The autism diagnostic experiences of French parents

Understanding autism diagnosis in primary care: Rates of diagnosis from 2004 to 2019 and child age at diagnosis

LAY ABSTRACT

The current demand for autism diagnostic services exceeds the ability of the workforce to assess and diagnose children in a timely manner. One solution may be to equip primary care providers (PCPs) with the tools and expertise needed to diagnose autism within their practice. PCPs are often trusted professionals who have many touchpoints with children during early development, in which they can identify early signs of autism. Recent initiatives have focused on bolstering PCPs' diagnostic capabilities; however, no studies have examined how the rates of autism diagnosis in primary care have changed over time. We aimed to evaluate whether autism diagnosis in primary care has changed over time and how diagnosis in primary care relates to a child's age at the time of diagnosis. We found that the likelihood of a child being diagnosed by a PCP decreased by about 2% with every passing year from 2004 to 2019 when accounting for demographic characteristics. In our sample, PCPs diagnosed children approximately 1 year earlier than non-PCPs (e.g., psychologists and psychiatrists). Further research is needed to understand why the proportion of children diagnosed by PCPs decreases over time. However, this decrease suggests more work is needed to get capacity-building initiatives into community primary care practice. Though we must continue to find effective ways to build community PCPs' ability to diagnose autism, the present findings support the crucial role PCPs can play in early autism diagnosis.

Autism Spectrum Disorder in Down Syndrome: Experiences from Caregivers

This study aimed to learn about the experiences of families of individuals with a dual diagnosis of Down syndrome (DS) and autism spectrum disorder (ASD) (DS-ASD), and to document the journey from early concerns to diagnosis and intervention. Caregivers completed an online survey describing their journey raising a child with DS-ASD. Survey responses were analyzed qualitatively and coded into categories to highlight common themes. Stereotypy, severe communication impairments, and behavioral difficulties prompted caregivers to pursue further evaluation. There was a mean 4.65-year gap between first noticing symptoms and receiving an ASD diagnosis. Several therapeutic interventions were identified as beneficial, including behavioral and communication support. Caregivers expressed frustration and described high levels of stress and social isolation. The diagnosis of ASD in children with DS is often delayed, and caregivers' initial concerns are frequently dismissed. Raising a child with DS-ASD can lead to social isolation and elevated caregiver stress. More research is needed to tailor diagnostic algorithms and therapeutic interventions to the unique needs of this patient population. Caregivers yearn for improved understanding of DS-ASD, more targeted therapies and educational programs, and more overall support.

Evaluating Parents' Concerns, Needs, and Levels of Satisfaction with the Services Provided for ASD Children in Saudi Arabia

Background

Supporting children with autism spectrum disorder (ASD) and their parents is vital in improving their children's abilities and their parents' ability to care for them. Thus, parents' perceptions of and levels of satisfaction with the services provided for their children must be assessed.

Aim

This study aimed to understand parents' perceptions of and satisfaction with the speech-language services (SLS) provided for ASD children in different health facilities in Saudi Arabia.

Methods

This cross-sectional study included 109 parents of ASD children. The survey included five sections dealing with (1) general information about the child; (2) assessment of the child's ASD characteristics (including their age when diagnosed, when they first noticed symptoms, and their speech, language, and communication abilities); (3) the reasons for enrollment in SLS sessions; (4) questions about SLS; and (5) parents' perceptions of SLS, satisfaction with the service, descriptions of their children's progress, and the respect and support they received.

Results

Parents' satisfaction levels were significantly higher when they had easy access to SLS, sufficient information and support, proper training in applying therapy exercises at home, and perceived respect and support from speech and language pathologists (SLPs). The reasons for discontinuing SLS included high session costs, the need for initial behavioral sessions, the lack of qualified SLPs, the end of the sessions, the lack of improvement, the nonavailability of specialized centers, and parents' dependence on home training only. They also sought opportunities for work and education, continuous and intensive SLS sessions, reduced costs, centers for adults with ASD, and accessible schools. Parents' main concerns were their children's poor speech and language skills, independence, and social acceptance.

Conclusion and Implications

The study highlighted the importance of understanding parents' experiences with SLS, identifying the factors that enhance SLS use by ASD children, and improving parents' satisfaction with such services.

Awareness of children's developmental problems and sharing of concerns with parents by preschool teachers and childcare workers: The Japanese context

BACKGROUND

This study aims to determine the extent to which preschool teachers and childcare workers are aware of the presence of developmental problems among children and to what extent they share information with parents about their concerns regarding a child's development or diagnosis of neurodevelopmental disorders (NDDs).

METHODS

We wrote to all 924 preschools and childcare centres in Japan's Nagano and Yamanashi prefectures to request participants. We then sent survey forms to the preschools and childcare centres that agreed to cooperate for three grades comprising 3-, 4- and 5-year-olds in the school year 2020. We asked the staff member in charge of each child to complete the survey. The survey included questions about the teacher's concerns regarding the possibility of an NDD and whether the matter had been shared with the children's parents.

RESULTS

We obtained data for 10 354 children from 206 preschools and childcare centres (response rate = 22.3%). Among these children, 457 (4.4%) had an NDD diagnosis that their parents shared with the teachers. However, the teachers of 1274 children (12.3%) had concerns regarding their development but were not informed by the parents about the diagnosis, if any. These 1274 children included 775 (60.8%) cases where the teachers failed to share their concerns with parents because (1) the teachers could not communicate with parents (n = 119), (2) the teachers were not sure if there was a neurodevelopmental problem (n = 360) and (3) the parents were not aware of the problem (n = 296).

CONCLUSIONS

Preschool teachers and childcare workers had concerns about the development of a substantial proportion of children in their charge. However, teachers and childcare workers did not share their concerns regarding many children's developmental problems with their parents. The findings suggest that there are challenges in information-sharing between teachers/childcare workers and parents.

