Broken bridges-new school transitions for students with autism spectrum disorder: A systematic review on difficulties and strategies for success

Building Better Bridges: Outcomes of a Community-Partnered New School Transition Intervention for Students on the Autism Spectrum

New school transitions can be challenging for students on the autism spectrum. No published, evidence-based interventions exist to support families and teachers of students transitioning to elementary and secondary school during this critical period. Using Community Partnered Participatory Research, we developed Building Better Bridges (BBB), a caregiver coaching intervention that includes training on effective school communication, educational rights, advocacy, and child preparation strategies. We compared BBB (n = 83) to a module/resources-only comparison (n = 87) in a four-site randomized controlled trial in racially and ethnically diverse, under-resourced communities. In our intent-to-treat analysis, caregivers and teachers in BBB rated students' transitions to the new classroom as more positive, relative to the comparison group. Results suggest this low-cost intervention can improve the transition process for families and students at high risk of poor transitions.

An Exploratory Study of Resilience to Stressful Life Events in Autistic Children

Background

Autistic children experience more stressful life events (SLEs) than their neurotypical peers, which are related to poor mental health outcomes in both neurotypical and autistic individuals. However, there is a lack of longitudinal research assessing the perceived impact of stressful life events on autistic children's mental health.

Method

Utilizing a novel statistical technique (Ratcliff et al., 2019), called 'area of resilience to stress events' or ARSE in R, we aimed to quantify aspects of resilience, growth, and non-resilience for 67 autistic children (6-13 years old) enrolled in a larger longitudinal study who experienced a SLE. Parents reported demographic information (e.g., child age, biological sex, household income) as well as the child's internalizing and externalizing symptoms and autism characteristics across multiple time points spaced one year apart (baseline, T2, T3, T4).

Results

There was substantial variability in the resilience process within the sample. Older children exhibited a less adaptive resilience process (i.e., higher total scaled scores or arsets). Perceived stress of the disruptive event was not correlated with resilience; however, there was a significant child age x stress severity interaction, suggesting that younger children in households that perceived the disruptive event as highly stressful exhibited more efficient resilience, or lower arsets scores, compared to other children.

Conclusions

This study introduces an innovative methodological approach to understanding the effects of stressful life events on the mental health of autistic children. Results have implications for family-based policy and practice and highlight for whom services may be most beneficial.

Trajectories of adaptive functioning from early childhood to adolescence in autism: Identifying turning points and key correlates of chronogeneity

Background

Previous research has demonstrated heterogeneous adaptive outcomes across the autism spectrum; however, the current literature remains limited in elucidating turning points and associated factors for longitudinal variability (chronogeneity). To address these empirical gaps, we aimed to provide a finer-grained characterization of trajectories of adaptive functioning from early childhood to adolescence in autism.

Methods

Our sample (N = 406) was drawn from an inception cohort of children diagnosed Autistic at ages 2-5. Adaptive functioning was assessed with Vineland Adaptive Behavior Scales (VABS, 2nd Edition) across 6 visits from the time of diagnosis by age 18. Parallel-process latent growth curve modeling were used to estimate domain-level VABS trajectories, followed by latent class growth analysis to identify trajectory subgroups. Child characteristics at diagnosis, family demographics, and participation outcomes at adolescence were compared across subgroups.

Results

Piecewise latent growth models best described VABS trajectories with two turning points identified at around ages 5-6 and 9-10, respectively reflecting transitions into school age and early adolescence. We parsed four VABS trajectory subgroups that vary by level of functioning and change rate for certain domains and periods. Around 16% of the sample exhibited overall adequate functioning (standard score >85) with notable early growth and social adaptation during adolescence. About 21% showed low adaptive functioning (standard score ≤70), with decreasing slopes by age 6 followed by improvements in communication and daily-living skills by age 10. The other two subgroups (63% in total) were characterized by adaptive functioning between low and adequate levels, with relatively stable trajectories entering school age. These subgroups differed most in their cognitive ability at diagnosis, household income, and social participation in adolescence.

Conclusions

We identified key individual and family characteristics and time windows associated with distinct adaptive functioning trajectories, which have important implications for providing timely and tailored supports to Autistic people across developmental stages.

Longitudinal Transition Between Regular and Special Education in Autistic Children: Predictors and Policy Effects

Inclusive education policies stimulate children with special educational needs, including autism, to attend regular education. We aimed to explore change over time in school placement and transitions of autistic children since the introduction of an inclusive education policy in the Netherlands (2014) and to examine the role of individual child characteristics. This study used longitudinal data from 2013 to 2021 on autistic children (N = 1463, aged 5-16 years). We expected an increase in regular school placements and transitions to regular schools. Surprisingly, the proportion of children with autism in regular schools slightly decreased. Special school placement was more likely for boys and autistic children with lower intelligence scores, co-occurring conditions or behavioral and peer relation problems. Younger autistic children and those with lower intelligence scores more often transferred from a regular to a special school. The opposite transition was more common in older autistic children and those with higher intelligence scores. The likelihood of special-to-regular transitions did not change, but regular-to-special transitions were more prevalent during the years just after the policy change than in later years. The inclusive policy had little impact on the school placement, and at most led to a delayed drop in referrals to special schools.

