, they also offer opportunities to enhance young people's self-concept, social relationships and therapeutic engagement. Clinician awareness of the socio-emotional implications of diagnostic shifts is vital to inform sensitive communication and support strategies.
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Prevalence and Incidence of Developmental Disorders in Korea: A Nationwide Population-Based Study. J Autism Dev Disord 2020; 50:4504-4511. [PMID: 32347466 DOI: 10.1007/s10803-020-04444-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Prevalence of developmental disorders (DDs) has been increasing worldwide. This study identifies a trend in their prevalence and incidence, using nationwide population-based data to analyze the characteristics of children with DDs in Korea. The prevalence of DDs steadily increased by more than four times (from 0.6 to 2.5) from 2003 to 2017. Boys had higher incidence than girls throughout the period, during which the gap increased from 19.1 to 31.4%. The incidence also increased by the size of city and medical insurance quartile. The ratio of autism spectrum disorder, developmental delay and language disorders among the total incident cases of DDs increased by 13.7%, 817.6%, and 30.7%, respectively, indicating their contribution to the trend of increasing prevalence.
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Gentles SJ, Nicholas DB, Jack SM, McKibbon KA, Szatmari P. Coming to understand the child has autism: A process illustrating parents' evolving readiness for engaging in care. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:470-483. [PMID: 31508991 PMCID: PMC6985991 DOI: 10.1177/1362361319874647] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
LAY ABSTRACT What is already known about the topic? Parents of children with autism often learn about their child's autism before diagnosis and can spend long periods seeking care (including assessment) before receiving a diagnosis. Meanwhile, parents' readiness to engage in care at this early stage can vary from parent to parent. What this paper adds? This study revealed how parents come to understand their child has autism-on their own terms, rather than from just talking to professionals. It also explained how parents' growing awareness of their child's autism leads them to feel more motivated to engage in care by seeking information and pursuing services. Four "optional steps" described how parents' growing readiness to engage in care at this early stage can vary, depending on their personal process. Implications for practice, research, or policy The results suggest ways that professionals can be more sensitive (a) to parents' varying awareness of autism and (b) to their varying readiness for being involved in early care. They also suggest ways to tailor parent supports to their individual situation and design care that is more family centered. Not all parents want high levels of involvement. Depending on their personal process, some parents may need care and support that is directed at them before feeling ready for professionals to engage them in care directed at the child.
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Čolić M, Dababnah S, Garbarino N, Betz G. Parental experiences raising children with autism spectrum disorder in Eastern Europe: a scoping review. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2019; 68:1-13. [PMID: 35173959 PMCID: PMC8843345 DOI: 10.1080/20473869.2019.1688931] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/30/2019] [Accepted: 10/30/2019] [Indexed: 06/14/2023]
Abstract
Parents of children with autism spectrum disorder (ASD) are often at greater risk of experiencing stress and lower quality of life, in comparison to parents of typically developing (TD) children and other developmental disabilities. Despite vast literature on parental experiences in Western countries, little is known about this topic in Eastern Europe. Thus, we aimed to map studies that addressed parental experiences of children with ASD in Eastern Europe using the Double ABCX theoretical framework. The Double ABCX Model of family adaptation describes how families responds to stressors over time, based on the intercorrelation of available resources, coping mechanisms and appraisal of stressors. Following a scoping review methodological framework, we conducted a comprehensive search of three databases. We ultimately included 15 peer-reviewed studies in the review. Within each study, we examined Double ABCX Model factors. The studies were conducted in nine Eastern European countries and included parents of children and adults with ASD. Consistent with studies conducted in Western countries, parents of children with ASD expressed more personal and family challenges and greater maladaptation compared to parents of TD children. Moreover, families reported lower satisfaction with quality of life and more health problems. The small number of included papers from nine countries suggests that parental experiences of children with ASD in Eastern Europe are overlooked in the literature. Future research should explore findings from this review that differed from the Western literature, including contributing factors to parental adaption in families in Eastern Europe.