Obtaining a First Diagnosis of Autism Spectrum Disorder: Descriptions of the Diagnostic Process and Correlates of Parent Satisfaction from a National Sample

Obtaining an autism spectrum disorder (ASD) diagnosis is often challenging for parents. The purpose of this study was to better understand this process and examine how elements of the process may influence parent satisfaction. A total of 406 parents of autistic children participated. Participants were administered a survey covering the ASD diagnostic process. Parents had developmental concerns early but experienced long wait times and usually attended many appointments. Mean diagnostic age was 3.26 years and overall delay was 1.20 years. Stress and being told there was "no problem" were significantly associated with parental satisfaction with the process. Findings provide insight into challenges experienced by families of autistic children and can help pinpoint areas where the diagnostic process may be improved.

The Diagnostic Period for Autism: Risk and Protective Factors for Family Quality of Life in Early Childhood

During the diagnostic evaluation period for autism or intellectual disability (ID), families of young children are at risk for poor adjustment. The present study aimed to document family quality of life (FQOL), along with associated risk and protective factors, during this critical step of families' services trajectory. FQOL was measured in a large sample of families of children recently diagnosed with a neurodevelopmental disorder and examined in relation to the type of services received, children's clinical profile, and family variables. FQOL was related to types of services, children's challenging behavior, parenting stress, and several aspects of family composition and status. These findings highlight a need for mental health support for parents, coaching interventions for challenging behaviors, and family-centered supports.

Autistic clinical profiles, age at first concern, and diagnosis among children with autism spectrum disorder

Background

To explore the relationship between autistic clinical profiles and age at first concern and diagnosis among children with autism spectrum disorder. The clinical profiles included the severity of autism, cognition, adaptability, language development, and regression.

Methods

The multivariate linear regression model was used to examine the association of diagnostic age and first-concern age with autistic clinical profiles and with further stratification analysis.

Results

A total of 801 autistic children were included. Language delay and regression were associated with earlier diagnostic age (language delay: crudeβ: -0.80, 95%CI%: -0.92--0.68; regression: crudeβ: -0.21, 95%CI%: -0.43--0.00) and the age of first concern of autistic children (language delay: crudeβ: -0.55, 95%CI%: -0.65--0.45; regression: crudeβ: -0.17, 95%CI%: -0.34--0.00). After stratification by sex, language delay tended to be more associated with the earlier diagnostic age among boys (crudeβ: -0.85, 95%CI%: -0.98--0.72) than among girls (crudeβ: -0.46, 95%CI%: -0.77--0.16). After stratification by maternal education level or family income level, language delay was most associated with the earlier diagnostic age in autistic children from families with higher socioeconomic levels.

Conclusion

Language delay, rather than other symptoms, promoted an earlier diagnostic age. Among male autistic children or children from families with higher socioeconomic levels, language delay was most significantly associated with an earlier age of diagnosis. Cognitive delay, or adaptive delay, was associated with a later age at diagnosis and presented only in autistic children from families with lower socioeconomic levels. There may be sex or socioeconomic inequality in the diagnostic age for autistic children. More publicity and public education about the diversity of autistic symptoms are urgently needed in the future, especially for low-socioeconomic families.

The Diagnostic Process for Children with Autism Spectrum Disorder: A Preliminary Study of Jordanian Parents' Perspectives

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.

Barriers and facilitators to accessibility, continuity, validity, flexibility, and provider-family relationship along the diagnostic pathway in developmental disabilities

BACKGROUND

Parents of children with developmental disabilities must navigate a complex network to obtain a diagnosis and interventions for their child. However, their subjective experience of this journey has yet to be analyzed through the lens of a theorical framework that could support research, organizational program evaluation, and facilitate providers' reflection on how to enhance families' diagnostic services trajectory.

AIMS

This study sought to examine the diagnostic journey as experienced by 77 parents whose children were recently diagnosed with developmental disabilities (e.g., autism, intellectual disability) in the metropolitan area of Montréal, Québec (Canada).

METHODS AND PROCEDURES

A mixed qualitative content analysis approach was used to describe their perspective on barriers and facilitators in reference to the five dimensions of the Evaluation of the Trajectory Autism for Parents (ETAP) model (Rivard et al., 2020): accessibility, continuity, validity, flexibility, and provider-family relationship.

OUTCOMES AND RESULTS

The barriers and facilitators related to systemic factors identified by parents were consistent with the five dimensions outlined by the ETAP model. However, beyond these characteristics of the service delivery system, parents additionally identified their own, personal facilitators CONCLUSIONS AND IMPLICATIONS: This study supports the relevance of the ETAP framework to understanding the experience of families seeking a diagnosis. It also reinforces the potential contributions of this model to organize extant and future research as well as structure program evaluation and improvements.

Examination of mother's opinions on developmental differences of children with autism in early period

Early diagnosis is extremely important for children with autism spectrum disorder (ASD), as other children having developmental disabilities. In early diagnosis, which is one of the most important elements of the treatment process, parents have a special place with different factors. Considering the importance of parents in early diagnosis, the aim of the study is to examine the opinions of the mother on early developmental differences in children with autism. The research is a case study designed in a qualitative research model. Accordingly, an interview form was developed by the researchers and data were collected in the scanning model in the first step of the study. In the second step of the study, data were obtained by using the semi-structured interview method, which is one of the qualitative research methods. In the study group of the research, 110 mothers were interviewed, whom were selected via purposeful sampling, and 87 mothers, who gave full answers to the questions, were included in the study. The data obtained were subjected to descriptive and thematic analysis. As a result of the study, it was found that children diagnosed with autism and children with development showed similar developmental characteristics during pregnancy and after birth. It was observed that mothers with a child diagnosed with autism have the awareness on the suspicion of autism in their children when they are between 18 and 24 months and 31 and 36 months, and they experienced problems in breast-feeding and falling asleep.

Parent experiences of obtaining an autism diagnosis for their daughter: An interpretative phenomenological analysis

LAY ABSTRACT

Autistic females are often diagnosed later than males and are also more likely to be misdiagnosed with other conditions. Co-occurring conditions may also be diagnosed at the time of the assessment but their autism diagnosis is missed. The majority of research examining the parent experience of obtaining an autism diagnosis for their child has included predominantly or exclusively male children in their samples. This study examines the experiences of parents in obtaining an autism diagnosis for their daughters in Australia through interview data which allowed for an exploration of their lived experiences. Several of the parents reported positive feelings of excitement or curiosity in relation to the assessment process which are emotions that have not been reported in earlier studies. While recent research advances have improved our understanding of gender differences in autistic behaviours, the findings of this study suggest that some practitioners have obsolete knowledge which may lead to misdiagnosis or missed diagnosis in some females. Although the extent that these experiences are representative of parents in the wider community is unknown, the fact that they are still being reported in the present day suggests that a proportion of health professionals continue to practice with outdated conceptualisations of autism.