Mother and child mental health over time in children with Autism and/or ADHD in the Longitudinal Study of Australian Children

This study utilised a longitudinal population-based study to explore mother and child mental health trajectories over time from child age 0 to 14 years, between children with ASD, ADHD, or ASD + ADHD. It explored whether a bidirectional relationship between mother psychological distress and child emotional and behavioural problems (EBPs) existed. The birth cohort from the Longitudinal Study of Australian Children was used. Child EBPs were assessed using the Strengths and Difficulties Questionnaire; and mother emotional distress using the Kessler K6. Generalised estimating equations and structured equation modelling was used to understand changes over time, differences between groups and bidirectional relationships. As expected, children with ASD, ADHD or ASD + ADHD had higher EBPs than children without, and their mothers had higher levels of psychological distress across most time points, but with differing trajectories. Mothers of children with ASD (with or without ADHD) showed increasing psychological distress over time, while mothers of children with ADHD had reducing distress. The bidirectional relationship between mother and child mental health found in children without diagnoses was only partially present in children with ASD/ADHD. Findings highlight support needs and discuss implications for transactional models of parent/child emotional problems in children with neurodevelopmental disorders.

Autistic pupils' experiences in primary and post-primary schools: A scoping review and consultation with autistic pupils in Ireland

Background and aims

Autistic pupils have the right to be heard in matters concerning their education and to be active agents in shaping their school experiences. Despite this, educational policies and research have rarely included the voices of autistic children, failing to identify what they consider to be beneficial and meaningful in their own education. This study aimed to (i) summarise existing literature exploring autistic pupils' experiences at school from their own perspectives and (ii) identify gaps for future research through a consultation with autistic pupils.

Methods

A scoping review was conducted to identify studies exploring first-person accounts of autistic pupils' school experiences (primary and secondary; aged 4-18 years) published between 2005 and 2023. Thematic analysis was conducted to identify overarching thematic categories across the included studies. Review findings were discussed through a consultation with a Child and Youth Advisory Group (CYAG) comprised of autistic pupils in Ireland (N = 3), to seek feedback and inform a future research agenda.

Main contribution

Thirty-six studies were included in the review and six themes were identified: Experiences of feeling misunderstood, of bullying and masking, of feeling excluded, of anxiety, of sensory needs in school, and of being overwhelmed during transitions. Consultation with the CYAG highlighted that these six themes were consistent with autistic pupils' experiences but that reports of positive experiences were missing in the literature.

Conclusions

This study identified several gaps in the literature on the school experiences of autistic pupils, based on both the scoping review and consultation with the CYAG. While the CYAG validated the themes identified in existing literature, there is a need for greater diversity in the samples included and increased focus on the potential positive aspects of the school experience. Implications. These findings have important research implications. In particular, further studies are needed with autistic pupils at primary school level, including those who are minimally or non-speaking, as well as ensuring pupils with positive school experiences are also represented. Findings also highlight the need for continued collaboration with autistic pupils themselves in matters concerning their education.

'It's scary starting a new school': Children and young people's perspectives on wellbeing support during educational transitions

BACKGROUND

Children and young people experience various transitions throughout their education. Theory and evidence highlight that these can be complex, and poor experiences of transitions can be associated with worsened outcomes, necessitating a need to develop and implement wellbeing support. However, children and young people's views are lacking in the literature, and studies tend to focus on specific transitions rather than on what matters for wellbeing during transitions generally.

AIMS

We explore children and young people's own perceptions of what would support wellbeing during educational transitions.

SAMPLE

We engaged with 49 children and young people aged 6-17 years, using purposeful maximum variation sampling to facilitate engagement of a diverse sample across a variety of education setting types.

METHODS

We undertook focus groups, using creative methods centred around a storybook, asking participants to make decisions as headteachers about wellbeing provision in a fictional setting. Data were analysed using reflexive thematic analysis.

ANALYSIS

We constructed four themes: (1) helping children and young people understand what to expect; (2) developing and sustaining relationships and support; (3) being responsive to individual needs and vulnerabilities; and (4) managing loss and providing a sense of closure.

CONCLUSIONS

Our analysis highlights a desire among children and young people for a considered, supportive approach that recognizes their individual needs and their connection to educational communities. The study makes a methodological and conceptual contribution, demonstrating the value of adopting a multifocussed lens to researching and supporting transitions.

A Digital Mental Health App Incorporating Wearable Biosensing for Teachers of Children on the Autism Spectrum to Support Emotion Regulation: Protocol for a Pilot Randomized Controlled Trial

BACKGROUND

As much as 80% of children on the autism spectrum exhibit challenging behaviors (ie, behaviors dangerous to the self or others, behaviors that interfere with learning and development, and behaviors that interfere with socialization) that can have a devastating impact on personal and family well-being, contribute to teacher burnout, and even require hospitalization. Evidence-based practices to reduce these behaviors emphasize identifying triggers (events or antecedents that lead to challenging behaviors); however, parents and teachers often report that challenging behaviors surface with little warning. Exciting recent advances in biometric sensing and mobile computing technology allow the measurement of momentary emotion dysregulation using physiological indexes.

