Influence of Community-Level Cultural Beliefs about Autism on Families' and Professionals' Care for Children

Exploring Social Support and Quality of Life Among Mothers of Children with Autism Spectrum Disorders: A Cross-Sectional Study

Background: Mothers of children with autism spectrum disorder (ASD) often experience significant stress, which can adversely affect their quality of life (QoL) and increase their reliance on social support. This study aimed to explore the relationship between social support and QoL among mothers of ASD children and identify associated factors. Methods: A cross-sectional study was conducted from December 2022 to March 2023, involving 218 mothers of ASD children in Saudi Arabia. An online questionnaire was distributed via autism associations. Inclusion criteria were mothers of children under 18 diagnosed with ASD, excluding those with diagnosed mental illnesses. Social support and QoL were measured using the Multidimensional Scale of Perceived Social Support (MSPSS) and the Quality of Life in Autism Questionnaire (QoLA). Statistical analysis was performed using Jamovi software. Results: The mean MSPSS and QoLA scores were 4.87 and 100.88, respectively, with a significant positive correlation (Spearman's rho = 0.509, p < 0.001). Social support was positively associated with higher education and negatively with having more than one autistic child. QoLA scores were significantly predicted by family income (>SAR 10,000 or US 2667) and MSPSS score (p < 0.001). Conclusions: Social support enhances maternal QoL and is influenced by educational level and income, highlighting the need for targeted interventions to support mothers with multiple ASD children. While individual support is important, prioritizing societal accessibility may offer more effective long-term solutions by proactively addressing systemic challenges faced by autistic individuals and their families.

Feasibility and cross-cultural validation of an adapted social skills group training programme (KONTAKTTM CHILD) for Chinese autistic children: a waitlist RCT protocol

INTRODUCTION

School-age autistic children commonly experience social communication and interaction challenges in their everyday lives. While international evidence suggests that social skills group training (SSGT) programmes can support autistic children, improving their psychosocial functioning, to date there is no standardised evidence-based SSGT tailored towards the needs of autistic children aged 8-12 years living in the Chinese Mainland. Therefore, the primary objective of this study will be to evaluate the feasibility and acceptability of a culturally adapted 16-session version of the social skills programme KONTAKT in Chinese autistic children. Additionally, preliminary efficacy and cost-effectiveness will be assessed to inform a future definitive trial.

METHODS AND ANALYSIS

This study will employ a randomised, single-blinded, waitlist-controlled feasibility design with 36 Chinese autistic children aged 8-12 years with IQ over 70 referred to the Child Development and Behavior Center in Guangzhou, China. Participants will be randomly assigned to either the immediate training group or the delayed training group stratified by sex. Feasibility will be assessed using quantitative and qualitative data obtained from the KONTAKT CHILD participants, their parents and facilitators of the programme. Preliminary efficacy and cost-effectiveness are assessed via quantitative data obtained at five time points. The primary efficacy outcome is participants' improvement in social skills as measured by the Contextual Assessment of Social Skills. Other outcomes include parents and teachers' reports of participants' autistic traits and adaptive functioning, participants' self-report and projective tests for self-assertiveness and psychosocial functioning, and parent reports on parental reflective functioning and perceived school support. Common process factors and their effects on outcomes will also be explored. Cost-effectiveness will consider from both societal and healthcare perspectives.

ETHICS AND DISSEMINATION

The current study protocol has been reviewed and ethics approval has been obtained from the Ethical Board Committee at the Third Affiliated Hospital of Sun Yat-sen University (II2023-119-01). The trial was pre-registered in Chinese Clinical Trials (ChiCTR2300072136) on 5 June 2023. The results of this trial will be actively disseminated through peer-reviewed publications and conference presentations. Any identifiable personal information will be anonymised to protect confidentiality.

PROTOCOL VERSION

2.0, 31 July 2024.

TRIAL REGISTRATION NUMBER

ChiCTR2300072136.

"We call it Bokoa jwa tlhaloganyo": Setswana parents' perspective on autism spectrum disorder

Introduction

There is a dearth of knowledge in South Africa about the incidence, prevalence, and effect of autism spectrum disorder (ASD). Consequently, national autism data is outdated, and World Health Organization (WHO) prevalence rates are being used.

Methods

This study focused on Ngaka Modiri Molema District to explore the cultural perspective of ASD in the Setswana culture from a parental or caregiver perspective, specifically those who attended the World Health Organization Caregiver Skills Training (WHO-CST) on ASD. This qualitative study used a phenomenological design and purposively sampled 6 out of 12 participants who wererecipients of WHO-CST. Semi-structured interviews, audio recordings, and field notes were used to collect data.

Results

The study found five main themes: understanding autism, indigenous perceptions of ASD, ways of interacting with children living with autism spectrum disorder, creating a friendly environment and symptoms of ASD.

Discussion

It was concluded that there is a lack of knowledge in Setswana culture about what ASD entails, and there are still some superstitious beliefs regarding ASD, resulting in late diagnoses. ASD studies with larger sample sizes, including medical professionals and policymakers, are recommended.