Parental perception of the process of communicating a diagnosis of autism spectrum disorder in the Republic of Croatia

The process of communicating a diagnosis of an autism spectrum disorder (ASD) stands out as the first important factor when confronting parents with such a diagnosis for their child. The situation in which a child is diagnosed with ASD is viewed as certainly one of the most stressful moments for parents. Previous research has indicated several factors that affect the positivity of parents' experiences. Therefore, the aim of the current study was to examine the experiences of parents in the Republic of Croatia concerning the process of communicating a diagnosis of ASD to them and to show the satisfaction level of parents with the characteristics of this procedure. The study involved 52 parents of children who were either suspected of having or diagnosed with ASD. For the purposes of the research, a questionnaire was constructed. The results showed a relatively high degree of parental satisfaction with the process of communicating a diagnosis of ASD. A significant correlation was found between parental satisfaction and the presence of positive characteristics in both the diagnostic process and communicating the diagnosis. However, the results also indicated that there is much room for improvement regarding the conditions and manner of expressing this unwanted news.

Is traditional back translation enough? Comparison of translation methodology for an ASD screening tool

Early identification of autism spectrum disorders (ASD) in non-English speaking children often relies on translation of English ASD screening measures. Most measures employ a forward-back translation approach, despite data suggesting that this method may result in poor psychometric properties. Some studies in non-ASD fields have suggested that a rigorous method of translation with cultural adaptation may yield better psychometric properties, but no studies in the ASD field have compared the two approaches directly. This investigation compares these two translation methodologies to determine if they produce psychometrically similar or dissimilar measures. Three hundred and eighty US-based Spanish-speaking caregivers of children 8-16 months old were randomly assigned to complete either a forward-back Spanish translation or a rigorous translation with cultural adaptation of a parent-report ASD screening tool. Measurement invariance analyses determined that the two translations were psychometrically dissimilar. Additional qualitative explanatory methods using cognitive interviews examined textual differences and participant preferences between non-invariant items. LAY SUMMARY: Autism screening questionnaires created in English need to be translated into other languages so non-English speaking parents can fill them out accurately. Traditionally, researchers have not considered cultural differences when they translate these questionnaires. When we compared a direct translation to a translation with cultural adaptations, the two questionnaires were statistically different. Parents interpreted and responded to the same questions differently, depending on which version they filled out.

Self-reported needs of caregivers of people with Autism Spectrum Disorder

OBJECTIVES

Autism spectrum disorder (ASD) has a major impact on caregivers. We aimed to describe caregivers' perceptions concerning their level of knowledge about ASD and their needs to better adapt education and training programs.

METHODS

This was a descriptive cross-sectional study conducted through a declarative and self-administered survey in France.

RESULTS

1,013 individuals answered the questionnaire in 2020. If most caregivers felt they had sufficient knowledge about ASD, they still expressed a high level of needs regarding acquiring knowledge, identifying available resources, and finding social/emotional support.

CONCLUSIONS

This study highlights the high level of needs of caregivers and their expectations of improving their knowledge and skills to help the person with ASD.

Determinants of satisfaction with the detection process of autism in Europe: Results from the ASDEU study

LAY ABSTRACT

Professional guidance and support in response to first concerns appears to be an important predictor of the level of satisfaction with the detection process of autism in young children. In this study, we analyzed the views of 1342 family members, including 1278 parents, who completed an online survey form collecting information about their experience and satisfaction with the early detection of autism in their child. Specifically, we were interested in how specific experiences with the detection process relate to the satisfaction with it and whether we could identify important predictors of satisfaction. The detection process is an emotionally charged period for parents, often described as painful, chaotic, and lengthy. A better understanding of their experiences is important to take appropriate action to improve the detection process. In our sample, the level of satisfaction with the detection process varied greatly from one respondent to another. Among the different experiences we considered, whether or not respondents received professional guidance and support in response to first concerns explained most of this variation. We also found that difficulty finding information about detection services, lack of professional guidance and support in response to first concerns, having to find a diagnostic service on one's own, and longer delays between confirmation of concerns and first appointment with a specialist were experiences associated with a greater likelihood of being unsatisfied. The findings of this study highlight the importance of the parent-professional relationship in the detection process and have important practical implications for health administrations to improve the detection process.

Factors associated with age of diagnosis in children with autism spectrum disorders: Report from a French cohort

LAY ABSTRACT

Autism spectrum disorder is an early onset neurodevelopmental disorder and diagnosis can be made as early as 18 months of age. Early diagnosis of autism spectrum disorder is critical as it leads to early intervention. Age of autism spectrum disorder diagnosis has been linked to the child profile as autism spectrum disorder is characterized by strong heterogeneity, but is also influenced by socio-economic factors. There is paucity of data on age of diagnosis of autism spectrum disorder in France. We therefore examined the age of autism spectrum disorder diagnosis in 554 children and adolescents enrolled in the ELENA cohort study with respect to the influences of child profile, family antecedents, and socio-economic factors. The mean age of diagnosis was 4.9 years (±2.8 years). Early diagnosis, before 3 years of age, was related to the co-occurrence of intellectual disability, higher autism spectrum disorder symptom severity, and lower communicative abilities. Children in low socio-economic status families tended to have an earlier diagnosis, but these children also had greater degree of intellectual impairment compared to children in high socio-economic status families. The age of autism spectrum disorder diagnosis was not associated with the presence of an older sibling with autism spectrum disorder. The observed current trend of an inverse relationship between socio-economic status and age of diagnosis of autism spectrum disorder suggests equitable access to autism spectrum disorder services in France where health coverage is universal and free. Better screening of more subtle/less severe forms of autism spectrum disorder is needed, as well as further assessment of the link between the co-occurrence of autism spectrum disorder and intellectual impairment in children in lower socio-economic status families.