OBJECTIVE

We present the framework and protocol for a pilot trial that will test a mobile digital mental health app, the KeepCalm app. School-based approaches to managing challenging behaviors in children on the autism spectrum are limited by 3 key factors: children on the autism spectrum often have difficulties in communicating their emotions; it is challenging to implement evidence-based, personalized strategies for individual children in group settings; and it is difficult for teachers to track which strategies are successful for each child. KeepCalm aims to address those barriers by communicating children's stress to their teachers using physiological signaling (emotion dysregulation detection), supporting the implementation of emotion regulation strategies via smartphone pop-up notifications of top strategies for each child according to their behavior (emotion regulation strategy implementation), and easing the task of tracking outcomes by providing the child's educational team with a tool to track the most effective emotion regulation strategies for that child based on physiological stress reduction data (emotion regulation strategy evaluation).

METHODS

We will test KeepCalm with 20 educational teams of students on the autism spectrum with challenging behaviors (no exclusion based on IQ or speaking ability) in a pilot randomized waitlist-controlled field trial over a 3-month period. We will examine the usability, acceptability, feasibility, and appropriateness of KeepCalm as primary outcomes. Secondary preliminary efficacy outcomes include clinical decision support success, false positives or false negatives of stress alerts, and the reduction of challenging behaviors and emotion dysregulation. We will also examine technical outcomes, including the number of artifacts and the proportion of time children are engaged in high physical movement based on accelerometry data; test the feasibility of our recruitment strategies; and test the response rate and sensitivity to change of our measures, in preparation for a future fully powered large-scale randomized controlled trial.

RESULTS

The pilot trial will begin by September 2023.

CONCLUSIONS

Results will provide key data about important aspects of implementing KeepCalm in preschools and elementary schools and will provide preliminary data about its efficacy to reduce challenging behaviors and support emotion regulation in children on the autism spectrum.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05277194; https://www.clinicaltrials.gov/ct2/show/NCT05277194.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/45852.

The development and validation of a questionnaire on parental involvement in the transition from kindergarten to primary school for children with developmental disabilities in China

BACKGROUND

At present, there is a lack of valid and reliable instruments that can measure parental involvement in the transition from kindergarten to primary school of children with developmental disabilities (DD) in China.

AIM

This study seeks to develop and validate the questionnaire on Parental Involvement in Transition from Kindergarten to Primary School (PITKPS) for children with DD in China.

METHODS

A total of 241 parents of children with DD participated in Study 1, and another 247 parents participated in Study 2. In study 1, we used item analysis and exploratory factor analysis to screen items and explore the factor structure of the PITKPS questionnaire. In study 2, three types of validity were examined: construct validity; convergent and discriminative validity; and criterion-related validity. Internal consistency was used to measure reliability.

RESULTS

The final version of the PITKPS questionnaire comprised 37 items that examined six factors. Confirmatory factor analysis supported the use of the six-factor model, and the results indicated that the questionnaire had good reliability and validity.

CONCLUSIONS

The PITKPS questionnaire can be used as a valid tool to assess the involvement of Chinese parents in the transition from kindergarten to primary school of children with DD.

Expert Consensus on the Resource Needs of Autistic Children and Young People in Ireland During the Early Months of the COVID-19 Pandemic

The COVID-19 pandemic has brought significant changes across society. This Delphi study aimed to gain expert consensus on challenges faced and resource needs for autistic children during the COVID-19 pandemic. Round 1 of the Delphi method employed semi-structured interviews with experts (N = 24) which were thematically analysed in order to identify needs, resource targets and resource development. In a follow-up Round 2 survey participants rated emergent need and resource in order of priority. Round 2 provided consensus on challenges faced with anxiety, routine and wellbeing ranked most important. Direction on resource design was also obtained. Consensus on the challenges and resources was achieved and is being integrated into a needs-based transition resources toolkit. Future studies could make use of the Delphi method to quickly gain consensus on focus of needs in other contexts and communities.

Does the severity of autism symptoms change over time? A review of the evidence, impacts, and gaps in current knowledge

Studies evaluating change in autism symptom severity across the lifespan have yielded inconsistent results, making it difficult to assess the prevalence of meaningful change in autism symptom severity, and what characterizes it. Better understanding the ways in which autism symptoms change over time is crucial, with important implications for intervention. Synthesizing information across past studies, autism symptom severity change (especially decreases) appears common, though stability of symptoms is also frequent. Symptom severity change is characterized by variability in patterns of change between different individuals (between-person), variability in change within a person's trajectory across time (within-person), and variability in change patterns across symptom domains (i.e., social-communication, restricted/repetitive behaviors). Variability in severity change is likely impacted by differences in person-level characteristics (e.g., sex, IQ, sociodemographic factors) as well as developmental processes across time. Numerous methodological issues may impact our ability to understand how common change in symptom severity is, including varying measurement tools, analytic approaches, and change patterns between symptom domains across time. Potential implications of better understanding and characterizing symptom severity change include incorporation of severity change patterns and predictors of change into research on biomarkers, and consideration of such predictors as moderators or mediators of change in clinical practice.

