Impact of a provider training program on the treatment of children with autism spectrum disorder at psychosocial care units in Brazil

Optimizing Care for Autistic Patients in Health Care Settings: A Scoping Review and Call to Action

OBJECTIVE

We conducted a scoping review of interventions designed to improve the health care experiences of autistic individuals and assessed the methodology and outcomes used to evaluate them.

METHODS

Literature from January 2005 to October 2020 was searched using PubMed, Excerpta Medica dataBASE (EMBASE), Cumulated Index to Nursing and Allied Health Literature (CINAHL), PsycINFO as well as hand searching. Studies included described an intervention for autistic individuals in inpatient or outpatient settings and evaluated the intervention using standardized methodology. Results were exported to Covidence software. Ten reviewers completed abstract screening, full text review, and then systematic data extraction of the remaining articles. Two reviewers evaluated each article at each stage, with a third reviewer arbitrating differences.

RESULTS

A total of 38 studies, including three randomized controlled trials (RCTs) were included. Twenty-six (68%) took place in dental, psychiatric, or procedural settings. Interventions primarily focused on visit preparation and comprehensive care plans or pathways (N = 29, 76%). The most frequent outcome was procedural compliance (N = 15), followed by intervention acceptability (N = 7) and parent satisfaction (N = 6). Two studies involved autistic individuals and caregivers in study design, and no studies assessed racial/ethnic diversity on intervention impact.

CONCLUSIONS

Well-designed evaluations of interventions to support autistic individuals in pediatric health care settings are limited. There is a need to conduct large multi-site intervention implementation studies.

Age of autism diagnosis in Latin American and Caribbean countries

LAY ABSTRACT

An earlier diagnosis of autism spectrum disorder might lead to earlier intervention. However, people living in Latin American and Caribbean countries do not have much knowledge about autism spectrum disorder symptoms. It has been suggested that the older a child is when diagnosed, the fewer opportunities he or she will have to receive services. We asked 2520 caregivers of autistic children in six different Latin America and Caribbean Countries, the child's age when they noticed some developmental delays and their child's age when they received their first autism spectrum disorder diagnosis. Results indicate that, on average, caregivers were concerned about their child's development by 22 months of age; however, the diagnosis was received when the child was 46 months of age. In addition, older children with better language abilities and public health coverage (opposed to private health coverage) were diagnosed later. On the contrary, children with other medical problems and more severe behaviors received an earlier diagnosis. In our study, children were diagnosed around the time they entered formal schooling, delaying the access to early intervention programs. In summary, the characteristics of the autistic person and the type of health coverage influence the age of diagnosis in children living in Latin America and Caribbean Countries.

Profile of Service Use and Barriers to Access to Care among Brazilian Children and Adolescents with Autism Spectrum Disorders

Delayed diagnosis and a lack of adequate care for people with autism spectrum disorder (ASD) are related to worse outcomes and quality of life. This study aimed to identify the profile of service use, barriers to access care, and factors related to those barriers in Brazilian families with children with ASD. A total of 927 families with children with ASD (3–17 years) from five Brazilian regions completed an online version of the Caregivers Needs Survey. Results showed that the most used services were behavioral interventions and pharmacotherapy, while the most used professionals were neurologists, nutritionists, speech therapists, psychiatrists, psychologists, and pediatricians. The main barriers included waiting lists, costs, and the absence of services or treatment. Service use varied according to age, the region of residence, type of health care system used, and the parents/caregivers’ education. Access to behavioral interventions was more frequent among users of the private system/health insurance and families whose caregivers had higher education. The absence of specialized services/treatments was less frequent among residents of state capitals and families whose caregivers had higher levels of education. This study highlights how families with children/adolescents with ASD in Brazil face significant barriers to access care related to sociodemographic factors.

The knowledge of Public Health Midwives on Autism Spectrum Disorder in two selected districts of the Western Province of Sri Lanka

BACKGROUND

Early interventions are important for improving outcome in autism. However, the diagnosis of autism is often delayed for 3-4 years, which leads to missed opportunities to initiate early intensive behavioural interventions, thus jeopardizing its prognosis. The lack of knowledge among healthcare workers about the features of autism is postulated to be the main reason for this delay.