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Affiliation(s)
- Marija Čolić
- Special Education Department, University of Hawaii at Manoa, Honolulu, USA
| | - Sarah Dababnah
- School of Social Work, University of Maryland, Baltimore, Baltimore, USA
| | - Nicole Garbarino
- School of Social Work, University of Maryland, Baltimore, Baltimore, USA
| | - Gail Betz
- University of Maryland, Baltimore, USA
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Liao X, Lei X, Li Y. Stigma among parents of children with autism: A literature review. Asian J Psychiatr 2019; 45:88-94. [PMID: 31542694 DOI: 10.1016/j.ajp.2019.09.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This literature review aims to summarize current findings from studies examined experiences of stigma among parents of children with autism. METHOD A systematic literature search was carried out to identify relevant studies. Two reviewers independently screened each records based on the selection criteria. Discrepancies were resolved through discussions. Included articles were classified by social-cultural settings. RESULT 25 studies were identified and included in the review, including 15 qualitative, 8 quantitative, and 2 mixed method studies. Parents do in fact experience courtesy stigma which subsequently develop into affiliate stigma. The study of stigma has not received enough attention for parents of children with autism. There lacked large prevalence studies and longitudinal studies examining stigma among parents of children with autism. CONCLUSION Parents of children with autism perceived and experienced stigma and various consequences which were varied with behaviors of autism and the severity of symptoms. Further studies should focus on developing intervention that help to erase stigma among parents of children with autism.
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Affiliation(s)
- Xiaoli Liao
- The Second Xiangya Hospital, Central South University, XiangYa Nursing School of Central South University, Changsha, Hunan, China.
| | - Xianyang Lei
- The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Yamin Li
- The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Jacobs D, Steyaert J, Dierickx K, Hens K. Physician View and Experience of the Diagnosis of Autism Spectrum Disorder in Young Children. Front Psychiatry 2019; 10:372. [PMID: 31191373 PMCID: PMC6547063 DOI: 10.3389/fpsyt.2019.00372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 05/13/2019] [Indexed: 12/27/2022] Open
Abstract
Introduction: Clinicians working with children with autism spectrum disorder (ASD) occupy an important position between parents and the wide-ranging research findings. However, it is not widely known how clinicians view and experience ASD in children, even though their perspective has been shown to significantly influence their work. Material and methods: Sixteen physicians working with preschool children without a diagnosis of (intellectual or other) disability with a (presumed) diagnosis of ASD participated in a semistructured interview. They described their professional views on ASD, and how they experienced its use in their clinical practice. The data were analyzed by applying the qualitative research method of interpretative phenomenological analysis of the data through Nvivo 11. Results: The main topic of the interviewed physicians' views and experiences of ASD in a young child comprised three inductively established themes: 1) physicians' views on ASD are multifaceted but fit within their personal clinical styles; 2) the ASD diagnosis is a "descriptive" part of a clinical trajectory; and 3) ASD treatment is a mix of "standard" approaches and a personalized search. These physicians' perspectives on ASD are composed of multiple and sometimes ambiguous facets. However, their views are embedded in their personal clinical styles in general (i.e., beyond ASD) and are experienced as clinically "workable." With the aim of finding an adequate approach to the problems parents bring to their office, many interviewed physicians say that-complementary to or rather than a classificatory diagnosis-they prefer using a personalized "profile" of a child in a therapeutic "process." Conclusions: The interviewed physicians consider doubts and concerns to be an inherent part of their clinical work with ASD in young children, but do not experience this ambiguity as an obstacle to clinical care. These physicians deal with the multiplicity of their views on ASD by basing their eclectic views on their generally adopted clinical styles, and by selecting what works for them, and for the parents and child, from what they regard as the 'textbook knowledge' on ASD. We discuss the implications of these findings for translating research results to the clinic.
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Affiliation(s)
- Delphine Jacobs
- Center for Biomedical Ethics and Law, Department of Medicine, KU Leuven, Leuven, Belgium
| | - Jean Steyaert
- Center for Autism Expertise, Child and Adolescent Psychiatry, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Kris Dierickx
- Center for Biomedical Ethics and Law, Department of Medicine, KU Leuven, Leuven, Belgium
| | - Kristien Hens
- Department of Philosophy, University of Antwerp, Antwerp, Belgium
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Legg H, Tickle A. UK parents’ experiences of their child receiving a diagnosis of autism spectrum disorder: A systematic review of the qualitative evidence. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 23:1897-1910. [DOI: 10.1177/1362361319841488] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The purpose of this article is to systematically identify, appraise and synthesise qualitative research concerning UK parents’ experiences of their child receiving a diagnosis of autism spectrum disorder. In total, 11 articles were located through a systematic search of five databases, reference lists, citations and grey literature. These were critically appraised and their results synthesised using meta-ethnography. The quality scores given to included studies were variable, so suggestions are made to improve reporting of future research. Three third-order constructs were developed: (1) emotional needs, (2) informational needs and (3) relational needs. Each relates to parents’ needs as they navigate the process of making sense of their child by seeking and adjusting to a diagnosis of autism spectrum disorder. Parents’ experiences of assessment and diagnosis of their children varied, but these needs were evident across the course of the process. Fathers seemed to find it more difficult than mothers to reconcile having a child with autism spectrum disorder, which may have been grounded in a sense of exclusion from the assessment process. The findings should be considered by professionals working with children, particularly those directly involved in diagnosing autism spectrum disorder. Clinical implications emphasise the need for consideration of parents’ emotional needs, provision of information to aid understanding, and strong relationships with professionals. Future clinical research, which should be informed by quality standards, might develop and evaluate standards of assessment and diagnosis, including post-diagnostic support.