Predicting academic success of autistic students in higher education

LAYMEN SUMMARY

What is already known about the topic?Autistic youths increasingly enter universities. We know from existing research that autistic students are at risk of dropping out or studying delays. Using machine learning and historical information of students, researchers can predict the academic success of bachelor students. However, we know little about what kind of information can predict whether autistic students will succeed in their studies and how accurate these predictions will be.What does this article add?In this research, we developed predictive models for the academic success of 101 autistic bachelor students. We compared these models to 2,465 students with other health conditions and 25,077 students without health conditions. The research showed that the academic success of autistic students was predictable. Moreover, these predictions were more precise than predictions of the success of students without autism.For the success of the first bachelor year, concerns with aptitude and study choice were the most important predictors. Participation in pre-education and delays at the beginning of autistic students' studies were the most influential predictors for second-year success and delays in the second and final year of their bachelor's program. In addition, academic performance in high school was the strongest predictor for degree completion in 3 years.Implications for practice, research, or policyThese insights can enable universities to develop tailored support for autistic students. Using early warning signals from administrative data, institutions can lower dropout risk and increase degree completion for autistic students.

"He's shouting so loud but nobody's hearing him": A multi-informant study of autistic pupils' experiences of school non-attendance and exclusion

Background and aims

Children and young people on the autism spectrum frequently report a range of negative educational experiences and face disproportionally high rates of school non-attendance, including school avoidance and permanent exclusion, which can have a significant impact on their well-being as well as educational and broader life outcomes. To date, few studies have examined the full range of proximal (child, parent/family, school levels) and distal (community and society levels) barriers to ensuring the school attendance and the inclusion of autistic pupils. The current study sought to do just that by examining autistic young peoples' school non-attendance and exclusion experiences from the perspectives of multiple informants.

Methods

We recruited 12 autistic pupils, who had previously experienced school avoidance and/or exclusion, from one local authority in England, United Kingdom. We conducted semi-structured interviews with the young people themselves, ten of their parents, eight of their current teachers and nine local authority professionals, including six educational psychologists and three specialist autism teachers. We analyzed interviewees' responses using reflexive thematic analysis.

Results

Interviewees gave overwhelmingly negative accounts of autistic pupils' school non-attendance and exclusion experiences. Our analysis identified a range of school-related factors they felt led to, or exacerbated, negative experiences in their former mainstream schools, and which ultimately led to their or their children's school non-attendance. It also went further to identify distal factors, including fragmented educational experiences, parents "fighting" against a complex bureaucratic system to secure appropriate education for their children, and limited professional involvement.

Conclusions

Our findings emphasize the importance of examining the broader context in which autistic pupils are embedded and demonstrate that such pupils are able to successfully attend-and even enjoy-school when they receive the appropriate care and support.

Implications

Schools and local authority professionals should seek to work in partnership with parents and autistic pupils to secure the necessary support for their inclusion in mainstream education. Government policy should support the provision of sufficient local authority professionals to adopt a more proactive approach to mitigate autistic pupils' avoidance of and exclusion from school.

Supporting self-determination of autistic students in transitions

BACKGROUND

Despite awareness of the need to support autistic students in transitions, great variability is found in transition supports provided across different school environments and staff within schools. Moreover, strategies implemented may not provide autistic students with the supports they need to reduce their anxiety and build their sense of self-determination during transitions.

AIM

The current paper aimed to determine what types of transition supports are employed in Australian schools to support autistic students and to consider these supports through the lens of self-determination theory.

METHODS

Surveys were conducted with 422 parents, educators and education specialists who provided information on transition supports employed in schools in open-ended questions. Transition supports were explored in more depth through interviews with a subset of 30 participants.

RESULTS

Findings indicate that schools provided a range of strategies, programmes and planning processes to support students in transitions. However, students were often passive recipients of supports who were rarely involved in the planning and implementation of strategies.

CONCLUSION

The results of this study suggest that current transition supports implemented in schools may support autistic students in some transitions, but are not likely to develop their self-determination to successfully navigate transitions over the long-term. WHAT THIS PAPER ADDS?: Drawing on self-determination theory, this study provides a unique and much needed examination of the types of strategies employed in schools and offers a critical reflection as to whether these strategies are likely to support autistic students to develop a sense of autonomy, competence and relatedness to successfully manage future transitions.

Comparing output from two methods of participatory design for developing implementation strategies: traditional contextual inquiry vs. rapid crowd sourcing

Background

Participatory design methods are a key component of designing tailored implementation strategies. These methods vary in the resources required to execute and analyze their outputs. No work to date has examined the extent to which the output obtained from different approaches to participatory design varies.