METHODOLOGY

A descriptive cross-sectional study was carried out among the PHMs in the Colombo and Kalutara districts of the Western Province, Sri Lanka. A specifically designed self-administered questionnaire was used to obtain information about the socio-demographic details. The knowledge about the signs and symptoms and common comorbidities of ASD were assessed using the "Knowledge about Childhood Autism among Health Workers (KCAHW) Questionnaire".

RESULTS

Out of 406 participants, 56.9 % (n = 231) were from the Colombo District. The mean knowledge of the participants on the "Knowledge about Childhood Autism among Health Workers (KCAHW) Questionnaire" was 13.23/19 (SD = 2.647). The knowledge was significantly higher in those who had participated in training programmes on autism (p < 0.01) and in those who have had contact with a child with autism (p < 0.05). Of the participants, 17.2 % (n = 70) believed that autism could be completely cured. 43.6 % and 42.2 % believed that poor attention from parents and parental conflicts during pregnancy and early childhood caused autism in children respectively.

CONCLUSION

The knowledge of PHMs on autism is inadequate, with regard to the comorbidities, aetiology and treatment options. In service programmes are useful in improving the knowledge of PHMs on autism.

Evaluation of a consulting training course for international development assistance for health

BACKGROUND

Development assistance for health (DAH) is an important component of foreign assistance. International health consultants usually play a key role in the international DAH field. However, there is still a shortage of consulting training in China. To address this issue and develop new backup force of DAH for China, the Global Health Institute of Wuhan University (GHIWHU) launched a training program called the "Consulting Training Course for International Development Assistance for Health". The purpose of this article is to evaluate the impact of the training on participants.

METHODS

We conducted the analysis using Kirkpatrick's model. An evaluation survey examining participants' reaction (level 1) and learning (level 2) was carried out among trainees following the training, and a follow-up telephone interview of application (level 3) was made in three months after the training.

RESULTS

A total of 25 participants from Chinese Consortium of Universities for Global Health (CCUGH) attended the training program. Results of satisfaction evaluation indicated that the training program was well received, with more than 85% of participants felt satisfied or relatively satisfied with the training. Trainees' self-ratings of the consulting knowledge and skills showed a significant increase (p < 0.001) from pre- to post-training. The follow-up interview revealed that the majority of participants applied the acquired knowledge and skills under various circumstances such as consulting program, teaching processes, writing reports, and et al. Meanwhile, participants considered that the lack of opportunities was one of the major application barriers. In addition, they expressed the willingness to participate in more relevant training and the need for more practice opportunities.

CONCLUSIONS

This is the first study evaluating a consulting training program in China. The results show that the training course has been successfully implemented and participants have been given consulting knowledge and skills. Future research should use better-designed training methods based on demand surveys and consider providing participants with practice or practicum opportunities. Also, it is necessary to conduct both primary and advanced training courses and evaluate participants' long-term behavior changes resulting from the training.

Plasma concentrations of the trace elements copper, zinc and selenium in Brazilian children with autism spectrum disorder

The association between the plasma levels of trace elements, such as copper (Cu), zinc (Zn) and selenium (Se), in people with autism spectrum disorder (ASD), has attracted the interest of many physicians in the very recent years, because the impaired homeostatic regulation of trace elements, including their levels in the bloodstream and their potential neurotoxicity, contribute to the onset and exacerbation of ASD. In this study, we investigated 23 pediatric subjects (≤ 18 yrs old, both sexes) with ASD, all residents in the city of Campo Grande in Brazil, by searching for their micronutrient levels in plasma in relation with metabolic and nutrition biomarkers. Aside for the few evidence reported, generally, the Brazilian cohort of ASD children here examined did not show a marked difference in micro-nutrient intake in relation with their resident geographical area and their dietary habit or metabolic state, although a slight difference in the levels of magnesium and phosphorus was retrieved due to sex difference.