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Stigmatization of Children and Adolescents with Autism Spectrum Disorders and their Families: a Scoping Study. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2019. [DOI: 10.1007/s40489-018-00156-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Nilses Å, Jingrot M, Linnsand P, Gillberg C, Nygren G. Experiences Of Immigrant Parents In Sweden Participating In A Community Assessment And Intervention Program For Preschool Children With Autism. Neuropsychiatr Dis Treat 2019; 15:3397-3410. [PMID: 31827325 PMCID: PMC6902863 DOI: 10.2147/ndt.s221908] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/31/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Barriers inherent in service systems for autism can hinder parents from getting help for their children, and this is probably especially true for immigrant parents. In order to provide accessible assessment and interventions for preschool children with autism, a multidisciplinary team was established in one district of a Swedish city, with a majority population of immigrants. AIM The aim of the present study was to gain knowledge of the parents' experiences of participating in the community assessment and intervention program. METHODS AND PROCEDURES A qualitative study with semi-structured interviews was conducted with parents of 11 children aged 3-5, who had been diagnosed with autism and participated in the community intervention program for at least 1 year. The interviews were recorded and transcribed verbatim, and data were analyzed following a phenomenological hermeneutical method. RESULTS The overall meaning of the parents' narratives was interpreted as "A new way of understanding my child made life more hopeful and more challenging than before". Their experience was interpreted as a process, captured in the three main themes: "An overwhelming diagnosis", "Cooperating with the team", and "Growing as a parent". CONCLUSION As lacking knowledge of available resources and support seems to be an important barrier to access services, the results underscore the importance of providing individually tailored services including comprehensive societal support to immigrant families with young children suffering from autism. The study also highlights the importance of addressing the parents' previous awareness and knowledge of autism early in the assessment process, as well as continually involving parents in the intervention program, and this may enhance parental growth.
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Affiliation(s)
- Åsa Nilses
- Center for Progress in Children's Mental Health, Region Vastra Gotaland, Gothenburg, Sweden
| | - Marianne Jingrot
- Research and Development Primary Health Care, Region Vastra Gotaland, Gothenburg, Sweden
| | - Petra Linnsand
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Child and Adolescent Specialist Centre, Angered Hospital, Region Vastra Gotaland, Angered, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Gudrun Nygren
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Child and Adolescent Specialist Centre, Angered Hospital, Region Vastra Gotaland, Angered, Sweden
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Sritharan B, Koola MM. Barriers faced by immigrant families of children with autism: A program to address the challenges. Asian J Psychiatr 2019; 39:53-57. [PMID: 30572272 DOI: 10.1016/j.ajp.2018.11.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 11/16/2018] [Accepted: 11/24/2018] [Indexed: 10/27/2022]
Abstract
Autism spectrum disorder (ASD) is a pervasive neurodevelopmental disorder characterized by social, communication, and behavioral deficits. Fortunately, early intervention has proved to be of significant benefit in the lives of children with ASD. However, timely access to health services and support requires equitable access, which is often a challenge for immigrant families. Barriers to equal access and support for immigrant families of children with ASD include cultural beliefs about child development and ASD, delayed diagnosis, access to services, and negative perceptions of services. There is a shortage of studies that explore how to increase understanding and collaboration among the immigrant population and health care practitioners to address these barriers. The barriers can indeed be appropriately addressed with structured programs and cultural models. The objectives of this article are to shed light on how barriers impact outcomes of immigrant children with ASD and to describe a culturally sensitive program model to address the barriers and provide awareness, education, and interventions for these immigrant families. The South Asian Autism Awareness Center in Toronto, Canada is presented as an example of such a model.
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Affiliation(s)
| | - Maju Mathew Koola
- Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington DC, USA.