Methods

We concurrently used two separate participatory design methods: (1) field observations and qualitative interviews (i.e., traditional contextual inquiry) and (2) rapid crowd sourcing (an innovation tournament). Our goal was to generate and compare information to tailor implementation strategies to increase the use of evidence-based data collection practices among one-to-one aides working with children with autism. Each method was executed and analyzed by study team members blinded to the output of the other method. We estimated the personnel time and monetary costs associated with each method to further facilitate comparison.

Results

Observations and interviews generated nearly double the number of implementation strategies (n = 26) than did the innovation tournament (n = 14). When strategies were classified into implementation strategies from the Expert Recommendations for Implementing Change (ERIC) taxonomy, there was considerable overlap in the content of identified strategies. However, strategies derived from observations and interviews were more specific than those from the innovation tournament. Five strategies (13%) reflected content unique to observations and interviews and 3 (8%) strategies were unique to the innovation tournament. Only observations and interviews identified implementation strategies related to adapting and tailoring to context; only the innovation tournament identified implementation strategies that used incentives. Observations and interviews required more than three times the personnel hours than the innovation tournament, but the innovation tournament was more costly overall due to the technological platform used.

Conclusions

There was substantial overlap in content derived from observations and interviews and the innovation tournament, although there was greater specificity in the findings from observations and interviews. However, the innovation tournament yielded unique information. To select the best participatory design approach to inform implementation strategy design for a particular context, researchers should carefully consider unique advantages of each method and weigh the resources available to invest in the process.

Pre-service Teachers' Perspectives on Transition to Kindergarten Practices for Autistic Children

Autistic children present with unique challenges that may be associated with challenges during the kindergarten transition process. While teachers endorse transition to kindergarten practices as important, implementation of effective transition practices is inconsistent. One possible reason is limited training during pre-service education; however, research about this is scarce. This study examined pre-service teachers' knowledge of autism spectrum disorder (ASD) and transitions to kindergarten. Findings indicate a lack of knowledge regarding both autism and transition, as well as significant differences in knowledge of autism, wherein those seeking special education certification reported higher levels of knowledge. These results highlight training opportunities for preparing pre-service teachers to better serve young autistic children.

Applying a public health approach to autism research: A framework for action

Most published autism research, and the funding that supports it, remains focused on basic and clinical science. However, the public health impact of autism drives a compelling argument for utilizing a public health approach to autism research. Fundamental to the public health perspective is a focus on health determinants to improve quality of life and to reduce the potential for adverse outcomes across the general population, including in vulnerable subgroups. While the public health research process can be conceptualized as a linear, 3-stage path consisting of discovery - testing - translation/dissemination/implementation, in this paper we propose an integrated, cyclical research framework to advance autism public health objectives in a more comprehensive manner. This involves discovery of primary, secondary and tertiary determinants of health in autism; and use of this evidence base to develop and test detection, intervention, and dissemination strategies and the means to implement them in 'real world' settings. The proposed framework serves to facilitate identification of knowledge gaps, translational barriers, and shortfalls in implementation; guides an iterative research cycle; facilitates purposeful integration of stakeholders and interdisciplinary researchers; and may yield more efficient achievement of improved health and well-being among persons on the autism spectrum at the population-level. LAY SUMMARY: Scientists need better ways to identify and address gaps in autism research, conduct research with stakeholders, and use findings to improve the lives of autistic people. We recommend an approach, based in public health science, to guide research in ways that might impact lives more quickly.

Identifying autism symptom severity trajectories across childhood

An individual's autism symptom severity level can change across childhood. The prevalence and direction of change, however, are still not well understood. Nor are the characteristics of children that experience change. Symptom severity trajectories were evaluated from early to middle childhood (approximately ages 3-11) for 182 autistic children. Symptom severity change was evaluated using individual change scores and the Reliable Change Index. Fifty-one percent of participants experienced symptom severity change: 27% of children decreased in severity, 24% increased and 49% were stable. Symptom severity decreases were more common during early childhood. Severity increases occurred at both early and middle childhood but increase in social affect severity was especially prominent during middle childhood. Most children experienced significant change during only one period and remained stable during the other. Girls decreased more and increased less in symptom severity than boys. Children that increased in severity decreased in adaptive functioning across childhood. Exploratory analyses indicated that a decrease in severity was associated with higher parental education level and older parental age at the time of the child's birth. Conversely, increase in autism severity was associated with lower parental education level and younger parental age at the child's birth. These findings extend recent observations that symptom severity change is more likely than previously appreciated. An understanding of the role of both biological and sociodemographic factors in determining a child's symptom trajectory may factor into future decisions on allocation and type of interventions distributed to young autistic children. LAY SUMMARY: We studied whether a child's autism severity changed from initial diagnosis until middle childhood (ages 3-11). We found that 27% of the children decreased in severity, 24% increased and the rest stayed the same. Symptom severity decreases were more common during early childhood while severity increases were more prominent during middle childhood. We also found that girls were more likely to decrease than boys. Whether a child decreased or increased is related, in part, to parental characteristics.