Racial Differences in the Prevalence of Autism Spectrum Disorder: A Systematic Review

PURPOSE

Racial differences in prevalence rates of autism spectrum disorder (ASD) have shifted in the United States (US) since the 1990s. This review addresses the nature and context of this shift and discusses potential contributing factors and areas for future research.

METHODS

Seventeen population-based epidemiological birth cohort studies on ASD prevalence in the US that included race as a variable are included in the review. Studies were identified via a keyword search on PubMed. To be included, studies were required to include race or ethnicity as a variable in the prevalence estimates, include at least 1000 cases with autism, and be published in English by June 3rd, 2023.

RESULTS

Results suggest that in nearly all birth cohorts prior to 2010, ASD prevalence rates were highest among White children. ASD prevalence rates among Black, Hispanic, and Asian/Pacific Islander (API) children (22.3, 22.5, and 22.2 per 1000, respectively) surpassed prevalence rates among White children (21.2 per 1000) in the 2010 birth cohort and continued to increase in the 2012 birth cohorts.

CONCLUSIONS

There are persistent racial differences in ASD prevalence in the US, and these differences were inverted after 2010, when ASD prevalence among Black, Hispanic, & API children surpassed ASD prevalence among White children. Possible drivers of this racial repatterning of ASD prevalence include changes in ASD screening and diagnosis, changes to health insurance policy, changes to immigration policy, and increased education attainment by minority groups.

Quality of Life and Its Associated Correlates of Parents of Children on the Autism Spectrum in Singapore

This cross-sectional study aimed to assess Quality of life (QoL) of parents of children on the autism spectrum in Singapore and identify its associated factors. Parents of children (age ≥ 5 years) completed the Quality of Life in Autism scale which measures parental self-rated QoL (higher scores denote greater QoL), and the perceived impact of the child's autism-related behaviors on parents (higher scores denote lesser impact). Information on the child's degree of autism (measured by the Social Responsiveness Scale, second edition [SRS-2]), community and social participation and cognitive and adaptive functioning were also obtained. Participants were 86 parents with mean child age 6.3 years (SD 1.0). Univariate analysis results revealed greater participation in community and social events to be two modifiable factors associated with higher parental QoL. However, these factors were not found to be significant in the multivariate model. Higher autism features (represented by higher parent-rated SRS scores) was associated with a greater perceived impact of the child's behaviors by parents in both univariate and multivariate analyses. Of note, child's cognitive or adaptive skills were not significantly associated with either QoL measure. Equipping parents to handle autism-related behaviors can be useful to reduce their impact on parental QoL. Facilitating community participation for these children may positively influence caregiver QoL as well.

Health Care for Youth With Neurodevelopmental Disabilities: A Consensus Statement

Individuals with a neurodevelopmental disability (NDD) face significant health care barriers, disparities in health outcomes, and high rates of foregone and adverse health care experiences. The Supporting Access for Everyone (SAFE) Initiative was developed to establish principles of health care to improve equity for youth with NDDs through an evidence-informed and consensus-derived process. With the Developmental Behavioral Pediatric Research Network, the SAFE cochairs convened a consensus panel composed of diverse professionals, caregivers, and adults with NDDs who contributed their varied expertise related to SAFE care delivery. A 2-day public forum (attended by consensus panel members) was convened where professionals, community advocates, and adults with NDDs and/or caregivers of individuals with NDDs presented research, clinical strategies, and personal experiences. After this, a 2-day consensus conference was held. Using nominal group technique, the panel derived a consensus statement (CS) on SAFE care, an NDD Health Care Bill of Rights, and Transition Considerations. Ten CSs across 5 topical domains were established: (1) training, (2) communication, (3) access and planning, (4) diversity, equity, inclusion, belonging, and anti-ableism, and (5) policy and structural change. Relevant and representative citations were added when available to support the derived statements. The final CS was approved by all consensus panel members and the Developmental Behavioral Pediatric Research Network steering committee. At the heart of this CS is an affirmation that all people are entitled to health care that is accessible, humane, and effective.

Assessing Autism Knowledge Across the Global Landscape Using the ASK-Q

Substantial variability exists with regard to autism service provision around the world. Service disparities observed in many low- and middle-income countries may be driven, in part, by limited autism knowledge; however, measurement limitations have made it difficult to quantify autism knowledge across countries. The current study uses the autism stigma and knowledge questionnaire (ASK-Q) to quantify autism knowledge and stigma between different countries and demographics. The current study compiled data from 6830 participants collected using adapted versions of the ASK-Q administered in 13 different countries, representing four different continents. Structural equation modeling was used to examine how autism knowledge varied across country and individual factors. Results reveal cross country variability with a large, 17-point difference between the countries with the highest knowledge (Canada) and the lowest knowledge (Lebanon). As expected, countries with higher economies had higher levels of knowledge. We also documented differences based on country worldview, participant occupation, gender, age, and education level. These results help to identify specific regions and populations that might most need greater information about autism.

Teachers and educators' experiences and perceptions of artificial-powered interventions for autism groups

BACKGROUND

Artificial intelligence-powered interventions have emerged as promising tools to support autistic individuals. However, more research must examine how teachers and educators perceive and experience these AI systems when implemented.