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Diagnostic accuracy of the ADOS and ADOS-2 in clinical practice. Eur Child Adolesc Psychiatry 2018; 27:1193-1207. [PMID: 29560529 DOI: 10.1007/s00787-018-1143-y] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 03/09/2018] [Indexed: 12/22/2022]
Abstract
The Autism Diagnostic Observation Schedule is a semi-structured, standardized assessment tool for individuals with suspected autism spectrum disorders (ASD) and is deemed to be part of the gold standard for diagnostic evaluation. Good diagnostic accuracy and interpersonal objectivity have been demonstrated for the ADOS in research setting. The question arises whether this is also true for daily clinical practice and whether diagnostic accuracy depends on specialized experience in the diagnostic evaluation. The present study explores the diagnostic accuracy of the original and the revised version of the ADOS for Modules 1 through 4. Thus, seven cases of ADOS executions were recorded and coded by a group of experts of specialized outpatient clinics for ASD. In an extensive consensus process, including video analysis of every minute of the ADOS executions, a "gold standard" coding for every case was defined. The videos of the ADOS administration were presented to a large group of clinicians (from daily clinical routine care) and their codings (n = 189) were obtained and analysed. Variance of coding and congruence with the expert coding were determined. High variance was found in the codings. The accuracy of the coding depends on the experience of the coder with the ADOS as well as on characteristics of the cases and the quality of the administration of the ADOS. Specialization in the diagnostic of ASD has to be claimed. Specialized outpatient clinics for ASD are required which guarantee a qualified diagnostic/differential diagnostic and case management with the aim of demand-oriented supply of individual cases.
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O'Connor C, Kadianaki I, Maunder K, McNicholas F. How does psychiatric diagnosis affect young people's self-concept and social identity? A systematic review and synthesis of the qualitative literature. Soc Sci Med 2018; 212:94-119. [PMID: 30029092 DOI: 10.1016/j.socscimed.2018.07.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 06/28/2018] [Accepted: 07/06/2018] [Indexed: 11/26/2022]
Abstract
Receiving a psychiatric diagnosis in childhood or adolescence can have numerous social, emotional and practical repercussions. Among the most important of these are the implications for a young person's self-concept and social identity. To ensure diagnoses are communicated and managed in a way that optimally benefits mental health trajectories, understanding young people's first-hand experience of living with a diagnosis is paramount. This systematic review collates, evaluates and synthesises the qualitative research that has explored how psychiatric diagnosis interacts with young people's self-concept and social identity. A search of 10 electronic databases identified 3892 citations, 38 of which met inclusion criteria. The 38 studies were generally evaluated as moderate-to-high quality research. Thematic synthesis of their findings highlighted the multifaceted ways diagnosis affects young people's self-concept and social identity. Diagnosis can sometimes threaten and devalue young people's self-concept, but can also facilitate self-understanding, self-legitimation and self-enhancement. A diagnosis can lead to social alienation, invalidation and stigmatisation, yet can also promote social identification and acceptance. Further research is needed to clarify which self and identity outcomes can be expected in a given set of circumstances, and to establish how self and identity effects interact with diagnoses' other clinical, practical, social and emotional consequences.
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Affiliation(s)
- Cliodhna O'Connor
- School of Psychology, University College Dublin, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland.
| | | | - Kristen Maunder
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Fiona McNicholas
- School of Medicine, University College Dublin, Dublin, Ireland; Our Lady's Children's Hospital Crumlin, Dublin, Ireland; Lucena Clinic, Rathgar, Dublin, Ireland
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Denman K, Smart C, Dallos R, Levett P. How Families Make Sense of Their Child's Behaviour When on an Autism Assessment and Diagnosis Waiting List. J Autism Dev Disord 2017; 46:3408-3423. [PMID: 27480420 DOI: 10.1007/s10803-016-2873-7] [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] [Indexed: 10/21/2022]
Abstract
Families waiting for an Autism Spectrum Condition assessment often experience difficulties explaining, or making sense of, the referred young person's behaviour. Little is known about this sense making, or how clinicians might support this ambiguity. This paper explored finite details of how five families do 'sense-making' in conversations with each other, while on the waiting list for an ASC assessment. A Discursive Psychology analysis of these conversations found that sense making was affected by (1) an interactional pattern of interruptions impeding the progress of sense making narratives; (2) face saving to maintain positive identities and shared understanding; and (3) difficulties in word finding within sense making narratives. These practices challenged the production of a coherent family sense making narrative.