Interventions and strategies to improve social support for caregivers of children with chronic diseases: An umbrella review

BACKGROUND

Social support is an important approach to improve the psychosocial health status and promote positive coping for caregivers of children with chronic diseases. Such an approach can reduce parenting stress, help resolve parenting difficulties through the use of various social support relationships.

METHODS

We performed an umbrella review methodology using the method of examination, analysis and synthesis of systematic reviews. A PRISMA flow diagram was used to show the search process. The Joanna Briggs Institute was used to appraise the quality of papers and a narrative synthesis was undertaken. Relevant English and Chinese systematic reviews were searched in Embase, PubMed, Web of science, OVID, CNKI, CBM, Wan Fang and Cochrane Library databases, until November 2021, June 2022.

RESULTS

Out of 1,905 records, we included fourteen systematic reviews for a synthesis. Evidence to promote social support for caregivers of children with chronic diseases was identified from four key aspects: (i) Intervention content; (ii) Intervention forms; (iii) Intervention time; and (iv) Sources of support.

CONCLUSIONS

The findings of this review suggest that a combination of differing interventions, especially for early family, including the content of parenting training or education, attitude building and resource provision, which can implement online is recommend. More interventional studies and quantitative evidence syntheses are still needed.

IMPACT

Adequate social support is essential to promote the psychological wellbeing of caregivers of children with chronic diseases. In the early stage of children's diseases, integrating different content and forms of interventions for caregivers' families and actively helping caregivers to identify available support resources can improve social support. The findings from this review can be used to guide caregivers of children with chronic diseases and provide evidence for healthcare professionals and social workers to carry out relevant interventions.

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

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

Ensuring Quality Transitions From Early Years' Establishments Into Primary Schools: Putting Research Into Practice

Preschool to primary school transitions can be a time of anxiety for pupils, parents, and practitioners. The purpose of this study was to investigate what should be in place to support transitions and develop a shared understanding of what constitutes a nurturing transition for children. It is hoped that sharing this across service providers will increase consistency of practice. The design took a flexible qualitative approach to ensure the co-creation of shared meaning. Following an initial exploratory activity using a Person Centered Planning (PCP) approach, four qualitative activities were identified. Early years’ staff, primary teachers, parents, and pupils were recruited as participants from within a Scottish local authority to take part in these collaborative activities with qualitative and quantitative components, which enabled the co-construction of a transition timeline that articulates the core activities needed for optimal early years’ centers (EYC) to primary transitions. This timeline outlines various preparatory activities that can be taken for all pupils and also those with identified additional support needs (ASNs). In addition, examples of excellence were identified. While this document illustrates examples of good practice, it is not meant to replace other existing positive transition work; rather it is a guide that can enhance existing procedures within any given context.

Reading and Writing Skills in Adolescents With Autism Spectrum Disorder Without Intellectual Disability

The purpose of this study is to extend the knowledge about academic achievement in individuals with autism spectrum disorder (ASD). To this end, first, we analyzed differences in a wide range of reading and writing skills in adolescents with ASD without intellectual disability (ASD-WID) and adolescents with typical development (TD). Second, these two groups were compared on academic outcomes in core subjects and indicators of successful transition to secondary school. Third, the potential contribution of literacy skills to academic outcomes was examined in the two groups. Participants were 56 adolescents between 12 and 14 years old, 30 with ASD-WID and 26 with TD. Results showed no significant differences between the two groups on measures of reading fluency or literal and inferential comprehension. However, the performance of the group with ASD was significantly lower on reading comprehension processes that assess cognitive flexibility. Regarding their written expression skills, significant differences were observed between the group with ASD and the group with TD on most of the indicators analyzed as: productivity, lexical diversity, and overall coherence (resolution component). In addition, findings showed that the deficits in reading and writing observed in the adolescents with ASD significantly affected their academic achievement, which was lower than that of their peers with TD and below what would be expected based on their intellectual capacity. Moreover, their families' perceptions of the transition to high school reflected worse adjustment and lower self-esteem, confidence, and motivation.

Disrupted Care Continuity: Testing Associations between Social Networks and Transition Success for Children with Autism

Children with autism situated in lower income families often receive intensive educational interventions as their primary form of treatment, due to financial barriers for community interventions. However, the continuity of care can be disrupted by school transitions. The quality of social relationships during the transition to a new school among parents, school staff and community providers, called the team-around-the-child (TAC), can potentially buffer a child with autism from the adverse effects caused by care disruptions. Qualities of social relationships, including trust and collaborative problem solving, can be measured using social network analysis. This study investigates if two different types of TAC relationships, defined as (1) the level of trust among team members and (2) the degree of collaborative problem solving among team members, are associated with perceived successful transitions for children with autism from lower income families. Findings suggested that TAC trust is significantly associated with the outcome of transition success for children with autism immediately post-transition.