OBJECTIVES

The first objective was to investigate informants' perceptions and experiences of AI-empowered interventions for children with autism. Mainly, it explores the informants' perceived benefits and challenges of using AI-empowered interventions and their recommendations for avoiding the perceived challenges.

METHODOLOGY

A qualitative phenomenological approach was used. Twenty educators and parents with experience implementing AI interventions for autism were recruited through purposive sampling. Semi-structured and focus group interviews conducted, transcribed verbatim, and analyzed using thematic analysis.

FINDINGS

The analysis identified four major themes: perceived benefits of AI interventions, implementation challenges, needed support, and recommendations for improvement. Benefits included increased engagement and personalized learning. Challenges included technology issues, training needs, and data privacy concerns.

CONCLUSIONS

AI-powered interventions show potential to improve autism support, but significant challenges must be addressed to ensure effective implementation from an educator's perspective. The benefits of personalized learning and student engagement demonstrate the potential value of these technologies. However, with adequate training, technical support, and measures to ensure data privacy, many educators will likely find integrating AI systems into their daily practices easier.

IMPLICATIONS

To realize the full benefits of AI for autism, developers must work closely with educators to understand their needs, optimize implementation, and build trust through transparent privacy policies and procedures. With proper support, AI interventions can transform how autistic individuals are educated by tailoring instruction to each student's unique profile and needs.

Traditional bullying, cyberbullying, and quality of life among adolescents in 35 countries: Do cultural values matter?

RATIONALE

Substantial evidence indicates that involvement in school bullying has been linked to lower quality of life (QoL). Yet there is little information elucidating the link between bullying involvement and QoL in different cultures.

OBJECTIVE

This study investigated the associations between different types of bullying involvement and QoL among adolescents. The moderating roles of cultural values in the relationship between bullying involvement and QoL were examined.

METHODS

This study included representative samples from 35 countries (N = 184,017) using data from the 2017/2018 Health Behavior in School-Aged Children (HBSC) survey and the new 2023 World Cultural Map Scores from the World Values Survey Wave 7 (2017/2021). Multilevel mixed-effects analysis was employed to examine individual-level and country-level effects simultaneously.

RESULTS

All types of bullying involvement were associated with lower QoL, with being a victim having the lowest QoL. Adolescents in societies that prioritize higher self-expression values exhibited a reduced propensity to engage in school bullying. In countries with higher self-expression values, there was a more pronounced negative association between bullying involvement and QoL. Traditional/Secular-rational values had no significant and consistent moderating effect on the association between bullying involvement and QoL. Those results were quite similar for both traditional bullying and cyberbullying.

CONCLUSION

These findings imply that cultural values are closely intertwined with adolescent bullying and quality of life. Therefore, prevention and intervention programs should pay more attention to addressing bullying and promoting the QoL of adolescents according to various cultural values.

The relationship between school mental health service use in high school and educational outcomes of adolescents with psychiatric disorders

This study aimed to examine the relationship between school mental health service use in high school and educational outcomes of adolescents with psychiatric disorders. The sample included 2617 adolescents who were enrolled in eighth grade in a large urban school district in the United States, were enrolled in Medicaid during eighth grade, and had a mental health diagnosis. Psychiatric hospitalization, school enrollment, school absences, out-of-school suspensions, school dropouts, and school exits for negative reasons were examined as mental health and educational outcomes. Compared with adolescents who used school mental health services for 2 years following eighth grade, adolescents who did not use school mental health service during the high school years had a significantly lower annual number of days enrolled in school and higher rates of exiting school for negative reasons such as school dropout and long-term hospitalization. Our findings support the positive role of school mental health care delivery in high schools in preventing negative educational outcomes for adolescents with psychiatric disorder.

A preliminary exploration of different coping strategies used by Korean immigrant parents of autistic children in high versus low family quality of life ratings

The experiences of coping in parents of autistic children have been extensively studied in the literature. While this research has identified both effective and ineffective coping strategies used by caregivers, no studies to date have examined how coping strategies used by parents might be linked to family quality of life outcomes. Furthermore, few studies exist examining both coping strategies and family quality of life in culturally and linguistically diverse populations. Thus, this study aimed to address both limitations. A total of 12 Korean immigrant parents of autistic children, 6 representing the high family quality of life group and 6 representing the low family quality of life group, shared their experiences related to coping and managing stress. Responses fell under three broad categories (problem-focused, emotion-focused, and adjustment-focused) with differences observed when comparing the high versus low family quality of life groups. A better understanding of the link between coping strategies and family quality of life outcomes may help identify effective and culturally sensitive supports for caregivers and families to improve their quality of life and well-being.

Quality of life in parents of autistic children: A transcultural perspective

Introduction

The concepts of health, illness, and disability as well as the perceptions of autism and quality of life (QoL) vary greatly across cultures and across time. This study sought to explore the interplay of culture on QoL and impact on parents caring for autistic children.

