Quality of Life in Hungarian Parents of Autistic Individuals

PURPOSE

Parents of autistic individuals have been known to have a lower overall quality of life (QQL) than those of typically developing children. We present the first Hungarian large-sample study whose objective was to explore the differences in QOL between parents of autistic individuals (AS) and those of neurotypical (NT) persons.

METHODS

Based on the ABCX model we developed a questionnaire comprising standardized scales to characterize the life of parents involved. Our data came from parents of 842 individuals (ASD = 521, NT = 321) between 0 and 49 years. Battery deployed standardized instruments to examine quality of life (WHO-QQL BREF and Quality of Life in Autism questionnaire, QOLA). We assessed the families' socio-economic/demographic characteristics, parents' psychological well-being, the autistic/neurotypical individuals' characteristics, and the interventions.

RESULTS

Our data showed significantly lower QOL in parents of autistic individuals in all domains of questionnaires. We analyzed 20 relevant factors to uncover the predictors of parental QOL. We confirmed the existence of most but not all predictors present in earlier literature and identified intervention-related predictors.

CONCLUSION

Our study confirms the importance of supporting parents in their role, and of providing health and social supports that focus on quality of life, in addition to child care.

Living with the delusion of autism recovery: A grounded theory study on the experiences of mothers

PURPOSE

This study employs Charmaz's (2014) constructivist Grounded Theory (GT) approach to explore and construct a theory about the experiences of mothers raising children diagnosed with autism spectrum disorder (ASD).

METHODS

Data were collected over 1.5 years from online forum posts written by 10 mothers and in-depth qualitative interviews conducted with nine mothers. During the theoretical sampling phase, an additional four mothers were interviewed face-to-face. The analysis adhered to Charmaz's constructivist GT methodology, encompassing initial coding, focused coding, and theoretical coding.

RESULTS

The study introduces the grounded theory, "Living with the Delusion of Autism Recovery," which encapsulates mothers' oscillation between hope and despair as they navigate their children's developmental journeys. This longitudinal analysis traces mothers' experiences from the pre-diagnosis phase through special education, addressing a significant gap in the literature by examining the progression of experiences rather than isolated moments.

CONCLUSIONS

The findings underscore the urgent need for timely interventions and robust support systems. Delays in diagnosis, driven by healthcare professionals' reluctance to diagnose early and the lack of a formal early intervention system, exacerbate developmental challenges. This research provides a unique contribution to the literature by centering on the experiences of Turkish mothers, shedding light on cultural nuances and the dynamic nature of parenting a child with ASD in Türkiye. It is notable as the first study of its kind in Türkiye, offering invaluable insights into the evolving experiences of these mothers.

Examining the Relationship Between Parental Broader Autism Phenotype Traits, Offspring Autism, and Parental Mental Health

Broader Autism Phenotype (BAP) traits may be present in parents of children on the autism spectrum. However, the prevalence and impact of these traits on parental mental health is poorly understood. We explore BAP traits and its relationship to mental health in 228 fathers and 261 mothers from a sample of 266 scholars from the EPINED study (Spain) grouped as follows: non-autism (N = 122), autism traits (N = 93: 38 subthreshold autism and 55 autism symptoms) and autism (N = 51). BAP rates were higher in fathers (36.9%) than in mothers (26.1%). Moreover, BAP was significantly more frequent in fathers of autistic children (52.3%) than in fathers of children without autistic traits (28.0%), with no differences between autistic conditions groups. Mothers of autistic children exhibited higher psychological distress (36.0%) than mothers of comparison group (19.2%). Fathers with BAP obtained significantly higher scores in emotional problems than fathers without BAP. Multivariate analyses showed that, fathers' emotional problems were associated with their BAP traits, whereas in mothers they were associated with having a child with autism as well as the child's emotional dysregulation. Identifying BAP in parents of autistic conditions children can help professionals to provide specific strategies for improving the well-being of children and parents.

Child and Family Characteristics Associated with Symptoms of Anxiety in Autistic Children: A Biobank Study

PURPOSE

Autistic children have an increased likelihood of anxiety, but more research is needed on the characteristics that predict various types of anxiety in this population.

METHODS

In this study, we examined a range of child and family predictors of various types of anxiety using a sample of 452 autistic children from the Australian Autism Biobank. We used logistic regression to examine child and family predictors of four common types of anxiety in autistic children: generalised, phobic, separation, and social anxiety.

RESULTS

We found that 62.8% of children in this sample had symptoms of at least one type of anxiety. Poor quality sleep habits were the only predictive factor consistently identified across all anxiety symptom types. Specific to children with indicated generalised, separation, and phobic anxiety symptoms were the predictive factors of being older than five years, and specific to generalised and social anxiety were the predictive factors of higher cognitive abilities. Maternal anxiety was also a predictive factor in indicated children's separation anxiety.

CONCLUSION

These findings can help inform the provision of more targeted support for autistic people, particularly the interaction of poor sleep habits and anxiety symptoms.

A Serial Mediation Model of Resilience Among Caregivers of Children With Autism

IMPORTANCE

Resilience has been reported as a vital element against the high burden on caregivers of children with autism. However, the intricate mechanisms underlying the concurrent interplay of positive factors with resilience within this demographic group remain less understood.

OBJECTIVE

To construct a model to verify the sequential mediating influence of hope and gratitude in the relationship between perceived social support and resilience among caregivers of children with autism.

DESIGN

Cross-sectional study.

PARTICIPANTS

A total of 193 caregivers of children with autism in mainland China.

OUTCOMES AND MEASURES

Data were collected using the Herth Hope Index, C-GQ-6 Gratitude Questionnaire, Perceived Social Support Scale, and Resilience Questionnaire for Parents of Children With Special Needs. The hypothesized mediating model was tested with Process 4.0 (Model 6) for SPSS (Version 26.0).

RESULTS

The relationship of perceived social support and resilience was mediated by hope, gratitude, and the hope-gratitude sequence. Hope exhibited a stronger mediation effect, accounting for 26.23% of the total effect.

CONCLUSIONS AND RELEVANCE

The results indicated significant positive correlations between perceived social support, hope, gratitude, and resilience, with perceived social support strongly linked to the other three. This study has important implications for occupational therapy, suggesting strategies for resilience-focused interventions tailored to caregivers of children with autism.

PLAIN-LANGUAGE SUMMARY

Resilience is essential for caregivers of children with autism. Studies show that parents of children with autism report having fewer social supports, reduced quality of life, and heightened mental health challenges, including anxiety, depression, and hopelessness. This research highlights the connections between caregivers' perceived social support, hope, gratitude, and resilience. Addressing caregiver social supports and mental health can enhance caregiver well-being as well as children's participation in meaningful activities. The findings suggest practical implications and insights for occupational therapy practitioners to strengthen and foster caregiver resilience and well-being in the autism community.

Self-compassion, mental health, and parenting: Comparing parents of autistic and non-autistic children

LAY ABSTRACT

Parenting can be challenging for any parent, particularly for those parenting autistic children. Research has shown that being kind, accepting, and mindful toward oneself during suffering, a concept known as self-compassion, can help enhance mental health. However, it is not fully understood how self-compassion benefits parenting experiences for parents of autistic children. Therefore, we conducted a study involving 178 parents of autistic children and 178 of autistic children to explore the associations between self-compassion, mental health, and parenting experiences. We found that parents of autistic children reported less self-compassion compared to parents of non-autistic children. For both groups of parents, self-compassion was linked to lower levels of ill-being and parenting stress, as well as higher levels of well-being and parenting competence. In parents of non-autistic children, both ill-being and well-being played a mediating role in the relationship between self-compassion and parenting experiences. However, in parents of autistic children, only well-being was found to mediate this relationship. These findings emphasize the importance of self-compassion and well-being in improving parenting experiences for parents of autistic children.