Challenges on Diagnoses and Assessments Related to Autism Spectrum Disorder in Brazil: A Systematic Review

Being a continental country, with over 210 million citizens, Brazil is similar to all of those who are part of the LAMIC (Low and middle income countries). It shows a big concentration of wealth, mainly in its south and southeast regions, as well as areas with immense poverty. In that sense, the health system also faces a huge amount of contrast. Inside University hospitals and facilities there are sophisticated tools and trained doctors prepared to assist in any kind of medical subject, including autism. But, unfortunately, at other times, the access to a good health system is made much harder. This results in many issues in the medical community, e.g., looking at the data regarding autism, there is a high average of the age of diagnosis. Another issue is the low number of professionals trained in ASD diagnosis and the few tools translated to Portuguese.

Family Impact During the Time Between Autism Screening and Definitive Diagnosis

Over the past 10 years, identification of Autism Spectrum Disorder (ASD) risk has dramatically increased due to the wide-spread implementation of screening programs; yet, there is limited understanding about parent perceptions and experiences during the time period when risk is identified, but prior to receiving a formal diagnosis-a period that can last months to years given the long wait-lists for formal ASD evaluations. The current study aimed to examine parent perceptions of family impact (i.e., the impact their child's behaviors have on the family) between the time of risk-identification and formal diagnosis among 277 children identified as at-risk for ASD through screening positive in primary care. We aimed to compare family impact among those whose child met diagnostic criteria for ASD and those who did not. Parents of children who received a non-ASD diagnosis reported a higher baseline level of family impact (F[1, 274] = 5.82, p = .017); however, perceived difficult child behavior was a stronger predictor of family impact (t[6] = 13.11, p < .001) than later diagnostic group (t[6] = - 2.10, p = .037), and child functioning did not predict family impact (t[6] = -0.31, p = .76). These results suggest that in this population, perceived difficult child behavior is a stronger predictor of family impact than later diagnostic category and should be considered an important factor in family support.

Rigorous Translation and Cultural Adaptation of an Autism Screening Tool: First Years Inventory as a Case Study

Screening tools for autism spectrum disorders serve a vital role in early identification of all children who may need evaluation and support. Recent studies suggest that traditional methods used in this field to translate such tools may be insufficient for maintaining linguistic, construct, or technical equivalence, resulting in screening tools that do not meet high psychometric standards in the new population. This study implemented a rigorous translation and cultural adaptation process by translating the First Years Inventory v3.1 (Baranek et al. First year inventory (FYI) 3.1. University of North Carolina at Chapel Hill Chapel Hill, NC, 2003) for a US-based Spanish-speaking population. A description of this process is provided with results from data collected during each phase. The unique challenges that were identified and addressed are detailed for future translation teams.

Parent stress and coping trajectories in Hispanic and non-Hispanic families of children at risk of autism spectrum disorder

LAY ABSTRACT

Little is known about parent experiences throughout the diagnostic process for autism or how these parent experiences may help explain the disparities that exist between Hispanic and non-Hispanic families in time-to-diagnosis among children identified as at risk for autism. The current study examined trajectories of parenting stress, coping, and perceived family impact over time, throughout the autism diagnostic process among Hispanic and non-Hispanic families. Hispanic families reported lower levels of parenting stress, coping, and negative family impact across time. Further, there were differences in the change in use of coping and the amount of negative family impact reported between Hispanic and non-Hispanic parents over time. These differences shed light on the unique experiences and strengths of Hispanic families demonstrate. Interventions that leverage those strengths and focus on education, empowerment, and resilience might be particularly beneficial for Hispanic families and may also better inform work to increase resilience.

How children with autism spectrum disorder perceive themselves: A narrative research

AIM

The purpose of this article is, through a dialog between the child and the author, to clarify how children with autism spectrum disorder (ASD) perceive themselves.

METHODS

The qualitative study's participants were nine children with ASD. Their ages were 8-18 years. Data were collected through two sessions of dialog between the child and the author. Data were analyzed through a qualitative inductive approach based on the perspectives of narrative analysis.

RESULTS

There were eight categories of how the children perceive themselves. The children talked about themselves as follows. The children with ASD wished to share feelings with others, sensitively read between the lines, and talked about the belief to cherish their friends. They were able to anticipate that repetitive behavior or interest in one thing would end someday. And they then made an effort to deal with problematic matters in social life.

CONCLUSION

This article proposes to understand the experience of "increasing alienation" in children with ASD. As a type of support to understand the child, this article proposed a dialog that elicits communication arrangements, specifically a dialog that focuses on forming a profound relationship of being able to share and communicate with each other.

Parent Experiences of Autism Spectrum Disorder Diagnosis: a Scoping Review

The 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.

First Alarm and Time of Diagnosis in Autism Spectrum Disorders

Early diagnosis of autism spectrum disorder (ASD) is of paramount importance as it opens the road to early intervention, which is associated with better prognosis. However, early diagnosis is often delayed until preschool or school age. The purpose of the current retrospective study was to explore the age of recognition of first alarming symptoms in boys and girls as well as the age at diagnosis of different subtypes of ASD in a small sample. A total of 128 parents' of children with ASDs were participated in the survey by completing a self-report questionnaire about early signs and symptoms that raised their concern. Parents of children with autism voiced concerns earlier and obtained diagnosis significantly earlier compared to parents of children with Asperger syndrome (p value <0.000). No significant difference (p value<0.05) has been detected between males and females in early manifestation of first signs and symptoms of ASD. The mean age at diagnosis was 3.8 years for autistic disorder, 6.2 years for children with Asperger syndrome and 6.4 years for other, e.g., PDD-NOS. The most commonly reported symptoms were speech and language problems (p value = 0.001) for children who were later diagnosed with autism, while behavior problems (p value = 0.046) as well as difficulties in education at school (p value = 0.013) for children with Asperger syndrome. The gap between early identification and diagnosis pinpoints the urgent need for national systematic early screening, the development of reliable and sensitive diagnostic instruments for infants and toddlers and heightened awareness of early signs of ASD among parents, teachers, and healthcare professionals and providers as well.