Methods

We used a transcultural dataset from seven countries (Australia, Hungary, Malaysia, Romania, Singapore, Spain, and the United Kingdom) with participating parents/carers reporting on the Quality of Life in Autism (QoLA) questionnaire. The QoLA questionnaire is a validated measure of QoL for parents of autistic children, with Part A subscale measuring parental QoL and part B subscale assessing the parental impact of the child's autism spectrum disorder (ASD) symptoms or features. We used the Quade's ranked analysis of covariance to determine significant differences between the countries in relation to QoLA Part A and Part B scores while adjusting for baseline differences using covariates such as parents' gender, child's age, and gender. Additionally, a post-hoc analysis with Bonferroni correction was also conducted to examine multiple pairwise comparisons.

Results and conclusion

We found that while the effect of features of ASD (Part B subscale) stayed strongly comparable between cultures, the self-reported parental QoL was most likely determined by different aspects of culture in different countries. It is concluded that while the ASD symptoms or features appear to affect parents in the same way across different countries, the parental QoL may be a culturally informed construct.

The roles and competencies of welfare commissioners supporting children with developmental disorders and their families expected by Japan's public health nurses

Background

Public Health Nurses (PHNs) collaborate with community volunteer welfare commissioners to support children with developmental disorders and their families lead a life without isolation.

Objective

This study aims to clarify the roles and competencies that PHNs expect of welfare commissioners in supporting children with developmental disorders and their families.

Methods

An online survey was administered through Survey Monkey© to 220 PHNs working in Japanese municipalities using an independently developed questionnaire regarding the roles and competencies of welfare commissioners supporting children with developmental disorders and their families expected by PHNs. Exploratory Factor Analysis (EFA) was performed to simplify the data structure and enhance understanding. The reliability of the scale was confirmed using Cronbach's α. Differences due to PHN attributes (e.g., experience collaborating with welfare commissioners) were analyzed using Welch's t-test. This study was conducted between April and September 2021.

Results

The highest scoring items were, for the role, "a welfare commissioner's role is to pass on accurate information to their successor," and for competencies, "a necessary competency for a welfare commissioner is to protect the information about children with developmental disorders, and their families learned during one's work." The EFA results revealed a two-factor structure for role items: Factor 1, "Supporting children with developmental disorders and their families and preventing abuse," and Factor 2, "Connecting to social resources." Competency items were also found to have a two-factor structure: Factor 1, "Understanding the position of children with developmental disorders and their families and connecting with local residents," and Factor 2, "Understanding developmental disorders and supporting them based on assessment." A comparison of the attributes of PHNs showed no significant differences.

Conclusion

PHNs feel welfare commissioners should pass on the information and protect confidentiality when supporting children with developmental disorders and their families. Furthermore, PHNs expect welfare commissioners to connect children with developmental disorders and their families to the community, prevent abuse, and provide support based on assessment. PHNs had the same expectations regarding the roles and competencies of welfare commissioners regardless of their own attributes.

Understanding the experiences and needs in autism education: A semi-structured interview among Chinese American parents of autistic children

Background and Aims

The diversity of the autistic population seeking professional services and education in the United States has increased. As the diagnosis of autism increases among the Chinese American immigrant population, there is also an increasing need to learn about this population and provide appropriate intervention and education for this group. However, current education and intervention provided for autistic individuals tend to be culturally blind. Gaps were found in our understanding of the cultural context and its relationship with the education mechanisms among Chinese American autistic families. The current study intends to investigate how Chinese American parents perceive the education materials and intervention strategies received by their autistic children as well as their experiences and needs in the education process.

Method

Semi-structured interviews were conducted among 10 Chinese American parents (one father and nine mothers) online. They all had children who had a formal diagnosis of autism spectrum disorder and received some intervention or education. Thematic analysis was used to analyse the results.

Results

The study suggested that most Chinese American parents were satisfied with the current education materials and intervention strategies provided to their autistic children. Due to cultural-related stigma, parents differ in their perceptions of children's autism diagnosis and characteristics as well as their expectations of children's culturally sensitive education. A theoretical model was created to provide culture-centered interpretation of the interconnected relationship between their pre- and post-immigration contexts and parenting attitudes.

Conclusions

Culture plays a critical role in understanding Chinese American parents' experiences, needs, and expectations of culturally sensitive education for their autistic children. Interconnected relationships were found between contexts and parenting attitudes, which were largely influenced by cultural-related stigma.

Implications

Suggestions and implications were provided for institutions and professionals working with Chinese American families and children. It is critical for them to learn about the experiences, needs, and attitudes of Chinese American parents to provide Chinese American autistic children with more appropriate and culturally sensitive education.