Caregivers and Coping: Well-Being, Depression, and Coping Strategies Among Caregivers of Young Adults With Developmental Disabilities

This 10-year study followed 134 caregivers of young adults with autism and intellectual disabilities, examining the effects of caregivers' coping strategies, sociodemographic features, and young adult symptomatology on caregiver well-being and depression. Lower caregiver education and higher young adult externalizing behaviors predicted lower well-being and higher depression among caregivers. Caregivers who were Black or mixed-race experienced higher depression than White caregivers. All five coping strategies investigated predicted changes in caregiver well-being and/or depression, with some effects moderated by young adult externalizing behaviors and sociodemographic features. Notably, higher use of positive coping among caregivers of adults with high externalizing behaviors predicted higher caregiver well-being and lower depression. Findings highlight the importance of effective coping strategies for improving caregiver mental health.

Global prevalence of depression in caregivers of children with autism: A systematic review and meta-analysis

PROBLEM

Depression is reported as the most common disorder among caregivers, especially for caregivers of children with autism. However, limited systematic reviews have investigated the prevalence of depressive symptoms among these caregivers. This systematic review and meta-analysis aim to synthesize the prevalence of global depressive symptoms among caregivers of children with autism and identify associated factors.

ELIGIBILITY CRITERIA

Articles were limited to English language and reported on the prevalence of depressive symptoms among formal or informal caregivers, aged 18 or older, of children with ASD, with no publication year restrictions.

SAMPLE

A total of 40 included studies involving 13,853 caregivers of children with autism were included.

RESULTS

Meta-analysis of 40 included studies involving 13,853 caregivers of children with autism showed a pooled prevalence estimate of 45 % (95 % CI: 39.0-51.0). Depressive symptoms were most prevalent in European studies, with a rate of 54 % (N: 980), closely followed by the Eastern Mediterranean region at 53 % (N:1071). The South-East Asia and Western Pacific region exhibited a prevalence of 40 % (N: 5719), while the Americas reported a rate of 38 % (N: 6083).

CONCLUSION

This review presents compelling evidence of a high global prevalence rate of 45 % for depressive symptoms among caregivers of children with ASD.

IMPLICATIONS

To enhance nursing support for caregivers of children with ASD, specific interventions are needed. Nurses should integrate mental health screenings into regular check-ups, link caregivers to community resources, and receive specialized training. Promoting respite care and collaborating with stakeholders can further address caregiver stress and mental health stigma.

Associations of maternal peripregnancy cannabis use with behavioral and developmental outcomes in children with and without symptoms of autism spectrum disorder: Study to Explore Early Development

Some studies report increased prevalence of autism spectrum disorder (ASD) and associated symptoms with prenatal cannabis exposure. We examined whether associations of maternal cannabis use from 3 months preconception through delivery ("peripregnancy") with behavior and development in the offspring varied with the presence of ASD symptoms. Children ages 30-68 months with ASD symptoms (i.e., met study criteria for ASD or had ASD symptoms on standardized assessments or community ASD diagnosis, N = 2734) and without ASD symptoms (other developmental delay/disorders or general population sample, N = 3454) were evaluated with the Child Behavior Checklist and Mullen Scales of Early Learning. We examined cannabis use during three time periods: peripregnancy, pregnancy, and only preconception. Peripregnancy cannabis exposure was reported for 6.0% of children with and 4.6% of children without ASD symptoms. Preconception-only cannabis use (versus no use) was associated with more aggressive behavior, emotional reactivity, and sleep problems in children with ASD symptoms, but not in children without ASD symptoms. Cannabis use during pregnancy was associated with increased attention and sleep problems in children with ASD symptoms; these associations did not differ significantly by ASD symptoms. Peripregnancy cannabis use was not associated with child developmental abilities regardless of ASD symptoms. In summary, associations of peripregnancy cannabis use with some behavioral outcomes differed in children with and without ASD symptoms. With rising cannabis use among pregnant women, future studies that examine a range of developmental risks associated with timing and patterns of cannabis use prior to conception as well as during pregnancy could inform clinical guidance.

The Support Needs of Parents of Children With Autism Spectrum Disorder: A Qualitative Study Based on the Nurturing Care Framework

AIM

To explore the support needs of parents of children with autism spectrum disorder (ASD) in China under the guidance of the nurturing care framework (NCF).

DESIGN

A descriptive qualitative study design was used.

METHODS

Fourteen parents of 2-6-year-old children with autism were recruited for face-to-face individual interviews in Chongqing between July and November 2023. NVivo 12.0 software was used to manage the data, and a directed content analysis was performed to extract themes.

RESULTS

Five nurturing care needs of parents of children with autism were extracted, including acquisition of health- and disorder-related knowledge and information, maintenance of psychological and physical wellbeing, desire for individualised caregiver skills training, creation of multi-agent social support network, and accessibility of high-quality and coordinated services.

CONCLUSION

Parents of children with autism have multidimensional unmet nurturing care needs. It is crucial to address these needs and develop targeted family support programs with consideration of the extracted need components.

IMPLICATIONS FOR PROFESSION AND/OR PATIENT CARE

This study implies that health education, parental empowerment and psychological support should be prioritised in future family support programs. The findings also emphasise the importance of establishing a cross-departmental coordination mechanism and building a multi-agent social support network for families of children with autism.

IMPACT

This study expands our understanding on the support needs of families of children with autism and enriches the theoretical connotation of nurturing care framework, and the results may inform the development of tailored support programs for families of children with autism in China.

REPORTING METHOD

The results are reported in accordance with the reporting guidelines of the Consolidated Criteria for Reporting Qualitative Studies (COREQ).

PATIENT OR PUBLIC CONTRIBUTION

No patient and public contribution.

Moderating effects of general self-efficacy on courtesy stigma and anxiety and depressive symptoms of parents of children with autism spectrum disorder

Background

Stigma, anxiety and depressive symptoms are highly prevalent in parents of children with autism spectrum disorder (ASD) and may have a detrimental impact on the rehabilitation and treatment of children with ASD, ultimately leading to more behavioral issues and higher rates of disability. Therefore, the purpose of this study was to identify the association between general self-efficacy, courtesy stigma, and anxiety and depressive symptoms, and to further discuss whether general self-efficacy moderated the association between courtesy stigma and anxiety and depressive symptoms in parents of children with ASD.

Methods

A total of 409 parents of children with ASD from Lianyungang, Jiangsu Province, Eastern China participated in a cross-sectional survey. A structured questionnaire was used to collect sociodemographic characteristics, courtesy stigma, general self-efficacy, anxiety symptoms, and depressive symptoms. Hierarchical multiple regression was used to assess the associations of courtesy stigma, general self-efficacy and courtesy stigma × general self-efficacy interaction with anxiety and depressive symptoms. Simple slope analysis was used to visualize the interaction.

Results

The courtesy stigma of parents of children with ASD was positively correlated with anxiety (B = 0.374, P < 0.001) and depressive symptoms (B = 0.366, P < 0.001). General self-efficacy was negatively correlated with anxiety (B = -0.200, P < 0.001) and depressive symptoms (B = -0.210, P < 0.001). The association between courtesy stigma and anxiety symptoms was different in the high (1 standard deviation (SD) above the mean, b = 0.258, standard error (SE) = 0.056, t = 4.567, P < 0.001) and low (1 SD below the mean, b = 0.470, SE = 0.053, t = 8.870, P < 0.001) groups of general self-efficacy. In addition, the association between courtesy stigma and depressive symptoms was also different in the high (1 SD above the mean, b = 0.241, SE = 0.056, t = 4.268, P < 0.001) and low (1 SD below the mean, b = 0.469, SE = 0.053, t = 8.844, P < 0.001) groups of general self-efficacy.