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Affiliation(s)
- Katie Denman
- Clinical Psychology, Plymouth University, Rolle Building, Drake Circus, Plymouth, Devon, PL4 8AA, UK.
| | - Cordet Smart
- Clinical Psychology, Plymouth University, Rolle Building, Drake Circus, Plymouth, Devon, PL4 8AA, UK
| | - Rudi Dallos
- Clinical Psychology, Plymouth University, Rolle Building, Drake Circus, Plymouth, Devon, PL4 8AA, UK
| | - Paula Levett
- Virgin Care Children's Integrated Services, Lescaze Offices, Shinners Bridge, Dartington, Devon, TQ9 6JE, UK
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Bargiela S, Steward R, Mandy W. The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype. J Autism Dev Disord 2017; 46:3281-94. [PMID: 27457364 PMCID: PMC5040731 DOI: 10.1007/s10803-016-2872-8] [Citation(s) in RCA: 425] [Impact Index Per Article: 60.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We used Framework Analysis to investigate the female autism phenotype and its impact upon the under-recognition of autism spectrum conditions (ASC) in girls and women. Fourteen women with ASC (aged 22–30 years) diagnosed in late adolescence or adulthood gave in-depth accounts of: ‘pretending to be normal’; of how their gender led various professionals to miss their ASC; and of conflicts between ASC and a traditional feminine identity. Experiences of sexual abuse were widespread in this sample, partially reflecting specific vulnerabilities from being a female with undiagnosed ASC. Training would improve teachers’ and clinicians’ recognition of ASC in females, so that timely identification can mitigate risks and promote wellbeing of girls and women on the autism spectrum.
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Affiliation(s)
- Sarah Bargiela
- Research Department of Clinical, Educational and Health Psychology, UCL, Gower Street, London, WC1E 6BT, UK
| | - Robyn Steward
- Centre for Research in Autism and Education, UCL Institute of Child Health, 55-59 Gordon Square, London, WC1H 0NU, UK
| | - William Mandy
- Research Department of Clinical, Educational and Health Psychology, UCL, Gower Street, London, WC1E 6BT, UK.
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Mediating Effects of Social Support on Quality of Life for Parents of Adults with Autism. J Autism Dev Disord 2017; 47:2378-2389. [DOI: 10.1007/s10803-017-3157-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Webster AA, Garvis S. The importance of critical life moments: An explorative study of successful women with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 21:670-677. [PMID: 28749234 DOI: 10.1177/1362361316677719] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ten women with autism spectrum disorder participated in oral interviews in order to share their experiences since their diagnosis and to discuss the factors that had enabled them to achieve success in different aspects of their life. Participants were encouraged to share their perspectives on their success and to discuss the challenges they encountered in their daily lives and how they overcame these. Interviews were analysed using a narrative-themed approach. Participants indicated that both internal and external factors enabled them to achieve success in different aspects of their lives. These included being an agent of change, a changed identity after diagnosis, experiencing the belief of others in their capability and seeing themselves as a mentor to others. Their experiences with overcoming obstacles in their lives enabled them to develop self-efficacy and to shape their own success.
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Carlsson E, Miniscalco C, Kadesjö B, Laakso K. Negotiating knowledge: parents' experience of the neuropsychiatric diagnostic process for children with autism. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2016; 51:328-338. [PMID: 26833425 DOI: 10.1111/1460-6984.12210] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 08/20/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Parents often recognize problems in their child's development earlier than health professionals do and there is new emphasis on the importance of involving parents in the diagnostic process. In Gothenburg, Sweden, over 100 children were identified as having an autism spectrum disorder (ASD) in 2009-11 through a general population language and autism screening of 2.5 year olds at the city's child healthcare centres. AIMS To increase understanding of parents' lived experience of the neuropsychiatric diagnostic process, i.e. the period from the initial screening at age 2.5 years to the 2-year follow-up of the ASD diagnosis. METHODS & PROCEDURES A qualitative design, a phenomenological hermeneutic method, was used. Interviews were conducted with parents of 11 children who were diagnosed with ASD 2 years prior. The parents were interviewed about their experiences of the neuropsychiatric diagnostic process, i.e. the time before the screening, the time during the neuropsychiatric multidisciplinary evaluation and the time after diagnosis. The interviews lasted for 45-130 min, and an interview guide with set questions was used. Most of the interviews were conducted at the parents' homes. OUTCOMES & RESULTS The essence that emerged from the data was negotiating knowledge, and the three themes capturing the parents' experiences of going through the process of having their child diagnosed with ASD were seeking knowledge, trusting and challenging experts, and empowered but alone. CONCLUSIONS & IMPLICATIONS The parents expected intervention to start directly after diagnosis but felt they had to fight to obtain the resources their child needed. After the process, they described that they felt empowered but still alone, i.e. although they received useful and important information about their child, they were left to manage the situation by themselves. As for clinical implications, the study points to the necessity of developing routines to support the parents during and after the diagnostic process. Recommended measures include developing a checklist outlining relevant contacts and agencies, establishing a coordinator responsible for each child, dividing the summary meeting at the clinic into two parts, making more than one visit to the preschool, and providing a parental training programme.
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Affiliation(s)
- Emilia Carlsson
- Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Carmela Miniscalco
- Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Björn Kadesjö
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Katja Laakso
- Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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