Articulating biological and social approaches in child and adolescent psychiatry

Child and adolescent psychiatry has been based on numerous fields of research and theories, including neuroscience, physiology, psychology (developmental, psychodynamic, systemic, cognitive-behavioral, etc.), anthropology, sociology, and education sciences. Integrating transdisciplinary knowledge in multi-level models is an ongoing challenge for the future that is not immediately applicable in clinical practice and research. Articulating, i.e., to connect, to be jointed, (psycho)biological and (psycho)social approaches in child and adolescent psychiatry is a daily challenge for clinicians and researchers. Research is often limited to specific fields whereas real-life clinical practice needs a pluralistic approach. Research designs, tools, and clinical training need to provide knowledge applicable to the necessarily pluralistic daily clinical practice. This article provides some perspectives on how to articulate biological and social approaches, from research to clinical practice, and discusses the concept of pluralistic approaches, multimodal interventions, and how to provide articulated mental health care and training. Suggestions to better articulate biological and social approaches are provided: (I) State that the research object can be approached from different theoretical, research and clinical angles and explain the one chosen; (II) Propose synthesis articles that articulate biological and social knowledge; (III) Design biological studies that take into account social factors, and design social studies that take into account biological factors; (IV) Design transcultural tools; (V) Build pluralistic interventions, i.e., therapeutic modalities and mental health care settings that articulate biological and social approaches; (VII) Develop training in pluralistic articulated care.

Clinical and demographic differences by sex in autistic Venezuelan children: A cross-sectional study

BACKGROUND

Sex differences in symptom severity and adaptive function in children with ASD have been historically inconsistent and studies are predominantly from American- and European-residing populations. Alike, there is limited information on the complex interplay between sex, intelligence, adaptive function, and autism symptom severity; this is crucial to identify given their predictive value for health outcomes in autism AIM: This study aimed to identify sex differences in autism symptom severity and adaptive function in a sample of Venezuelan children.

METHOD

One-hundred-and-three Venezuelan children ages 3-7 completed a comprehensive assessment for symptom severity, adaptive functioning, and intelligence.

RESULTS

Sex differences were not present in any autism diagnostic domain or adaptive function.Symptom severity was not a significant predictor for adaptive function, which contrasts with studies sampling American children.

CONCLUSION

This study corroborates other findings based on non-American children, where symptom severity was not a function of adaptive function. Awareness of the interplay of culture, sex-related standards, and autism symptomatology will result in better identification and diagnosis of autism regardless of sex or cultural background. What this paper adds? This paper aids the current literature on sex difference on both autism symptom severity and adaptive function. It also provides a snapshot of the relationship between symptom severity, adaptive function, and other psychological variables that influence the outcome of children with ASD.

Diagnostic Process and Barriers Among Chinese-American and Korean-American Parents of Children with Autism

OBJECTIVE

We sought to understand the experiences of Chinese-American and Korean-American parents of children with autism, including their initial concerns regarding their child's development, reported health professionals' responses to these concerns, diagnostic barriers, and factors associated with early autism diagnosis.

METHOD

We designed a survey with support from an expert advisory group and Asian-American parents of children with autism. We measured 3 time points of diagnostic history, areas of parents' concerns, professionals' responses to their concerns, 15 types of diagnostic barriers, and professionals' helpfulness. We used descriptive and independent t tests to analyze data from 28 parents of children with autism.

RESULTS

Most of the parents (86%) had early concerns about their children's developmental delays and expressed their concerns to health professionals. However, approximately 60% of the parents reported that the professionals did not conduct developmental screenings or make referrals to specialists. The most common diagnostic barrier was the stress of the diagnostic process, followed by navigating health care systems. Parents who required interpreters noted poor quality and unavailability. Early child developmental concerns were associated with early autism diagnoses.

CONCLUSION

Although many Chinese-American and Korean-American parents had early concerns regarding their child's development and shared their concerns with health care professionals, parents encountered many barriers, including the stress of the diagnostic process. Chinese-American and Korean-American parents with limited English proficiency required additional support. Health care professionals' active listening and responses to parents' concerns can promote early diagnosis.

Autistic children's age difference in affiliate stigma and resilience of their parents in China: A cross-sectional study

BACKGROUND

Parents of children with Autism Spectrum Disorders (ASD) experience high levels of stigma, especially in China where the culture is shame socialized. Resilience can help overcome stigma; while parent characteristics predict resilience, other factors may also be significant such as the child's age.

OBJECTIVE

The study sought to identify the differences in affiliate stigma and resilience among Chinese parents of children with ASD according to the child's age, and to determine whether the levels of resilience and experience of stigma are related.

METHODS

A cross-sectional survey of 184 parents of children with ASD was conducted. Affiliate stigma and resilience were measured using the Chinese version of the 22-item Affiliate Stigma Scale and the Chinese version of the Connor-Davidson Resilience Scale. Differences were examined by using regression and correlation analysis.

RESULTS

Parents of school-age children experienced more affiliate stigma than parents of preschoolers, but there was no difference in resilience when other factors were controlled.

CONCLUSIONS

Considering the child's age is important to understand affiliate stigma and resilience, particularly where resilience is protective and could inform the design of support strategies for preschooler parents.