Conclusions

General self-efficacy could moderate the impact of courtesy stigma on anxiety and depressive symptoms. Therefore, among parents of children with ASD who experienced high courtesy stigma, enhancing general self-efficacy could be an effective strategy to reduce anxiety and depressive symptoms in this population.

The Effects of the COVID-19 Pandemic on Mental Health in Mothers of Autistic Children and Mothers of Children with Fragile X Syndrome

Background

The COVID-19 pandemic adversely affected the mental health of American mothers and mothers of children with disabilities may have been disproportionately impacted. The present study characterized psychological well-being, social support, and caregiving responsibilities during the pandemic across mothers of children with autism, fragile X syndrome (FXS), and neurotypical children.

Methods

Participants were 54 mothers of children with FXS, 46 mothers of autistic children, and a control group of 80 mothers of neurotypical children. Mothers completed questionnaires on depressive and anxiety symptoms, perceived decline in psychological well-being due to the pandemic, pandemic-related changes in caregiving responsibilities, and levels of social support.

Results

Over half of the mothers of children with autism and over one-third of the mothers of children with FXS reported clinically significant symptoms of depression and anxiety, with rates significantly higher than the control mothers. Though all mothers reported a surge in caregiving responsibilities, mothers of children with FXS experienced greater increases in caregiving responsibilities and social support was lower in both disability groups. Caregiving responsibilities and social support were associated with psychological well-being due to the pandemic across all groups.

Conclusions

Findings highlight the harsh impact of the pandemic on the mental health of mothers of children with FXS and autism. The staggering rate of clinical depressive and anxiety symptoms reported by these groups underscores the urgent need for improved access to psychological services and family-centered supports, with increased caregiving responsibilities and inadequate social support representing important risk factors for mental health problems.

Validation of Autism Stigma Knowledge - Questionnaire (ASK-Q) for Brazilian Portuguese

Background

Low levels of knowledge among health professionals about autism spectrum disorders (ASD) can impair the care provided to people with autism. In Brazil, there are still no validated instruments that assess the knowledge of pharmacy students and pharmacists regarding ASD.

Objective

This study aimed to carry out the cross-cultural adaptation of the Autism Stigma Knowledge Questionnaire (ASK-Q) into Brazilian Portuguese and to evaluate the evidence of content validity.

Methods

This study was conducted in two stages, as recommended in the literature. Stage 1 corresponded to cross-cultural adaptation carried out in six phases (translation of the ASK-Q, synthesis of the translations, evaluation by a committee of experts, evaluation by the target audience of pharmacy students and pharmacists, reverse translation, and evaluation by the author of the original instrument). Step 2 corresponds to the assessment of content validity evidence.

Results

The instrument presented semantic, idiomatic, conceptual, and cultural equivalences, and the author considered the adaptation adequate. Content validity had an adequate coefficient (0.89). The ASK-Q was cross-culturally adapted to the Brazilian context according to the main theoretical framework.

Conclusions

Future studies will be conducted to evaluate other evidence for the validity of the ASK-Q-Brasil. These studies will be fundamental in assessing knowledge about ASD.

Effectiveness of Online Parent Training for Vietnamese Parents of Children with Autism Spectrum Disorders

Background

Parent training (PT) programs have been implemented for neurodevelopmental disorders such as autism spectrum disorder (ASD) in recent years. However, in Southeast Asia, the diffusion of rehabilitation programs for children with ASD and that of PT as a parental support measure has been slow.

Methods

This study assessed the effectiveness of an online PT program that was developed in Japan and remotely delivered to Vietnamese parents of children with ASD residing in Vietnam. Sixteen parents of Vietnamese children with ASD participated in seven online Tottori University-style PT sessions. The online PT was conducted in real-time from Japan, considering the two-hour time difference between countries. Lectures and exercises were presented in Vietnamese with PowerPoint materials. Japanese staff provided explanations in Japanese, which were then simultaneously translated by a Vietnamese interpreter. Attendance, completion of homework assignments, and the number of statements on Zoom and social media were tallied. A pre-post-test design was employed to measure changes in parents' mental health factors and children's behavior. A post-intervention questionnaire was administered to assess participant's acceptance of PT.

Results

The findings showed that attendance and task completion rates were considerably high. The study found that the mental health scores of parents significantly improved after participating in online parenting training compared to before. However, there were no statistically significant improvements found in children's behavior. The study also confirmed high satisfaction with the cross-country online parenting training.

Conclusion

This study confirmed that TUPT, developed in Japan and implemented as an online PT for parents of children with ASD living in Vietnam, was effective in improving parental mental health. The program acceptability questionnaire also showed positive results. This study is the first step in the evaluation and dissemination of Internet-based, cross-country parent training for parental support in Asia.

Predictors of Change in Wellbeing and Mental Health of Parents of Autistic Pre-Schoolers

Parenting is a rewarding experience but is not without its challenges. Parents of Autistic children face additional challenges, and as a result can experience lower levels of wellbeing and more mental health problems (i.e., depression, anxiety, stress). Previous studies have identified concurrent correlates of wellbeing and mental health. However, few have investigated predictors of subsequent wellbeing and mental health, or of change over time, among parents of pre-school aged autistic children. We examined child-, parent-, and family/sociodemographic factors associated with change in parents' mental health and wellbeing across three timepoints (spanning approximately one year) among 53 parents of Autistic pre-schoolers (M = 35.48, SD = 6.36 months. At each timepoint, parents reported lower wellbeing and greater mental health difficulties compared to normative data. There was no significant group-level change over time in parent outcomes. However, individual variability in short-term (~ 5 months) wellbeing and mental health change was predicted by a combination of child- and parent-related factors, while variability in medium-term (~ 10 months) change was predicted by parent factors alone. Parents' description of their child and their relationship predicted change in both wellbeing and mental health. Furthermore, participating in a parent-mediated intervention (available to a subgroup) was a significant predictor of change in wellbeing. Our findings highlight potentially modifiable factors (e.g., learning healthier coping strategies) that may positively impact both short- and medium-term change in parental outcomes.

Adverse Childhood Experiences and Autism: A Meta-Analysis

Evidence suggests that autistic children have a higher probability of experiencing adverse childhood experiences (ACEs) compared to their non-autistic peers. This meta-analysis (PROSPERO: CRD42022262635) aimed to quantify the association of autism and ACEs. Eight databases and Google Scholar were searched for studies that reported dichotomous outcomes regarding the associations between ACEs and autistic individuals, compared to non-autistic individuals. A random-effects model was used to calculate the average Odds Ratio (OR) of the relationship between a diagnosis of autism and ACEs. A total of 40 studies with 5,619,584 participants were included, generating an overall average OR 2.11 (CI 1.61, 2.77). Significant differences in the magnitude of association were found across studies with regards to the type of ACEs studied, comparison groups, and population type. Overall, moderate certainty evidence (downgraded for bias) indicates that autistic individuals are at greater risk of experiencing ACEs, compared to non-autistic individuals. Appropriate support for autistic individuals and their families are required to prevent ACEs and treat the impact of ACEs.