Should we use the Parental Stress Index-Short Form in parents of children with ASD? A French validation study

BACKGROUND

Parents of children with Autism Spectrum Disorder (ASD) exhibit higher levels of parental stress than parents of typically developing children. The most frequently used tools to assess parental stress is the Parenting Stress Index (PSI) or its Short Form (PSI-SF).

AIMS

This study was designed to test the validity of the PSI-SF in French parents of children with ASD (N = 370).

METHODS AND PROCEDURES

First, a confirmatory factor analysis was conducted to test the initial 3-factor structure (36 items) which indicate a poor model fit. Then, an exploratory factor analysis was performed and convergent validity was assessed.

OUTCOMES AND RESULTS

A 3-factor structure (21 items) explaining 44 % of the variance was observed. Dimensions were moderately correlated and exhibited good internal consistency. Convergent validity was checked through the PSI-SF association with anxiety and depression (HADS), quality of life (WHOQOL-Brief) and appraisal of being a parent of a child with ASD (ALES).

CONCLUSIONS AND IMPLICATIONS

Future research should use the full version of the PSI-SF and examine its factor structure. More studies on the factor structure of the PSI-SF are needed to find out if it is a suitable tool for measuring stress in parents of children with ASD in France.

A developmental and sequenced one-to-one educational intervention (DS1-EI) for autism spectrum disorder and intellectual disability: A three-year randomized, single-blind controlled trial

BACKGROUND

Children with autism spectrum disorder (ASD) and intellectual disability (ID) are an understudied population whose school inclusion is challenging.

METHODS

We assessed the effects of "Developmental and Sequenced one-to-one Educational Intervention" (DS1-EI), a ten-hour-per-week adapted instruction programme for five- to nine-year-old children with ASD and ID treated in outpatient health care institutions. A single-blind multisite randomized controlled trial was conducted to compare DS1-EI given for three years with treatment as usual (TAU)(trial registration numbers: ANSM130282B-31 (April 16, 2013) and ACTRN12616000592448). The primary outcome was the change in the psycho-educational profile (PEP). Secondary variables included the Childhood Autism Rating Scale (CARS), Autism Diagnostic Interview-Revised (ADI-R), Vineland Adaptive Behaviour Scale-II (VABS-II), Children's Global Assessment Scale (CGAS) and annual assessment of educational achievement. Statistical analyses used linear mixed models.

FINDINGS

Seventy-two participants with severe ASD and ID were recruited. Intention-to-treat and per-protocol analyses showed no significant group*time interaction for the PEP, CARS, ADI-R, VABS-II and CGAS but a significant effect for educational achievement with a better improvement in the DS1-EI group. At the 36-month time point, more DS1-EI children were included in mainstream classrooms. Additional analyses using multivariate models taking into account moderating variables at the baseline (e.g., Developmental Quotient) confirmed that DS1-EI had a significant effect on educational outcomes.

INTERPRETATION

DS1-EI did not improve communication or social skills in children with ASD and ID compared with TAU. However, DS1-EI enhanced school skills in four domains (language, mathematics, inter modality, and school autonomy) favouring inclusion in mainstream classrooms more than TAU. Providing such adapted instruction is feasible and should be encouraged.

FUNDING

CNSA; Fondation Bettencourt-Schueller; Fondation EDF.

Developmental and sequenced one-to-one educational intervention (DS1-EI) for autism spectrum disorder and intellectual disability: a two-year interim report of a randomized single-blind multicenter controlled trial

Background

Children with autism spectrum disorder (ASD) and moderate to severe intellectual disability (ID) face many challenges. There is little evidence-based research into educational settings for children with ID and ASD and in France. Little is known about how this unserved population could benefit from intervention and education. This study assessed the feasibility and efficacy of a new intervention model using an individualized educational approach.

Methods

We conducted a randomized, single-blind controlled trial to assess a novel intervention: the “Developmental and Sequenced One-to-One Intervention (DS1-EI)”. In DS1-EI, trained teachers worked one-to-one with each child in a small classroom setting, offering 10 h per week of the intervention. The focus was on encouraging spontaneous communication, promoting skills through play with peers, supporting positive interactions, and developmental and sequenced learning. We enrolled 5- to 9-year-old children with ASD and ID across 11 French child care institutions for children with co-occurring ASD and ID. Participants were matched in dyads by developmental quotient and randomized to the treatment-as-usual (TAU) group or the DS1-EI group. Independent raters blindly assessed the primary variables: The Childhood Autism Rating scale (CARS) and the Psychoeducational Profile, third edition (PEP-3). The secondary variables included the Vineland Adaptive Behavior Scale II (VABS-II) and the Clinical Global Assessment Scale (CGAS). Here we perform interim analyses at 24 months.

Results

At baseline, 72 participants were randomized. Nine patients (5 in the DS1-EI group and 4 in the TAU group) dropped out of the study. Using linear mixed models, both intent-to-treat (ITT) and per-protocol (PP) analyses at the 12-, 18- and 24-month outcomes showed no significant group nor group-by-time interaction effects. However, we found significant improvements in most primary and secondary variables over time in both groups.

Conclusions

The study did not show that DS1-EI was superior to TAU in treating children with ASD and ID over 24 months. However, the low dropout rate shows that DS1-EI is feasible, and well accepted. As the study is still ongoing, we need to wait for data at 36 months to ensure whether DS1-EI could be recommended.

Trial registration

ANSM130282B-31 (April 16, 2013) and ACTRN12616000592448. Registered 6 May 2016, retrospectively registered, http://www.anzctr.org.au/

Autism Spectrum Disorder: The Parental Experience

In 2018, one in every 59 children was diagnosed in the United States with autism spectrum disorder (ASD). ASD is a developmental disability, which is a biologically based neurodevelopmental disorder that affects a child's social interaction and communication skills. ASD includes repetitive patterns and restrictive behaviors, which could last a lifetime. Limited awareness of disease condition, less effective coping strategies, and inadequate guidance lead to increased stress levels among parents of children with ASD. Parents experience peaks and troughs of social, emotional, and financial challenges as they go through a pre-diagnosis phase, diagnosis phase, and post-diagnosis phase. The shortage of health care providers and fragmentation of care in the health care delivery system delays early diagnosis and management of ASD. Primary care providers along with the U.S. physician workforce for patients with ASD are strongly encouraged to review their practices on early screening and diagnosis and have clearly planned out care for every child with a family-centered approach. [Journal of Psychosocial Nursing and Mental Health Services, 58(2), 14-19.].