Trajectories of Symptom Severity in Children with Autism: Variability and Turning Points through the Transition to School

This study examined the trajectories of autistic symptom severity in an inception cohort of 187 children with ASD assessed across four time points from diagnosis to age 10. Trajectory groups were derived using multivariate cluster analysis. A two trajectory/cluster solution was selected. Change in trajectory slopes revealed a turning point marked by plateauing in symptom reduction during the period of transition to school (age 6) for one of the two trajectories. Trajectories were labelled: Continuously Improving (27%) and Improving then Plateauing (73% of sample). Children in the two trajectories differed in levels of symptom severity, language, cognitive, and adaptive functioning skills. Study findings can inform the development of more personalized services for children with ASD transitioning into the school system.

"It just fits my needs better": Autistic students and parents' experiences of learning from home during the early phase of the COVID-19 pandemic

BACKGROUND AND AIMS

The COVID-19 pandemic has caused unprecedented disruption to people's lives, especially for families, whose children have been taken out of schools during lockdown restrictions and required to learn from home. Little is known, however, about the perceived impact of the lockdown restrictions on the educational experiences of autistic children and young people - a group whose conventional schooling experiences are already often challenging. In this study, we sought to (1) understand these experiences from the perspectives of autistic young people and their parents, and (2) identify the underlying sources of positive experiences at this challenging time, in order to inform the ways in which autistic children might flourish at school in more normal times.

METHODS

Ninety-one Australian participants, including 16 autistic young people aged 12-18 years, 32 autistic parents and 43 non-autistic parents of autistic young people aged 3-18 years, took part in semi-structured interviews about their experiences of life during the initial phase of the COVID-19 pandemic. The interviews were subjected to reflexive, thematic analysis to identify themes and subthemes for each research question.

RESULTS

Overall, our participants initially found the transition to learning from home extremely challenging, with parents reporting that the support received from schools was far from adequate. After that initial period of transition, however, many autistic children reported flourishing at home both educationally and personally. For these children and families, we identified three key ingredients essential to this flourishing, including: (i) the importance of connected, trusting relationships ('people'); (ii) the sensory and social safety of home ('place'); and (iii) the flexibility to pace and structure learning to suit the individual child ('time').

CONCLUSIONS

While the initial COVID-19 lockdown presented many challenges to children learning at home, there were aspects of this otherwise-unsettling situation that enabled children to thrive and from which we can learn for the future.

IMPLICATIONS

These findings have important implications for understanding how and when autistic children might thrive in institutional educational settings once the pandemic subsides, focusing on the relationships between teachers and students, the nature of the physical learning environment and the need for greater flexibility in planning the school day.

The Association Between Autism Spectrum Traits and the Successful Transition to Mainstream Secondary School in an Australian School-Based Sample

The transition to secondary school is an important educational milestone impacting wellbeing and academic achievement. Students with Autism Spectrum Disorder may be vulnerable during transition however little is known about how Autism Spectrum (AS) traits influence transition outcomes. Generalised estimating equations were used to examine how AS traits were associated with four indicators of successful transition in a school-based sample of 51 students. Higher AS traits were associated with lower quality of life, school belonging and mental health, however the hypothesised decline after school transition was not supported. Characteristics of both the primary and secondary school appeared to be contributing to the wellbeing of students with high AS traits which could be clarified by further investigation with a larger sample.

"The big wide world of school": Supporting children on the autism spectrum to successfully transition to primary school: Perspectives from parents and early intervention professionals

Background:

The transition to primary school is often a complex and uncertain time for autistic children and their families. Understanding how best to develop school readiness and support transition to primary school for autistic children is essential. School readiness and transition planning are influenced by a range of personal and contextual factors, and it is important to understand the perspectives of the various stakeholders involved in the transition process.

Methods:

A qualitative exploration employing focus groups and interviews was undertaken with early intervention (EI) staff (n = 45) and parents (n = 18) across Australia to understand their perspectives on school readiness and the transition to primary school.

Results:

Thematic analysis identified four emerging themes facilitating transition including: 1) building the child; 2) building the parents; 3) building the receiving school; and, 4) connecting the system.

Conclusion:

Findings highlight the need to consider school readiness and transition planning from a holistic perspective, ensuring clear, collaborative and ongoing communication between parents, teachers and EI staff, using a strength-based approach, and individualizing transition planning.

Meaningful Transitions: Enhancing Clinician Roles in Transition Planning for Adolescents With Autism Spectrum Disorders

Purpose The purpose of this tutorial is to provide speech-language pathologists (SLPs) with foundational information that will assist them in transition planning for students with autism spectrum disorder (ASD) based on a review of current literature. SLPs must be knowledgeable of transition planning in order to assist students with ASD and their families with preparing for their future. An appreciation and awareness of pertinent assessments, functional goals, and factors associated with successful postsecondary outcomes are essential competencies that SLPs need when planning for the transition process. SLPs are ideal workforce development partners. They facilitate independence, communication, and interaction skills necessary for postsecondary and workplace success. Speech-language services are one of the most common special education services received by high school students with Individualized Education Programs. However, SLPs receive little preparation on the specifics or nuances of transition planning prior to working in the educational settings, despite the high incidence of speech-language services in secondary education. Method This tutorial reviews and synthesizes research findings related to assessment planning, goal-setting, and Individualized Education Program implementation for achieving meaningful postsecondary transitions for students with ASD. Additionally, it highlights some of the key postsecondary skillsets related to speech-language therapy services, including the development of self-determination, self-advocacy, social competence, and adaptive behaviors. Conclusion Greater focus on higher quality transition planning requires SLPs to develop high levels of knowledge and competencies in the transition planning process. This tutorial educates clinicians on the unique challenges faced by individuals with ASD and provides evidence-based strategies to help students and families successfully plan for and navigate postsecondary transitions.