Psychometric Properties of the Chinese Version of the Core Symptom Index: A Study among Chinese Parents of Children with Autistic Spectrum Disorders

(1) Background: Parents of children with autism spectrum disorders often experience psychological distress, which can affect the quality of childcare they provide. It is crucial to screen for psychiatric symptoms among these parents. The core symptom index (CSI) is a widely recognized tool used to assess general symptoms, including depression, anxiety, and somatic issues. It has proven validity and reliability across diverse Thai populations. Given the cultural similarities between Thai and Chinese populations, the CSI has been successfully implemented within the Chinese population. Nevertheless, it is crucial to research its validity and reliability in the general Chinese population. This study aimed to investigate the psychometric properties of the Chinese version of the CSI among parents of children with autism spectrum disorders using confirmatory factor analysis (CFA). (2) Methods: A total of 794 Chinese parents raising children with autism participated in this study. All completed the CSI, along with the social inhibition subscale of the Interpersonal Problems Inventory and the Couple Satisfaction Index. Factorial validity was assessed using CFA to determine how well the bifactor three-factor model fits the data. Various structural models were compared using model fit indices. Convergent and discriminant validity were examined by exploring correlations with the social inhibition subscale and the Couple Satisfaction Index. Invariance testing of the CSI was conducted across multiple groups based on gender, age, and education using CFA. The reliability of the CSI was evaluated using McDonald's omega coefficients. (3) Results: The bifactor model emerged as the best-fitting model for the data, suggesting that the total score of the CSI adequately represents overall psychiatric symptoms. The CSI exhibited significant correlations with the social inhibition subscale (r = 0.41, p < 0.01) and smaller correlation coefficients with the Couple Satisfaction Index (r = -0.16, p < 0.05), indicating both convergent and discriminant validity. The invariant test results support scalar invariance levels based on gender and age but only partial invariance for education. The Chinese version of the CSI demonstrated high consistency, with McDonald's omega coefficients ranging between 0.86 and 0.95. (4) Conclusions: The bifactor model of the Chinese version of the CSI is validated, making it a suitable tool for measuring depression, anxiety, and somatization symptoms among parent(s) of children with autism spectrum disorders. Further research on other Chinese populations is encouraged.

Clinical and Family Implications of Cannabidiol (CBD)-Dominant Full-Spectrum Phytocannabinoid Extract in Children and Adolescents with Moderate to Severe Non-Syndromic Autism Spectrum Disorder (ASD): An Observational Study on Neurobehavioral Management

Autism Spectrum Disorder (ASD) encompasses a wide range of neurodevelopmental conditions characterized by deficits in social interaction, communication and behavior. Current pharmacological options are limited and feature significant side effects. In this study, we conducted a retrospective, observational, and cross-sectional cohort study to evaluate the effects of Cannabidiol (CBD)-dominant, full-spectrum cannabis extract, containing Tetrahydrocannabinol (THC) in a ratio of 33:1 (CBD:THC), on non-syndromic children and adolescents (5-18 years old) with moderate to severe ASD. Thirty volunteers were recruited, underwent neuropsychological evaluations and were treated with individualized doses of CBD-dominant extract. Clinical assessments were conducted by the designated clinician. Additionally, parents or caregivers were independently interviewed to assess perceived treatment effects. We found significant improvements in various symptomatic and non-symptomatic aspects of ASD, with minimal untoward effects, as reported by both clinical assessments and parental perceptions. The observed improvements included increased communicative skills, attention, learning, eye contact, diminished aggression and irritability, and an overall increase in both the patient's and family's quality of life. Despite its limitations, our findings suggest that treatment with full-spectrum CBD-dominant extract may be a safe and effective option for core and comorbid symptoms of ASD, and it may also increase overall quality of life for individuals with ASD and their families.

The Relationship Between Fatigue and Quality of Life in the Turkish Mothers of Children with Autism Spectrum Disorder

This study aimed to investigate the different effects of fatigue and health-related quality of life in the Turkish mothers of children with autism spectrum disorder (ASD) through comparisons with mothers of typically developing children, and to evaluate the relationship between different aspects of maternal fatigue, depression, and maternal health-related quality of life. The study included a total of 103 mothers, comprising 60 mothers of children with ASD and 43 mothers of typically developing children. The Nottingham Health Profile and Quality of Life in Autism Questionnaire-Parent Version were used to assess the health-related quality of life. Fatigue was assessed comprehensively with the Fatigue Impact Scale and the Fatigue Severity Scale. The Nottingham Health Profile total and physical mobility domain and the quality of life were the strongest factors, explaining with a variance of 66.7% the fatigue impact on cognitive function. The mothers' quality of life accounted for 64.8% of the variance in factors that explained fatigue. Physical mobility, social isolation and quality of life were associated with the physical impact of fatigue and were explained with a variance of 52.4%. Emotional reactions and quality of life were explained with a variance of 52.7% in the fatigue of psychosocial function. The current study has highlighted that the fatigue of Turkish mothers of children with ASD has a greater impact on cognitive, physical and psychosocial functions. Furthermore, the quality of life, physical mobility, social isolation, and emotional reactions of mothers have a significant impact on maternal fatigue.

Child behavior problems and parental psychological distress in Chinese families of children with autism: The putative moderating role of parental social support and cultural values

The wellbeing of parents of children with autism residing in mainland China remains understudied. We aimed to examine whether and how parental perceived social support, individualism, and collectivism acted together to moderate the relationships between child behavior problems and parental psychological distress in Chinese parents of children with autism. With convenience and snowball sampling, data on 268 primary caregiver parents of children with autism were collected from an online cross-sectional survey. Linear regression analysis indicated that child behavior problems were significantly associated with increased psychological distress in Chinese parents of children with autism. There was no evidence to support the stress-buffering model of social support in moderation analysis of the association between child behavior problems and parental psychological distress. Nonetheless, increased social support was associated with lower levels of parental psychological distress. Moderated moderation analyses did not support a role for individualism or collectivism as a moderator of the putative buffering role of social support. However, there was evidence that parental individualism was associated with increased parental psychological distress. Our findings highlight that child behavior problems are a robust correlate of parental psychological distress, and parental social support may act as a compensatory factor promoting less psychological distress rather than having a protective role. The role of social support and cultural values in the wellbeing of parents of children with autism in China requires additional exploration, including longitudinal research designs.

The Relationship between Anxiety Symptoms and Perceived Quality of Life among Caregivers of Children with Autism Spectrum Disorder in the Amazon

The relationship between anxiety symptoms and perceived quality of life among caregivers of children with autism was verified. To assess perceived quality of life, the Short Form Healthy Survey Item was used; perception of anxiety symptoms was assessed using the Beck Anxiety Inventory. Eighty caregivers of children with autism participated, with 68.7% of caregivers being mothers. Of the total number of caregivers, 68.8% had a severe level of anxiety. Regarding perceived quality of life, they demonstrated greater impairment in limitation due to physical aspects, limitation due to emotional aspects, vitality, and pain. Caregivers with severe anxiety levels had a worse quality of life in the domains of pain (p = 0.012), social aspects (p < 0.001), limitation due to emotional aspects (p = 0.001), and mental health (p < 0.001). However, in the functional capacity domain, caregivers with a moderate level of anxiety had a better physical capacity score (p = 0.001). There was a negative correlation between the general anxiety score and the general physical (p = 0.029) and general emotional components of perceived quality of life (p < 0.001). It was found that caregivers of children with ASD have a high level of anxiety, which is a predictor of the perception of a worse quality of life.

Differences in Interpersonal Resources and Risk Factors Among Mothers and Fathers of Children on the Autism Spectrum: A Serial Mediation Model

Mothers and fathers of children on the autism spectrum may differ in their perception of their interpersonal resources and risk factors. Fathers (114) and mothers (507) of children on the autism spectrum participated in the study. Fathers (vs. mothers) reported lower interpersonal resources (interpersonal emotion regulation and perceived support from friends and formal sources, but not family) and higher levels of interpersonal risk factors (social, not emotional, loneliness). A serial mediation model indicated that parents' gender predicted interpersonal emotion regulation which in turn related to parents' social loneliness directly and indirectly through perceived social support. Fathers of children on the autism spectrum may differ from mothers in perceptions of interpersonal resources and risk factors related to parents' social belonging needs.

High Depressive Symptoms, Low Family Functioning, and Low Self-Efficacy in Mothers of Children With Autism Spectrum Disorder Compared to Two Control Groups

BACKGROUND

Parents of children with autism spectrum disorder (ASD) face unique challenges in raising their children, and they are at higher risk for depression compared to parents of children with typical development (TD) and other disabilities.