The estimation of the functioning of families with ASD children

BACKGROUND

Autism Spectrum Disorder (ASD) is a disease described as a neurodevelopmental disorder as the impairment of social and communication functions. Life of the people with ASD depends on the early introduction of intensive therapeutic programmes, modifying the undesirable behaviours, and aimed at teaching social and communication skills.

AIMS

The goal of the present work is to estimation the functioning of families with an ASD child and compare it to the functioning of families with children not diagnosed with ASD.

METHODS

The study was performed using Flexibility and Cohesion Evaluation Scales. The study included 70 parents of ASD children, and 70 parents with children without diagnosed ASD, as the control group.

RESULTS

The parents of children with autism achieve lower results in the Balanced Cohesion sub-scale than the control group. Also, the parents of ASD children obtained higher scores in the Disengaged sub-scale than the control group.

CONCLUSIONS

The results of this papers can suggesting the risk of the appearance of a disturbed family system, functioning in families with children with ASD, which should be a trigger for providing these families with early family functioning diagnosis and consequent support and therapy.

Biographical disruption or cohesion?: How parents deal with their child's autism diagnosis

Currently, we are witnessing a precipitous rise in autism diagnoses among children, and several bodies of sociological research are attempting to explain this development. However, the experiences within parental contexts have been inadequately examined; that is, how parents feel about and act upon the awareness of their child's autism diagnosis. Drawing upon a qualitative study among Danish parents of 20 children recently diagnosed with autism, this paper contributes with situated insights into parents' experiences. We identify a spectrum of feelings towards the autism diagnosis, including both relief and grief. In the absence of theoretical notions drawing attention to how a child's diagnosis influences parents' self-conceptions and understandings of their child, we develop the concept of 'parent-biographical disruption': the parents' rethinking of themselves and their child that might be caused by a chronic condition such as autism. Based on the variety of findings, we discuss what we call 'parent-biographical cohesion' as a counterpart to 'disruption'. By 'cohesion' we refer to the diagnostic awareness potentially creating clarification for parents about the past, present and future parenting of their child instead of disrupting their self-understandings as parents. In this way, through the notion of a parental-biographical spectrum of disruption and cohesion, we emphasize the diversity in how parents deal with a child's autism diagnosis and the variety of needs for rethinking parental biographies in the wake of a diagnosis.

Actual and perceived speedy diagnoses are associated with mothers' unresolved reactions to a diagnosis of autism spectrum disorder for a child

Reaction to a child's diagnosis can strongly affect the parent, but little is known about the aspects of the diagnostic process associated with such reactions. The pre-diagnostic levels of anxiety, depression, and parenting stress of 67 volunteer mothers of children subsequently diagnosed with autism spectrum disorder were assessed, along with the children's functioning. The speed and number of professionals involved in the diagnosis were recorded, and mothers completed a post-diagnosis assessment of their perceptions of the process. Longer actual and perceived diagnosis speeds predicted resolved reactions to diagnosis. Mothers' psychological states pre-diagnosis did not predict reactions to diagnosis. Providing a measured diagnostic process, and strong relationship with mothers, rather than aiming for speed alone, may well be more productive for the parent and child.

Predictors of Caregivers' Satisfaction with the Management of Children with Autism Spectrum Disorder: A Study at Multiple Levels of Health Care

Background: Caregivers are the initial gatekeepers in the health care management of children with autism spectrum disorder (ASD). Methods: This cross-sectional study aimed to determine the factors associated with caregivers’ satisfaction with different levels of health care services in managing children with ASD in Kelantan. The satisfaction scores of 227 main caregivers of confirmed ASD children were assessed with a modified Parent Satisfaction Scale (PSS) questionnaire. Results: The analysis showed that caregivers who waited longer for a doctor’s consultation in primary care had a reduced PSS score, whereas caregivers who were satisfied with the waiting time in primary care had higher PSS scores. At the secondary care level, caregivers who possessed at least a diploma had reduced PSS scores, whereas caregivers who were satisfied with both doctors’ consultation times and occupational therapy appointments had higher PSS scores. At the tertiary care level, caregivers with an underlying medical problem and who had children undergoing occupational therapy for two months or more had reduced PSS scores. Nevertheless, the analysis showed that caregivers who were concerned with their children’s sleeping problems, who had been informed about parental support, who were satisfied with speech and occupational therapy appointments, who were satisfied with waiting times at tertiary care clinics, and who were satisfied with their doctor’s knowledge and experience had higher PSS scores. Conclusions: This study elucidated the importance of understanding caregivers’ satisfaction in attaining care for their ASD children and highlighted the need to promote factors that would increase caregivers’ satisfaction with current ASD services.

Pathways to a diagnosis of autism spectrum disorder in Germany: a survey of parents

BACKGROUND

Early identification of autism spectrum disorders (ASD) is a prerequisite for access to early interventions. Although parents often note developmental atypicalities during the first 2 years of life, many children with ASD are not diagnosed until school age. For parents, the long period between first parental concerns and diagnosis is often frustrating and accompanied by uncertainty and worry.

METHODS

This study retrospectively explored the trajectories of children with a confirmed ASD diagnosis during the diagnostic process, from first parental concerns about their child's development until the definite diagnosis. A survey concerning the diagnostic process was distributed to parents or legal guardians of children with ASD from three specialized ASD outpatient clinics in Germany.