Exploring Autism, Culture, and Immigrant Experiences: Lessons from Sri Lankan Tamil Mothers

Background: Canada is home to a mosaic of cultures with immigrant communities from a wide range of countries, but there are significant variations in how autism spectrum disorder (ASD) may be understood across different immigrant groups, including Sri Lankan Tamils. Such gaps in knowledge may present challenges for immigrant families that are trying to access appropriate care for their child, including occupational therapy services. Purpose: This descriptive qualitative study aimed to better understand the experiences of immigrant Sri Lankan Tamil parents of children diagnosed with ASD in Southern Ontario, Canada. Method: Interviews were analyzed using an in-depth content analysis. Findings: Results demonstrated parents' perceived supports and barriers towards ASD intervention planning, and indicated that parents were generally satisfied by the level of cultural competence in current ASD systems. However, families may still experience significant immigrant-related barriers that are not fully addressed. Implications: Recommendations to improve cultural awareness among occupational therapists utilizing ASD interventions are suggested.

Awareness and knowledge of autism spectrum disorder in Western China: Promoting early identification and intervention

PURPOSE

Given the increasing prevalence of autism spectrum disorder (ASD) and the public health problems it creates; early identification and interventions are needed to improve the prognosis of ASD. Hence, this study surveyed different groups of people who are likely to have early contact with autistic children to provide an informed basis for early detection and effective diagnosis and interventions.

METHODS

Three groups of people were recruited for the study from Changshou District and Wushan County of Chongqing, in Western China: 269 medical workers, 181 educators, and 188 community residents. Their understanding and knowledge of autism was measured using a self-made questionnaire.

RESULTS

The positive finding was that the three groups had a certain level of understanding of autism, but they had some misunderstandings of the core problems, and there were significant differences in the understanding of autism among the three groups. Younger medical workers knew more about autism than older ones did. The ability of educators and community residents to identify autistic symptoms was positively related to their level of education and their experience with autistic children. Television and the internet were the main sources of information about autism for participants.

CONCLUSIONS

The medical workers, educators, and community residents in the investigated areas in western China may be able to identify early signs of autism but have an inadequate understanding of autism. In areas far from cities, it is necessary to strengthen the training of medical workers in primary health care to promote autism screening and referral in educational institutions and communities. Using internet technology to provide public education and professional training about autism in remote areas could be a very promising method in Western China.

Perceived barriers to care for migrant children and young people with mental health problems and/or neurodevelopmental differences in high-income countries: a meta-ethnography

OBJECTIVES

To develop conceptual understanding of perceived barriers to seeking care for migrant children and young people (aged 0-25 years) with mental health problems and/or neurodevelopmental differences in high-income countries.

DESIGN

Qualitative evidence synthesis using meta-ethnography methodology. We searched four electronic databases (Medline, PsycINFO, Global Health and Web of Science) from inception to July 2019 for qualitative studies exploring barriers to care (as perceived by migrant communities and service providers) for migrant children and young people in high-income countries with neurodevelopmental differences and/or mental health problems. The quality of included studies was explored systematically using a quality assessment tool.

RESULTS

We screened 753 unique citations and 101 full texts, and 30 studies met our inclusion criteria. We developed 16 themes representing perceived barriers to care on the supply and demand side of the care-seeking process. Barriers included: stigma; fear and mistrust of services; lack of information on mental health and service providers lacking cultural responsiveness. Themes were incorporated into Levesque et al's conceptual framework of patient-centred access to healthcare, creating a version of the framework specific to migrant children and young people's mental health and neurodevelopmental differences.

CONCLUSIONS

This is the first qualitative evidence synthesis on barriers to care for mental health problems and/or neurodevelopmental differences in migrant children and young people in high-income countries. We present an adapted conceptual framework that will help professionals and policy-makers to visualise the complex nature of barriers to care, and assist in improving practice and designing interventions to overcome them. Similar barriers were identified across study participants and migrant populations. While many barriers were also similar to those for children and young people in general populations, migrant families faced further, specific barriers to care. Interventions targeting multiple barriers may be required to ensure migrant families reach care.

A community-engaged approach to examining barriers and facilitators to accessing autism services in Korean immigrant families

LAY ABSTRACT

Perceptions and experiences of culturally and linguistically diverse groups in accessing autism services in Canada are extremely limited. Thus, this study partnered with a community member to explore Korean immigrant parents' perceptions of barriers and facilitators to accessing autism services in British Columbia, Canada. Interviews were conducted with 20 Korean parents of autistic children. Barriers and facilitators at the system, provider, and family/cultural level were identified. Barriers at the system level included delays and waitlists for services, and ineffective school policies to address child behavioral challenges. At the provider level, barriers included a lack of qualified professionals, negative attitudes, and lack of guidance navigating services. For family/cultural-related barriers, these included language and communication difficulties, out-of-pocket costs, and stigma impeded service access. Facilitators at the system level included family-centered care and prioritization of mental health supports. At the provider level, strengths included culturally competent and bilingual professionals. The family/cultural-related facilitators identified were informal support networks, characteristics of the parent, and connections to cultural community organizations. The findings emphasize the need to understand and consider diverse experiences, preferences, and values in the design and provision of autism services for families and their children.