AIMS

(1) To compare prevalence of depressive symptoms among mothers of children with ASD (n = 101), Down syndrome (DS, n = 101), and TD (n = 43) and (2) to describe the relationships among depression, self-efficacy, and family functioning, and describe the mediating role of maternal child care self-efficacy between depressive symptoms and child behavior.

METHODS

In this cross-sectional study, mothers completed the Social Communication Questionnaire, Aberrant Behavior Checklist, Patient Health Questionnaire-9 (PHQ-9), Family Assessment Device General Functioning Scale, and Maternal Self-Efficacy Scale.

RESULTS

Mothers of children with ASD had significantly higher mean PHQ-9 scores (p < .001), higher proportion of positive depression screening (p < .001), and lower family functioning (p < .001). Better family functioning is associated with less depression, better self-efficacy, and less severe ASD symptoms and behaviors. Self-efficacy mediated the relationship between depression and child ASD symptoms, and problematic behavior.

CONCLUSIONS

The rates of reported history of depression and low family functioning in mothers of children with ASD are twice the rate in mothers of children with DS and TD. Maternal child care self-efficacy is protective against maternal depression, even in the presence of severe child problematic behaviors and ASD symptoms. Interventions that increase child care self-efficacy and family functioning may be helpful in addressing depression in mothers of children with ASD.

Does Parental Mental Health Moderate the Association between Parenting Stress and Child Externalizing Behaviors Among Autistic Children?

Parents of autistic children experience significant parenting stress, which is prospectively associated with increases in child externalizing behaviors. However, family factors that place specific families at risk for experiencing the negative impacts of parenting stress on child externalizing behaviors have not been identified. The present study examined whether parental mental health moderates the association between parenting stress and child externalizing behaviors. Parents of 501 autistic children (Mage=5.16yrs) completed the Parenting Stress Index and Eyberg Child Behavior Inventory. Parents reported whether they had ever been diagnosed with a mental health disorder. Parenting stress, parental internalizing diagnosis, and parental externalizing diagnosis all independently predicted child externalizing behavior. However, parenting stress did not interact with any category of parental mental health diagnoses to predict child externalizing. Results implicate high levels of parenting stress as a risk factor for increased child behavior problems among autistic children across parental mental health statuses. Interventions aimed at reducing parenting stress may improve parent outcomes and prevent the development of child externalizing behaviors among families of autistic children.

Early intervention service needs of mothers with a child diagnosed with autism spectrum disorder in Turkey: A qualitative study

BACKGROUND

Early intervention services play a crucial role in the prevention and management of Autism Spectrum Disorder (ASD). With the increasing prevalence of ASD, understanding the specific needs of mothers and their children is essential for the development of effective interventions and support systems.

METHODS

This interview study examines the early intervention service needs of Turkish mothers with children aged 2-6 who have been diagnosed with ASD. Semi-structured in-depth interviews were conducted with nine mothers. Thematic analysis was carried out following the guidance and six steps procedures described by Braun and Clarke.

FINDINGS

The study's findings reveal six distinct themes that encompass the needs expressed by the participating mothers: 1) psychological support needs, 2) social support needs, 3) financial support needs, 4) strengthening the family, 5) government-based enhancement, and 6) the need for social awareness.

DISCUSSION

The findings underscore the significance of comprehensive early intervention services tailored to address the needs of mothers. The stressors associated with the impact of ASD on families are highlighted, aligning with Guralnick's framework. The findings emphasize the need for holistic intervention programs and stress the importance of collaborative relationships among parents, educators, and service providers.

APPLICATION TO PRACTICE

The practical implications of this study benefit healthcare professionals, policymakers, educators, and stakeholders. The emphasis lies in aligning interventions with the ASD needs of both mothers and children, ultimately aiding in the development of effective policies and the enhancement of the quality of care for individuals with ASD in Turkey.

Theoretical-Methodological Foundations for the Global Integration Method (Método de Integração Global-MIG) in the Treatment of Autism Spectrum Disorder

Currently, there is no intervention model for autism spectrum disorder (ASD) that addresses all levels and factors of the International Classification of Functioning, Disability and Health (ICF, WHO). The most researched programs focus on naturalistic, developmental and behavioral approaches to socio-communication. Less attention has been paid to motor and environmental reactivity aspects (behavior/interest restriction and sensory reactivity). The evidence rationale for the Global Integration Method (MIG, "Método de Integração Global"), a model addressing sensorimotor reactivity in addition to socio-communication, is presented. MIG is an integrative, interdisciplinary, family-oriented intervention and naturalistic program that addresses all levels and moderating factors of ASD's impact. MIG's theoretical rationale is based on the predictive coding impairment and embodied cognition hypotheses. MIG incorporates both bottom-up (flexible therapeutic suit, social-motor synchronization) and top-down (schematic social information processing, narratives, imagery) strategies to promote the building and use of accurate, flexible and context-sensitive internal predictive models. MIG is based on the premises that predictive coding improves both socio-communication and environmental reactivity, and that the postural stabilization provided by the flexible therapeutic suit frees information processing resources for socio-cognitive learning. MIG builds on interdisciplinary, professionally and parentally mediated work based on behavioral principles of intensive training in a situated environment.

The influence of sex on major psychiatric comorbidities and parental psychiatric disorders in 22,698 children and adolescents with ICD-9-CM-based autism spectrum disorder

It remains unclear how major psychiatric comorbidities and parental psychiatric disorders differ in males and females with autism spectrum disorder (ASD). Between 2001 and 2011, 17,627 children and 5071 adolescents with ASD (ICD-9-CM code: 299) were identified from Taiwan's National Health Insurance Research Database and assessed for major psychiatric comorbidities and parental psychiatric disorders. Compared with females with ASD, males with ASD were more likely to be diagnosed as having attention deficit hyperactivity disorder (relative risk [RR], 95% confidence interval [CI] 1.63, 1.51-1.75) and disruptive behavior disorder (1.38, 1.17-1.62) and less likely to be diagnosed as having schizophrenia (0.45, 0.36-0.56), bipolar disorder (0.58, 0.45-0.74), or intellectual disability (0.53, 0.49-0.58). Furthermore, compared with women, having a parental history of schizophrenia (RR, 95% CI 0.66, 0.49-0.89) or intellectual disability (0.34, 0.19-0.61) was less associated with ASD among men. However, the difference in ASD diagnosis between ICD-9-CM and ICD-10/11-CM systems may reflect the different, but surely overlapping, entity of ASD, which may limit the generalization of our results. Additional studies should be performed.

Poor Physical Health in Caregivers of Children with ADHD or ASD and its Association with Health Risk Behaviours: NHIS 2016-2018

BACKGROUND

There is a dearth of evidence regarding physical health problems and health risk behaviours (e.g., drinking, physical inactivity, smoking, and suboptimal sleep behaviour) in caregivers of children with attention deficit hyperactivity disorder or autism spectrum disorder (CCAA). The purposes of the current study were to examine differences in physical health problems between CCAA and caregivers of children without attention deficit hyperactivity disorder and autism spectrum disorder (CCWAA) and to explore health risk behaviours associated with those problems.

METHOD

Data from the 2016-2018 National Health Interview Survey were used in the current study. 10 common physical health problems were compared between CCAA and CCWAA by using multivariable logistic regressions. In addition, in order to detect associated health risk behaviours, decision tree analysis was performed for physical health problems in CCAA.