RESULTS

The response rate was 36.9%, and the final sample consisted of carers of 207 affected children (83.6% male, mean age 12.9 years). The children had been diagnosed with childhood autism (55.6%), Asperger syndrome (24.2%), or atypical autism (20.3%). On average, parents had first concerns when their child was 23.4 months old, and an ASD diagnosis was established at a mean age of 78.5 months. Children with atypical autism or Asperger syndrome were diagnosed significantly later (83.9 and 98.1 months, respectively) than children with childhood autism (68.1 months). Children with an IQ < 85 were diagnosed much earlier than those with an IQ ≥ 85. On average, parents visited 3.4 different health professionals (SD = 2.4, range 1-20, median: 3.0) until their child received a definite ASD diagnosis. Overall, 38.5% of carers were satisfied with the diagnostic process.

CONCLUSIONS

In this sample of children with ASD in Germany, the time to diagnosis was higher than in the majority of other comparable studies. These results flag the need for improved forms of service provision and delivery for suspected cases of ASD in Germany.

Timing of Parents' Concerns Related to Autism Spectrum Disorder and its Diagnosis: A Mediation Analysis

Parents are the first to indicate concerns about their child's development in up to 80% of children with autism spectrum disorder (ASD). They often notice symptoms related to ASD around the first two years, but the average age of diagnosis is 3.5 years old. This study examined the relationships between parents' early concerns and the time lag between suspicion and diagnosis. Forty-eight Spanish-speaking families were enrolled in this study. Parents were asked about early signs that made them think that their child could possibly have ASD. Mediation analyses showed that the child's age at suspicion mediated between sibling status and the time lag between suspicion and a formal diagnosis (β = -.53, p < .01). Having another child with typical development accelerated parents' detection of ASD signs (β = -.62, p < .001). The number of social-communication concerns that parents detected mediated this relationship (β = -.28, p < .01). Parents who reported more social-communication concerns perceived these signs earlier, but have to cope with a longer time lag until diagnosis than those who reported more concerns related to restrictive and repetitive behaviors and interests, or other developmental concerns. Moreover, this relationship between concerns of ASD and the diagnoses was explained by the child's age. Training pediatricians on how to respond to parent questions and concerns could reduce the time lag between parents' concerns and diagnosis of ASD.

Infant and dyadic assessment in early community-based screening for autism spectrum disorder with the PREAUT grid

Background

The need for early treatment of autism spectrum disorders (ASD) necessitates early screening. Very few tools have been prospectively tested with infants of less than 12 months of age. The PREAUT grid is based on dyadic assessment through interaction and shared emotion and showed good metrics for predicting ASD in very-high-risk infants with West syndrome.

Methods

We assessed the ability of the PREAUT grid to predict ASD in low-risk individuals by prospectively following and screening 12,179 infants with the PREAUT grid at four (PREAUT-4) and nine (PREAUT-9) months of age. A sample of 4,835 toddlers completed the Checklist for Autism in Toddlers (CHAT) at 24 months (CHAT-24) of age. Children who were positive at one screening (N = 100) were proposed a clinical assessment (including the Children Autism Rating Scale, a Developmental Quotient, and an ICD-10-based clinical diagnosis if appropriate) in the third year of life. A randomly selected sample of 1,100 individuals who were negative at all screenings was followed by the PMI team from three to five years of age to identify prospective false negative cases. The clinical outcome was available for 45% (N = 45) of positive children and 52.6% (N = 579) of negative children.

Results

Of the 100 children who screened positive, 45 received a diagnosis at follow-up. Among those receiving a diagnosis, 22 were healthy, 10 were diagnosed with ASD, seven with intellectual disability (ID), and six had another developmental disorder. Thus, 50% of infants positive at one screening subsequently received a neurodevelopmental diagnosis. The PREAUT grid scores were significantly associated with medium and high ASD risk status on the CHAT at 24 months (odds ratio of 12.1 (95%CI: 3.0–36.8), p < 0.001, at four months and 38.1 (95%CI: 3.65–220.3), p < 0.001, at nine months). Sensitivity (Se), specificity, negative predictive values, and positive predictive values (PPVs) for PREAUT at four or nine months, and CHAT at 24 months, were similar [PREAUT-4: Se = 16.0 to 20.6%, PPV = 25.4 to 26.3%; PREAUT-9: Se = 30.5 to 41.2%, PPV = 20.2 to 36.4%; and CHAT-24: Se = 33.9 to 41.5%, PPV = 27.3 to 25.9%]. The repeated use of the screening instruments increased the Se but not PPV estimates [PREAUT and CHAT combined: Se = 67.9 to 77.7%, PPV = 19.0 to 28.0%].

Conclusions

The PREAUT grid can contribute to very early detection of ASD and its combination with the CHAT may improve the early diagnosis of ASD and other neurodevelopmental disorders.

Links between Autism Spectrum Disorder Diagnostic Status and Family Quality of Life

Quality of life is often relatively lowered in families of children with additional needs, and this may be particularly the case where additional needs are accompanied by an autism spectrum disorder (ASD). Here we explore the effects of diagnostic status specifically, comparing families with children with an ASD diagnosis with others who a) have additional needs but no signs of ASD; and b) have additional needs and signs of ASD but no diagnosis. Mothers (n = 76) of children with additional needs completed standardised questionnaires about quality of life, stress, service provision, child behaviour and presence and severity of ASD traits. In addition, a group of mothers of typically developing young people (n = 17) completed standardised questionnaires on individual and family quality of life and on the behaviour of their son or daughter. Mothers of typically developing young people had significantly higher individual and family quality of life scores than each of the three other groups. Increased severity of ASD was associated with increased maternal stress, which in turn was associated with decreased family and maternal quality of life. The group reporting the lowest quality of life and the highest stress were the mothers of individuals with signs of ASD but no diagnosis. This pattern did not seem to be explained by lack of access to services, or rates of intellectual disability or challenging behaviour in this sub-group. The finding that poor quality of life and high stress was most apparent in the sub-group of mothers with children who had signs of ASD but did not have a diagnosis of ASD suggests that an interesting topic for further investigation is whether receipt of a diagnosis itself can positively influence quality of life and levels of maternal stress.