Examining factors related to the age of diagnosis of children with autism spectrum disorder from immigrant and non-immigrant backgrounds in a diverse clinical sample

A timely diagnosis of autism spectrum disorder (ASD) is important for children as that may help inform the best services and supports needed for optimal outcomes. However, disparities in the identification of ASD have been consistently documented for racial/ethnic minority and immigrant populations. The majority of studies of immigrant populations have focused on the qualitative experience of ASD, however, greater knowledge about the predictors of the age of initial ASD diagnosis is needed. This study examined the child, maternal, and family-level factors that predicted the age of initial ASD diagnosis in a diverse clinical sample through a retrospective medical record review. Medical records of clinical evaluations conducted between 2004 and 2014 were reviewed for children with ASD born to immigrant and non-immigrant mothers. Regression analyses found that for both groups of children with ASD, using verbal language to communicate and having another diagnosis (attention-deficit/hyperactivity disorder or another condition) predicted an older age of initial ASD diagnosis. For children with ASD born to immigrant mothers, residing in a multilingual household was associated with a younger age of diagnosis. These results highlight the complexities of an ASD diagnosis among diverse children and families, particularly among immigrant communities. LAY SUMMARY: This research looked at predictors of when children received their first autism spectrum disorder diagnosis across children born to immigrant mothers and children born to U.S.-born mothers. Living in a multilingual home was related to a younger age of diagnosis for children of immigrant mothers; being verbal and having another diagnosis was related to an older age of diagnosis for both groups of children. This highlights the need to improve diagnostic services for diverse children.

'I was scared at first, but not anymore': interpersonal contact and attitudes toward people with intellectual and developmental disabilities among Korean American adolescents and young adults

The purpose of this qualitative study is to explore experiences of naturalistic interpersonal contact with persons with intellectual and developmental disabilities (IDD) and attitudes toward persons with IDD among Korean American adolescents and young adults. In interviews with 12 Korean American high school and college students, Korean American participants reported six common themes regarding their experiences of interpersonal contact with persons with IDD: 1) affective attitude, 2) behavioral attitude, 3) cognitive attitude, 4) communication with persons with IDD, 5) moments of having a positive attitude, and 6) comparisons of attitudes in the United States and Korea. Recommendations for research and practical implications are discussed.

Cross-cultural perspectives on the meaning of family quality of life: Comparing Korean immigrant families and Canadian families of children with autism spectrum disorder

This study sought to examine and compare conceptualizations and descriptions of family quality of life, from the perspectives of Korean immigrant and Canadian families of children with autism spectrum disorder. Thematic analysis of semi-structured interviews from 13 Korean immigrant parents and 12 Canadian parents of children with autism living in BC, Canada was conducted. For Korean immigrant families, three themes were identified: family cohesiveness, value orientation, and acceptance from society. For Canadian families, themes comprising family interactions, support, emotional well-being, individual characteristics, and comparisons to other families were essential elements in defining their family quality of life. Findings highlight how cultural values and differences may translate into different conceptualizations of family quality of life and underscore the need for cross-cultural and diverse perspectives in the study and development of future assessment tools.

Can pictorial narration offer a solution to teacher training on the effective inclusion of students with autism spectrum disorder in low-resource settings? Investigation on knowledge and stigma change

LAY ABSTRACT

In this study, we explored whether pictorial narration could offer a solution to teacher training on effective inclusion of students with autism spectrum disorder in the Lao People's Democratic Republic. For this purpose, pre- and post-training knowledge data were collected from 87 Laotian teachers who participated in teacher training using a pictorial narrative e-module called The Story of Khamdy^TM. The teachers' knowledge test results and feedback were analyzed. The findings indicated that teachers' acceptance toward the training method had positive effects on their knowledge changes and supported the use of a pictorial narration approach in imparting knowledge about inclusive education and autism spectrum disorder to teachers in a least developed country.

Nonclinical Factors in Autism Diagnosis: Results From a National Health Care Provider Survey

OBJECTIVE

The prevalence of autism spectrum disorder (ASD) has increased 10-fold in the past 40 years, and disparities have been noted by race/ethnicity and socioeconomic status, prompting concern about diagnostic accuracy. Provider perceptions of ASD diagnostic accuracy are not known. We conducted a survey of providers who diagnose ASD assessing how nonclinical factors might affect ASD diagnostic rates.

METHODS

The mixed-mode survey was sent to the members of the Society of Developmental and Behavioral Pediatrics with clinical interest in ASD (n = 400). Respondents used a Likert-type scale to address how often they and their colleagues overdiagnosed or underdiagnosed ASD. They were also asked how families grouped by race/ethnicity, education, socioeconomic status, and urbanicity perceived an ASD diagnosis.

RESULTS

Sixty-three percent of providers completed the survey. Eight point seven percent of providers self-reported that they overdiagnose ASD at least sometimes. However, 58% of providers reported that local colleagues overdiagnose ASD at least sometimes. Seven point eight percent of providers self-reported underdiagnosing ASD at least sometimes and cited parents not wanting a diagnosis as one of the most common reasons they may underdiagnose. Providers reported that non-white and rural families were more likely to think that ASD diagnosis was "a bad thing" than "a good thing" than white and urban and suburban families, respectively.