RESULTS

Of the 10 physical health problems, caregivers of children with ADHD showed significantly higher likelihood of experiencing nine (arthritis, asthma, back pain, high cholesterol, diabetes, heart problems, hypertension, neck pain, obesity), compared to CCWAA. Caregivers of children with autism spectrum disorder (ASD) showed significantly higher likelihoods of experiencing two physical health problems compared to CCWAA. The decision tree analysis revealed that age (> 42 years), and suboptimal sleep behaviour (not 7-8 hours), and smoking (current smoker) were the frequent predictors for physical health problems in CCAA.

CONCLUSION

The results of the current study represent an important milestone in further investigating physical health problems in CCAA.

Health-related quality of life in family caregivers of autistic adults

Introduction

Family members of autistic individuals often provide support for their autistic relative throughout the lifespan which can lead to massive burden themselves. Reduced health-related Quality of Life (HRQoL) in family caregivers is assumed; however, only a handful studies on the HRQoL of family caregivers providing care to adult relatives exist as opposed to autistic children. Thus, the current study aimed to (i) investigate the current state of physical and mental HRQoL of family caregivers of autistic adults compared to the general population, and (ii) examine caregiver-related (e.g., age, subjective caregiver burden) and care recipient-related variables (e.g., symptom severity, utilization of formal services) explaining variance in the caregivers' HRQoL.

Methods

N = 149 family caregivers completed a nationwide online survey, including the Short-Form Health Survey (SF-8) in order to assess the HRQoL. T-tests were used to compare the HRQoL of family caregivers with the general population. Bivariate correlational and multiple linear regression analyses were conducted in order to identify predictors explaining variance in family caregivers' HRQoL.

Results

Family caregivers of autistic adults reported significantly lower physical (M = 46.71, SD = 8.72, Cohen's d = 0.42) and mental HRQoL (M = 40.15, SD = 11.28, Cohen's d = 1.35) compared to the general population. Multiple linear regression with the mental HRQoL as the outcome showed a significant model (F(11, 95) = 5.53, p < .001, adj. R2 = .32) with increased subjective burden explaining most of the variance in mental HRQoL (ß = .32, GDW = .141, p < .001). Multiple linear regression analysis with the outcome physical HRQoL did not reveal a statistically significant model (F(11,95) = 1.09, p = .38). However, bivariate analyses also showed a positive correlation with the subjective caregiver burden (r= .20, p < .05).

Discussion

Findings highlight the need to consider HRQoL (and caregiver burden) of family caregivers of autistic adults in several healthcare settings to monitor a potential comprised health status in early stages, with the long-term goal to improve family caregivers' HRQoL.

"We are exhausted, worn out, and broken": Understanding the impact of service satisfaction on caregiver well-being

Few studies exist that have examined the impact of service-related factors and system-level disruptions (i.e., the pandemic) on families of autistic children in Canada using large sample sizes. To address this gap, the goal of this research was to examine the impact of satisfaction with autism services on caregiver stress, controlling for important demographic variables, such as family income, marital status, and child level of support needs. The impact of navigating and accessing services on parent well-being was also explored. A total of 1810 primary caregivers of autistic children or youth living in Ontario, Canada completed a survey with both closed- and open-ended questions in the summer of 2021. A hierarchical multiple regression was conducted to examine the impact of satisfaction with autism services on caregiver stress. Open-ended responses on the survey from a subset of the sample (n = 637) were coded using thematic analysis to understand the impact of navigating and accessing services on parent well-being. Satisfaction with services significantly predicted caregiver stress after controlling for marital support, family income, and child level of support needs. Qualitative analysis revealed impacts of navigating and accessing services in three areas: (1) Physical, (2) Emotional/Psychological, and (3) Financial Well-being. Understanding parent perceptions of satisfaction with services can shed light on strategies for improving services that support parent well-being.

Mental health challenges faced by autistic people

Mental health challenges impede the well-being of autistic people. This Review outlines contributing neurodevelopmental and physical health conditions, rates and developmental trajectories of mental health challenges experienced by autistic people, as well as unique clinical presentations. A framework is proposed to consider four contributing themes to aid personalized formulation: social-contextual determinants, adverse life experiences, autistic cognitive features, and shared genetic and early environmental predispositions. Current evidence-based and clinical-knowledge-informed intervention guidance and ongoing development of support are highlighted for specific mental health areas. Tailored mental health support for autistic people should be neurodivergence-informed, which is fundamentally humanistic and compatible with the prevailing bio-psycho-social frameworks. The personalized formulation should be holistic, considering physical health and transdiagnostic neurodevelopmental factors, intellectual and communication abilities, and contextual-experiential determinants and their interplay with autistic cognition and biology, alongside resilience. Supporting family well-being is integral. Mutual empathic understanding is fundamental to creating societies in which people across neurotypes are all empowered to thrive.

Parenting confidence and social support as predictors of coping strategies in parents of children newly diagnosed with autism spectrum disorder: A cross-sectional study

AIMS

The aims of the study were to describe coping strategies in parents of children with autism spectrum disorder at the early stage of diagnosis and to examine the predictive effects of parenting confidence and social support on coping strategies.

DESIGN

A descriptive cross-sectional study.

METHODS

A convenience sample of 193 parents of children newly diagnosed with autism spectrum disorder in Guangzhou, China, were included from October 2020 to January 2021. The Simplified Coping Style Questionnaire, Parenting Sense of Competence Scale and Social Support Rating Scale were employed for data collection. Multiple hierarchical regression analyses examined the relationship between coping strategies and the independent variables.

RESULTS

The mean positive coping strategies score was higher than the negative coping strategies score. Parenting efficacy, subjective support and support utilization predicted positive coping strategies, and parenting satisfaction was a protective factor against negative coping strategies.

CONCLUSION

Parents tend to engage in positive coping at the early stage of diagnosis. Improving parenting confidence and social support might help parents adopt positive coping strategies and prevent negative coping.

IMPACT

More effective and long-term support for families of children with autism spectrum disorder is expected. Interventions should be focused on enhancing parenting satisfaction and efficacy to employ positive coping strategies and decrease negative coping.

REPORTING METHOD

We adhered to EQUATOR guidelines and reported results based on STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public involvement.

functional outcome in late adolescence/early adulthood of patients with autism spectrum disorder and its relationships with parental burnout and depression: A preliminary multi-center, cross-sectional study

The aim of this study is to determine the functioning of adults with autism spectrum disorders (ASDs) diagnosed in childhood and depression and burnout levels among their parents. A total of 261 adults with ASDs and their parents were recruited for the study. Both parents completed the Beck Depression and Maslach Burnout Inventories and reported the functioning of their adult offspring with ASDs. Only 5.4 % of our sample reported "good" or "very good" outcomes. The most common psychiatric comorbidities were intellectual disabilities and attention-deficit/hyperactivity disorder. Maternal burnout and depression scores were significantly elevated compared to those of fathers. There is an undeniable urgent need for more research to identify the needs of adults and families suffering from ASD. Modifications for those with ASD may have to be made for support in workplaces, achieving driving licenses, using public transportation and attendance at tertiary education.

A longitudinal study of the relationships between sleep problems in autistic children and maternal mental health

LAY ABSTRACT

Autistic children experience increased the rates of sleep problems. These sleep problems have been associated with mother's mental health symptoms. However, the direction of these relationships is not well understood. This study investigated the relationships between autistic children's sleep problems and mothers' mental health over a 12-year period using data collected as part of the Longitudinal Study of Australian Children. Data from 397 autistic children and their mothers were included in this study. Mothers completed a questionnaire about their own mental health and common childhood sleep problems at four time points from 4-5 years to 14-15 years. The results showed important relationships between mothers' mental health symptoms and child sleep problems at two time points. Specifically, (1) mothers' mental health symptoms when the child was aged 4 to 5 years predicted child sleep problems at age 6 to 7 years; and (2) child sleep problems at age 12-13 years predicted mothers' mental health symptoms when the child was aged 14 to 15 years. Interestingly, these significant relationships also coincide with key developmental transition time points, when the child is transitioning in and out of primary school. These findings highlight the need for increased support for both the child and mother at these times to optimise outcomes for both.