How Taiwanese parents of children with autism spectrum disorder experience the process of obtaining a diagnosis: A descriptive phenomenological analysis

An autism spectrum disorder can result in considerable stress and confusion for parents as they attempt to understand their child's problems and obtain a diagnosis. Few studies have explored the parental experience in the context of Chinese culture. The purpose of this study was to understand the experiences of parents in Taiwan of children diagnosed with autism spectrum disorder. In total, 15 parents, 1 father and 14 mothers, were recruited by purposive sampling. This qualitative study used semi-structured interviews and descriptive phenomenological analysis. The findings indicated that parents of children diagnosed with autism spectrum disorder underwent five coping experiences during the diagnostic process: (1) uncertainty and difficulty understanding their child's behaviour, which occurred during the pre-diagnosis phase; (2) obligation to obtain professional services; (3) anxious searching for a second opinion, which occurred during the diagnosis phase; (4) acceptance and fortitude and (5) further adjustment during the post-diagnosis phase. Our findings add to our understanding of how parents experience the diagnostic process, which could improve medical professionals' counselling and support for parents at the stage of obtaining a diagnosis for their children.

A Developmental and Sequenced One-to-One Educational Intervention for Autism Spectrum Disorder: A Randomized Single-Blind Controlled Trial

INTRODUCTION

Individuals with autism spectrum disorder (ASD) who also exhibit severe-to-moderate ranges of intellectual disability (ID) still face many challenges (i.e., less evidence-based trials, less inclusion in school with peers).

METHODS

We implemented a novel model called the "Developmental and Sequenced One-to-One Educational Intervention" (DS1-EI) in 5- to 9-year-old children with co-occurring ASD and ID. The treatment protocol was adapted for school implementation by designing it using an educational agenda. The intervention was based on intensity, regular assessments, updating objectives, encouraging spontaneous communication, promoting skills through play with peers, supporting positive behaviors, providing supervision, capitalizing on teachers' unique skills, and providing developmental and sequenced learning. Developmental learning implies that the focus of training is what is close to the developmental expectations given a child's development in a specific domain. Sequenced learning means that the teacher changes the learning activities every 10-15 min to maintain the child's attention in the context of an anticipated time agenda. We selected 11 French institutions in which we implemented the model in small classrooms. Each institution recruited participants per dyads matched by age, sex, and developmental quotient. Patients from each dyad were then randomized to a DS1-EI group or a Treatment as usual (TAU) group for 36 months. The primary variables - the Childhood Autism Rating scale (CARS) and the psychoeducational profile (PEP-3) - will be blindly assessed by independent raters at the 18-month and 36-month follow-up.

DISCUSSION AND BASELINE DESCRIPTION

We enrolled 75 participants: 38 were randomized to the DS1-EI and 37 to the TAU groups. At enrollment, we found no significant differences in participants' characteristics between groups. As expected, exposure to school was the only significant difference [9.4 (±4.1) h/week in the DS1-EI group vs. 3.4 (±4.5) h/week in the TAU group, Student's t-test, t = 5.83, p < 0.001].

ETHICS AND DISSEMINATION

The protocol was authorized by the competent national regulatory authority (Agence nationale de sécurité du médicament et des produits de santé) and approved by the local Ethics Committee (Comité de Protection des Personnes) at the University Hospital Saint-Antoine (May 7, 2013). The findings will be disseminated through peer-reviewed journals and national and international conferences.

TRIAL REGISTRATION NUMBERS

ANSM130282B-31 (April 16 2013) and ACTRN12616000592448 (May 6 2016).

Impact of Diagnostic Practices on the Self-Reported Health of Mothers of Recently Diagnosed Children with ASD

Objectives: Obtaining a diagnosis of an Autism Spectrum Disorder (ASD) for a child is a pivotal point in developing the treatment plan for the child but can also be regarded as highly stressful by parents. The current study examined the impact of different aspects of the diagnosis process on the self-reported mental health of mothers of children undergoing a diagnosis for ASD in a cross-sectional cohort design. Methods: One-hundred-fifty-eight mothers of consequently diagnosed children with ASD participated. The severity of the children’s ASD and their intellectual functioning was assessed within twelve months of the diagnosis, and the mothers completed a psychometric assessment battery including the Hospital Anxiety and Depression Scale, General Health Questionnaire, and Questionnaire on Resources and Stress. Results: The actual time from first reporting a problem to obtaining a diagnosis, and the speed of the diagnostic process from first to last appointment, were both negatively related to patenting stress. In contrast, mothers’ perceptions of the speed and helpfulness of the process were negatively related to levels of anxiety and depression. The number of professionals involved in the process and the perceived coherence of the diagnosis were also negatively related to aspects of mothers’ functioning. Conclusions: Care is needed to help mothers through the diagnostic process with regard to their own functioning. Providing information and help sources throughout the process, while keeping the number of professionals involved to a minimum, may improve the parent perception of the process and reduce the negative impacts of the diagnosis on the family as a whole.

Negotiating knowledge: parents' experience of the neuropsychiatric diagnostic process for children with autism

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.

A meta-synthesis on parenting a child with autism

BACKGROUND

The lifelong nature of autism in a child has deep implications on parents as they are faced with a range of challenges and emotional consequences in raising the child. The aim of this meta-synthesis was to explore the perspectives of parents in raising a child with autism in the childhood period to gain an insight of the adaptations and beliefs of parents toward autism, their family and social experiences, as well as their perceptions toward health and educational services.

METHODS

A systematic search of six databases (PubMed, EMBASE, PsychInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects [DARE]) was conducted from inception up to September 30, 2014. Full-text English articles of qualitative studies describing parents' perceptions relating to the care of children younger than 12 years of age and diagnosed with a sole disorder of autism were included.

RESULTS

A total of 50 eligible articles were appraised and analyzed, identifying four core themes encompassing all thoughts, emotions, and experiences commonly expressed by parents: 1) The Parent, 2) Impact on the Family, 3) Social Impact, and 4) Health and Educational Services. Findings revealed that parents who have a child with autism experienced multiple challenges in different aspects of care, impacting on parents' stress and adaptation.

CONCLUSION

Health care provision should be family centered, addressing and supporting the needs of the whole family and not just the affected child, to ensure the family's well-being and quality of life in the face of a diagnosis of autism.