Barriers to and Facilitators of Successful Early School Transitions for Children with Autism Spectrum Disorders and Other Developmental Disabilities: A Systematic Review

Early school transitions are exciting, yet challenging, experiences for children with special needs, such as autism spectrum disorder (ASD), and their families. Transition to school support practices can help facilitate this difficult process for key stakeholders. The purpose of this systematic review was to synthesize the literature on transition to kindergarten support practice use for children with ASD and other developmental disabilities. Qualitative and quantitative studies were analyzed using textual narrative synthesis, following the guidelines from the Centre for Reviews and Dissemination. Overall, 39 individual studies were included. Results highlighted particular parent, child, and support staff needs during the transition to school, while also emphasizing the importance of collaborative practices in facilitating successful school beginnings.

Short Report: Social Perception of High School Students with ASD in Norway

An increasing number of students with autism spectrum disorder (ASD) enroll in inclusive schools and classrooms. The aim of this study was to research how students with ASD experience the social aspect of inclusive high schools. Five adolescences with Asperger syndrome were interviewed, and the results show that high school was perceived as an important platform for social training, and an equally important place to find new friends and acquaintances. A majority of the participants had experienced loneliness and bullying in junior high school. However, they experienced high school as a new start, with a more open and inclusive environment. Nevertheless, several of the participants expressed that they used quite a lot of energy on social settings, such as interpreting social situations and on being amongst a larger group of students. In order to support this group of adolescents in their schooling, it is important to look at their strength and resources, and not only focus on the challenges and difficulties.

Developing an Online Tool to Measure Social Network Structure and Perceived Social Support Amongst Autistic Students in Higher Education: A Feasibility Study

The academic, daily-living, and social challenges all students face during university transition can become magnified for many autistic students, who might struggle to adapt to changes in their social network structure (SNS) and perceived social support (PSS). This study assessed the development, feasibility, and convergent validity of a novel online tool (Social Network and Perceived Social Support-SNaPSS) designed to quantitatively and qualitatively evaluate SNS and PSS during university transition. SNaPSS demonstrated good feasibility for completion amongst autistic students (Study 1, n = 10, 17-19 years), and adequate convergent validity against other PSS, autism symptom severity, and social anxiety measures amongst autistic (n = 28) and typically developing students (Study 2, n = 112, 17-19 years). Broader implications of SNaPSS to measure SNS/PSS are discussed.

Expectations of the transition to secondary school in children with developmental language disorder and low language ability

BACKGROUND

A successful transition from primary to secondary school for typically developing (TD) children is associated with academic and psychosocial outcomes. Children with developmental language disorder (DLD) tend to have pervasive needs in both of these domains, yet little is known about their experience of this transition. We have no information concerning the transition for children with low language (LL).

AIM

(1) To explore the expectations of the transition to primary school for children with DLD, children with LL proficiency, and their TD peers; (2) to examine the predictors of transition concerns for each group.

SAMPLE

Children aged 10-11 in the final year of primary school with DLD (n = 30), LL (n = 29), or TD (n = 48) were recruited from eight UK primary schools in the summer term.

METHODS

A battery of standardized language and psychosocial assessments, including the School Concerns Questionnaire (SCQ; Rice et al. British Journal of Educational Psychology, 81, 2011, 244), was administered.

RESULTS

The TD group had significantly lower levels of school concern than DLD and LL groups while DLD and LL groups did not significantly differ. Scholastic competence predicted overall concerns of children with DLD; social competence predicted TD overall concerns; and no variables predicted overall concerns of children with LL. Exploration of school concern subfactors highlighted the importance of emotion recognition for all groups and social competence for children with LL.

CONCLUSIONS

Results indicate that school provision to facilitate a successful transition may most usefully target different areas depending on pupils' language level.

Awareness and Knowledge Associated with Autism Spectrum Disorders Among University Students in Zambia

Experiences with Autism Spectrum Disorders (ASDs) in sub-Saharan Africa are characterized with lots of uncertainty, including lack of awareness and knowledge. This study examined ASD awareness and knowledge among 488 University of Zambia undergraduate students using an autism awareness and knowledge survey. Study findings on awareness revealed a high proportion of students-seventy-nine percent (79%) had never heard of ASD before the survey. Significant variation in aspects of ASD knowledge was explained by gender, having children, internet use and school of study. Implications of low levels of ASD awareness and knowledge is a call to invest in ASD awareness campaigns through different platforms in order to promote ASD knowledge that translates into increased ASD understanding for better service provision in Zambia.