Clinically elevated depression scores do not produce negative attentional biases in caregivers of autistic children

Objective

Depression scores in caregivers of autistic children often fall in the clinical range. The attention of clinically depressed individuals tends to be biased toward negatively toned information. Whether caring for an autistic child might also be characterized by a negative attentional bias was explored here.

Methods

A sample of N = 98 (57 caregivers and 41 controls) completed questionnaires assessing depressive symptoms. Orienting attention to (i.e., vigilance), and shifting attention away from (i.e., disengagement), negative information was assessed via an online version of the emotional face dot probe task.

Results

Mean depression scores in caregivers, falling in the borderline clinical range, were significantly higher compared with controls. Groups, however, were indistinguishable with respect to vigilance and disengagement, and these attentional indices were unrelated to depression scores.

Conclusion

Caring for an autistic child, while associated with borderline clinical depression scores, was not characterized by a negative attentional bias. Findings are discussed in the context of methodological shortcomings and recommendations for future research.

Brief Report: Family Accommodation is Associated with the Impact of Childhood Anxiety in Autism

Anxiety is commonly experienced by children on the autism spectrum, and can negatively impact their lives. Family accommodation has been linked to the impact of anxiety on the child's life in non-autistic children. This study tested whether the same relationship holds for children on the autism spectrum. A community sample (n = 118) of parents of children on the spectrum completed questionnaires on their child's autism characteristics and severity and impact of their child's anxiety, their own anxiety and family accommodation behaviours. Family accommodation was associated with the impact of child anxiety, over and above anxiety severity of the child and parent. Findings support the involvement of parents in psychosocial support for children on the autism spectrum experiencing anxiety.

Individually tailored dosage regimen of full-spectrum Cannabis extracts for autistic core and comorbid symptoms: a real-life report of multi-symptomatic benefits

Autism Spectrum Disorders (ASD) may significantly impact the well-being of patients and their families. The therapeutic use of cannabis for ASD has gained interest due to its promising results and low side effects, but a consensus on treatment guidelines is lacking. In this study, we conducted a retrospective analysis of 20 patients with autistic symptoms who were treated with full-spectrum cannabis extracts (FCEs) in a response-based, individually-tailored dosage regimen. The daily dosage and relative proportions of cannabidiol (CBD) and tetrahydrocannabinol (THC) were adjusted based on treatment results following periodic clinical evaluation. Most patients (80%) were treated for a minimum of 6 months. We have used a novel, detailed online patient- or caregiver-reported outcome survey that inquired about core and comorbid symptoms, and quality of life. We also reviewed patients' clinical files, and no individual condition within the autistic spectrum was excluded. This real-life approach enabled us to gain a clearer appraisal of the ample scope of benefits that FCEs can provide for ASD patients and their families. Eighteen patients started with a CBD-rich FCE titrating protocol, and in three of them, the CBD-rich (CBD-dominant) FCE was gradually complemented with low doses of a THC-rich (THC-dominant) FCE based on observed effects. Two other patients have used throughout treatment a blend of two FCEs, one CBD-rich and the other THC-rich. The outcomes were mainly positive for most symptoms, and only one patient from each of the two above-mentioned situations displayed important side effects one who has used only CBD-rich FCE throughout the treatment, and another who has used a blend of CBD-Rich and THC-rich FCEs. Therefore, after FCE treatment, 18 out of 20 patients showed improvement in most core and comorbid symptoms of autism, and in quality of life for patients and their families. For them, side effects were mild and infrequent. Additionally, we show, for the first time, that allotriophagy (Pica) can be treated by FCEs. Other medications were reduced or completely discontinued in most cases. Based on our findings, we propose guidelines for individually tailored dosage regimens that may be adapted to locally available qualified FCEs and guide further clinical trials.

Social support mediates the relationship between dispositional gratitude and psychological distress in caregivers of autistic children

Grateful caregivers report lower levels of psychological distress. Social support, engendered by gratitude and buffering against stress, might mediate this effect. Here we explored whether the protective psychological effect of dispositional gratitude might be mediated by increased social support. A sample of 126 caregivers of autistic children completed questionnaires assessing dispositional gratitude, social support and psychological distress. Gratitude inversely predicted psychological distress, as did social support after adjusting for gratitude. Gratitude positively predicted social support. Gratitude no longer predicted psychological distress after adjusting for social support. Indirect effects analysis revealed the gratitude-distress relationship occurred indirectly via social support. Grateful caregivers reported higher levels of social support, and this predicted lower psychological distress. Gratitude, relatively stable as a disposition, has a state component that is sensitive to change, and healthcare professionals might do well to recommend gratitude enhancing interventions for caregivers of autistic children.

How effective are group-based psychoeducation programs for parents of children with ASD in Turkey? A systematic review and meta-analysis

Recent research shows that group-based psychoeducation programs designed for parents of children with ASD have grown in popularity over time. The international evidence for the effectiveness of psychoeducation programs designed for parents of children with ASD in developed societies emphasizes the importance of providing a synthesis of the effectiveness of programs in developing societies. This study's primary aim is to assess the efficacy of group-based psychoeducation programs in Turkey for parents of children with ASD. The second aim is to investigate how the programs are influenced by the potential moderators (type of involvement, research design, number of sessions, duration of sessions, and number of participants). For these purposes, a database search was conducted that included group-based psychoeducation programs for parents of children with ASD implemented in Turkey. Twelve group-based psychoeducation programs that met the inclusion criteria were included in the study. The results showed that group-based psychoeducation programs for parents of children with ASD had "medium" effects on psychological symptoms [ES(SE) = 0.65 (.08), 95%CI (0.48-0.81)], "low" effects on social skills [ES(SE) = 0.32 (.16), 95%CI (0.02-0.62)], and "high" effects on well-being [ES(SE) = 1.05 (.19), 95%CI (0.66-1.43)]. According to moderator analyses, the type of involvement and the number of sessions were statistically significant moderators of psychological symptoms, but not the research design, duration of sessions, or number of participants.

Occurrence and correlates of anxiety and depression in carers of autistic children across three nations

Purpose

Caring for an autistic child is associated with elevated stress, anxiety and depression. Although some data suggest that 'child' or 'carer' factors may moderate the severity of carer distress, relatively few international comparisons have been made, limiting the generalizability of previous findings. This study aimed to address this issue.

Method

A survey-based comparison was made of carers from three nations (Australia, Denmark, Greece), and the effects of demographic, child, and carer variables upon carer anxiety and depression were investigated.

Results

Only limited cross-nation consistency was found for nation, child, or carer variables and their effects upon carer anxiety or depression.

Conclusion

The application of universal treatment models for carer anxiety and depression may be of differing value across nations.

Parenting Challenges in Families of Children with a Diagnosis of Autism Spectrum Disorder: A Qualitative Research Study in Istanbul

Introduction

This qualitative research study examines problems experienced by families with children who have received a diagnosis of autism spectrum disorder (ASD) living in Turkey.

Background

In recent years, Turkey has moved to expand services to children who have received a diagnosis of ASD and their families. However, families still experience hidden issues that are crucial to consider while developing appropriate policies.

Method

In this study, we interviewed 10 families whose children attended special education schools in the Bağcılar and Bahçelievler districts of Istanbul. We used semistructured interviews conducted via phone, WhatsApp video chat, and Zoom and a phenomenological approach to gain an in-depth understanding of the caregivers' experience. Themes were obtained by utilizing descriptive analysis.

Results

Parents expressed a variety of concerns including financial burden, intrafamilial conflict, mental health problems, and community-related issues.