CONCLUSION

Providers report moderate rates of ASD misdiagnosis and perceive differences in diagnostic preferences according to family characteristics. The study results may help explain the trends and disparities in ASD diagnosis.

Neuroimaging Markers of Risk and Pathways to Resilience in Autism Spectrum Disorder

Autism spectrum disorder is a complex, heterogeneous neurodevelopmental condition of largely unknown etiology. This heterogeneity of symptom presentation, combined with high rates of comorbidity with other developmental disorders and a lack of reliable biomarkers, makes diagnosing and evaluating life outcomes for individuals with autism spectrum disorder a challenge. We review the growing literature on neuroimaging-based biomarkers of risk for the development of autism and explore evidence for resilience in some autistic individuals. The current literature suggests that neuroimaging during early infancy, in combination with prebirth and early genetic studies, is a promising tool for identifying biomarkers of risk, while studies of gene expression and DNA methylation have provided some key insights into mechanisms of resilience. With genetics and the environment contributing to both risk for the development of autism spectrum disorder and conditions for resilience, additional studies are needed to understand how risk and resilience interact mechanistically, whereby factors of risk may engender conditions for adaptation. Future studies should prioritize longitudinal designs in global cohorts, with the involvement of the autism community as partners in research to help identify domains of functioning that hold value and importance to the community.

A Conceptual Framework for Understanding the Cultural and Contextual Factors on Autism Across the Globe

Autism research is heavily skewed toward western high-income countries. Culturally appropriate screening and diagnostic instruments for autism are lacking in most low- and middle-income settings where the majority of the global autism population lives. To date, a clear overview of the possible cultural and contextual factors that may affect the process of identifying and diagnosing individuals with autism spectrum disorders (ASD) is missing. This study aims to outline these factors by proposing a conceptual framework. A multidisciplinary review approach was applied to inform the development of the conceptual framework, combining a systematic review of the relevant autism research literature with a wider literature search spanning key texts in global mental health, cultural psychiatry, cross-cultural psychology, and intellectual disability research. The resulting conceptual framework considers the identification, help-seeking, and diagnostic process at four interrelated levels: (a) the expression; (b) recognition; (c) interpretation; and (d) reporting of autism symptoms, and describes the cultural and contextual factors associated with each of these levels, including cultural norms of typical and atypical behavior, culture-specific approaches to parenting, mental health literacy, cultural beliefs, attitudes and stigma, as well as the affordability, availability, accessibility, and acceptability of services. This framework, mapping out the cultural and contextual factors that can affect the identification, help-seeking, and diagnosis of ASD may function as a springboard for the development of culturally appropriate autism screening and diagnostic instruments, and inform future cross-cultural autism research directions. The framework also has relevance for clinicians and policy makers aiming to improve support for underserved autism populations worldwide. Autism Res 2020, 13: 1029-1050. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The vast majority of autism research is conducted in western high-income settings. We therefore know relatively little of how culture and context can affect the identification, help-seeking, and diagnosis of autism across the globe. This study synthesizes what is known from the autism research literature and a broader literature and maps out how culture and context may affect (a) the expression, (b) recognition, (c) interpretation, and (d) reporting of autism symptoms.

Stigma, Acceptance and Belonging for People with IDD Across Cultures

Purpose of Review

This review explores recent literature (from 2017 onwards) to identify current developments related to reducing stigma and increasing acceptance for people with Intellectual and Developmental Disabilities (IDD) in their communities across diverse cultures.

Recent Findings

We identified literature related to experiences of stigma for people with IDD and their families across diverse cultures, as well as current and potential interventions and approaches for promoting acceptance.

Summary

Although the literature confirms that stigma is still a major barrier to acceptance and inclusion for people with IDD regardless of culture, there appears to be progress in terms of using diverse approaches to support acceptance and belonging. Researchers are also increasingly acknowledging the importance of culture and context in the experience and mitigation of stigma. There remains a need for researchers and practitioners to include people with IDD in identifying and prioritising interventions that promote belonging within their communities.

Providing early detection and early intervention for autism spectrum disorder in South Africa: stakeholder perspectives from the Western Cape province

We set out to examine key stakeholder perspectives on early detection and intervention for autism spectrum disorder (ASD) in South Africa. Early detection and intervention improves child and family outcomes and lessens long-term costs. We focused on stakeholders in the Western Cape province, one of the better-resourced in terms of healthcare. Eight senior management level stakeholders, two each from government's Health, Education, and Social Development, and the non-profit sector were identified using purposive sampling. In-depth interviews focused on key implementation- related themes. The National Integrated Early Childhood Development Policy was the most relevant to early detection and intervention. This policy, however, is not ASD specific. This lack of specificity is in keeping with an emerging theme: ASD was only seen within the context of other developmental disabilities, particularly by Health and Social Development. Specific ASD early detection and intervention may not currently align with Health and Social Development departmental goals. These departments are primarily responsible for identifying and providing services and financial support to young children with ASD. Increased ASD knowledge and local South African statistics on prevalence, burden and associated costs may alter this approach. At this time, ASD early intervention may be more closely aligned with Education department goals.