Conclusions

Moving forward, the emerging social work profession should assist children who have been given a diagnosis of ASD and their parents in accessing mental and behavioral health and community-level resources, especially mothers, as they often bear the most responsibilities in Turkey.

Online Parent Training for Parents of Children with Autism Spectrum Disorders: Prototype Development of the On-Demand Type

Background

Parent training (PT) is a promising support for improving parents' mental health, and behavior in children with autism spectrum disorders (ASD). In recent years, there has been an increase in online PT studies. We developed a prototype for the on-demand PT. In this study, we examined changes in the program implementation, accomplishment of homework, parents' mental health, and behavior of children among parents of children with ASD.

Methods

This study participated two mothers of children with ASD. The first was the mother of a child aged three years and eight months with ASD and intellectual disability; the second was the mother of a child aged four years and 5 months who had a diagnosis of ASD. An on-demand PT consisting of six sessions was provided online. The program was structured so that the participants watched lecture videos for each session, answered a confirmation test, and submitted homework to advance to the next session. Feedback for the submitted homework and questions was provided via email by the researchers.

Results

Both participants watched the program on a schedule for all sessions and submitted all tests and homework assignments. The percentage of correct responses to the tests per session was 100% for both participants. Two of the four target behaviors of the children changed significantly. Pre- and post-questionnaires also showed improvements in the scores of parental depression and parenting stress, as well as overall behavior of the child.

Conclusion

The program in this study was developed as a prototype for on-demand PT, and two case studies showed positive results. Although this program was on-demand, changes in parent and child behaviors were confirmed by the scale and actual behavior records. Further demonstration is needed to increase the number of cases and to compare the results between the groups.

Lower Risk of Burn Injury in Children and Adolescents with Autism Spectrum Disorder: A Nationwide Population-Based Study

Little research has examined burn injury in the pediatric population with autism spectrum disorder (ASD). We used data from Taiwan's National Health Insurance Research Database to identify 15,844 participants aged <18 years with ASD and 130,860 participants without ASD. Our results revealed that the hazard ratios differed across three age ranges. The ASD group had a lower risk of burn injury than the non-ASD group when they were less than 6 years of age, a higher risk from 6 years to 12 years of age, and no difference when they were older than 12 years of age. More research is required to study the characteristics and causes of burn injury in the pediatric population with ASD.

The relationship between camouflaging and mental health in autistic children and adolescents

Camouflaging involves the masking of autistic traits in social situations. While camouflaging may function as a potential barrier to the early diagnosis of autism, minimal research into camouflaging in autistic young people has been conducted. It is also important to evaluate the impact of camouflaging on the mental health of autistic children and adolescents. This study evaluated camouflaging in a sample of 359 female and 374 male autistic children and adolescents (4-17 years, 48.9% females). Findings indicated that camouflaging was a significant predictor of internalizing (i.e., anxiety, depression, somatic complaints) symptoms, when controlling for age, gender, and IQ. We also found evidence for some gender differences in camouflaging. Parents endorsed more autistic traits for females compared with males, whereas there were no differences in autistic traits across sex in the clinician-administered assessment. There was also evidence for a relationship between age and camouflaging, with adolescents showing a larger discrepancy between parent and clinician reported autistic traits. This has implications for clinical assessment and future research and is important for understanding how best to support the mental health of autistic children and adolescents.

Posttraumatic growth: the role of perceptions, coping and depressive symptoms among mothers of children with Autism Spectrum Disorder in Greece

Background: Parenting a child with Autism Spectrum Disorder (ASD) may lead to emotional distress. However, it has been recognized that it can also be accompanied with positive experiences that may conduce parents to posttraumatic growth (PTG). Few studies have investigated the factors that may be associated with growth. The present study aimed to assess the role of maternal perceptions, coping strategies and depressive symptoms to PTG. Method: In this cross-sectional study, 123 mothers of ASD offspring completed self-reported questionnaires to assess posttraumatic growth (PTGI); coping strategies (Βrief-COPE); perceptions about ASD (B-IPQ) and depressive symptoms (PHQ-9). Hierarchical regression analysis was used to assess their independent associations. Results: A significant proportion of mothers (56.1%) reported moderate to high growth levels (PTGI ≥ 63). Nearly half of the mothers (46.3%) reported clinically significant depressive symptoms. Engagement (b = 0.361), cognitive reframing (b = 0.214), personal control (b = 0.200) and depressive symptoms (b = -0.232) were independently and significantly associated with PTG. Conclusions: Mothers of children with ASD may experience moderate to high PTG. Engagement, cognitive reframing, personal control and depressive symptoms were significant predictors of growth level. Interventions aiming to support mothers to potentiate their personal control over ASD, to use adaptive coping strategies and to reduce distress may facilitate their growth.

Effectiveness of the internet based parent education program on applied behavior analysis for parents of children with autism spectrum disorder

BACKGROUND

Parent education (PE) in autism spectrum disorder (ASD) is recognized as an important component of support for families living with ASD. Specifically, the knowledge of how to interact with children based on applied behavior analysis (ABA) is useful for parents. In this study, a short-term, internet based on-demand PE program was conducted for parents of children with ASD to acquire knowledge of ABA and basic teaching techniques.

METHODS

Parents of children with ASD were recruited as study participants. They attended on-demand lectures from their homes, performed homework tasks based on lecture content and emailed them to our team. The General Health Questionnaire 30 (GHQ) and Knowledge of Behavioral Principle as Applied to Children (KBPAC) were assessed before and after the program.

RESULTS

Of the 25 participants, 21 attended all programs and completed all homework tasks and pre- and post-assessments. However, communication among participants via the bulletin board was low. KBPAC scores increased significantly from pre- to post-program scores, and GHQ subscales regarding anxiety and mood modulation decreased significantly from pre- to post-program scores. Positive results were obtained in the post-questionnaires as well.

CONCLUSION

These findings suggest the practical applicability of an online PE program for parents of children with ASD based on ABA.

Social Support and Parenting Stress in Hispanic Parents of Children with Autism Spectrum Disorder

The purpose of this integrative review is to synthesize the literature examining the relationship between parenting stress and social support in Hispanic parents of children with autism spectrum disorder (ASD). A database search of studies that evaluated parenting stress and social support in this population was conducted. Fourteen studies met inclusion criteria. Despite high stress levels, both informal and formal social supports improved parenting stress among Hispanic families. Few studies evaluated culturally sensitive social support interventions. With the increasing prevalence of ASD, the development of culturally sensitive social support interventions is necessary to promote the well-being of Hispanic families.

Impact of Belgian COVID-19 lockdown restrictions on autistic individuals' socio-communicative behaviors and their parents' quality of life

BACKGROUND

In the spring of 2020, Belgian authorities enforced a full lockdown period to contain the spread of the SARS-CoV-2 virus. This lockdown drastically disrupted the daily life of autistic individuals' and that of their families. In the midst of these extraordinary circumstances, we assessed the impact of social restrictions on autistic individuals' behavior and their parents' or caregivers' quality of life; we also sought to identify individual characteristics that may influence such changes.

METHODS

We designed an online survey targeting caregivers living with an autistic child or adult. The questionnaire included 125 five-point Likert questions which targeted changes in families' quality of life and in autistic individuals' behavior, as well as factors likely to influence the extent and direction of these changes.

RESULTS

We collected data from 209 French-speaking Belgian respondents. Respondents reported that the lockdown brought about a higher frequency of nonfunctional socio-communicative behaviors, as well as a decrease in families' quality of life. Parents who had less access to respite care experienced a steeper decrease in their quality of life. Autistic individuals with comorbidities, and whose parents had less access to respite care and implemented fewer rules at home during lockdown were more likely to display nonfunctional socio-communicative behaviors.

CONCLUSION

COVID-19 lockdown restrictions had a negative impact on both autistic individuals and their parents.