'A blender without the lid on': Mealtime experiences of caregivers with a child with autism spectrum disorder in South Africa

Experiences of caregivers of children with autism during the COVID-19 pandemic: A scoping review

BACKGROUND

 The coronavirus disease 2019 (COVID-19) outbreak has had a profoundly negative impact on people all over the world, particularly those with disabilities such as autism. However, there are gaps in research understanding the impact of COVID-19 on this population and the support required.

AIM

 To explore the evidence available on the impact of the COVID-19 pandemic on caregivers of children with autism.

METHOD

 A scoping review methodology using the Arksey and O'Malley framework was employed. Five electronic databases from March 2020 to December 2022 were reviewed. Two thousand two hundred and six articles were retrieved with primary search terms: caregivers (population), autism (diagnosis) and COVID-19 (context). Following the screening of titles, abstracts and articles, 36 articles were included in the final review. Thematic and content qualitative analysis was completed.

RESULTS

 Preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) guided the reporting of the findings. Three main themes were identified: (1) caregiver's mental health and wellbeing, (2) response to remote health care and support and (3) caregiver resilience.

CONCLUSION

 The pandemic affected children with autism and their families regarding changes in routine, difficulties with support and emotional states. However, little research has been conducted on the impact in upper-middle-income countries such as South Africa.Contribution: The findings from this review carry practical implications that extend beyond the pandemic, such as political instability or natural disasters that may present similar stressors for children with autism and their families.

Experiences of families with children diagnosed with Autism Spectrum Disorder in World Health Organization Afro-Regions: A scoping review

A scoping review on Autism Spectrum Disorder (ASD) and its impact on the families of affected children was undertaken due to insufficient information available on the diverse experiences impacting their lives. Using the Joanna Briggs Institute methodology, eligibility criteria were guided by Population (families), Concept (family experiences), and Context (African region). English-language articles were sought from a variety of databases and search engines. The publication date of the identified articles ranged from 2003 to 2021 with most published in 2020 (n = 10), and the majority using qualitative methodologies (n = 51). Most family members involved were parents (n = 51) and their ages ranged from 18 to 75 years. The families experienced various challenges related to their child with regard to education, healthcare, and the broader community including lack of support. Family coping strategies included believing in God, attending counseling sessions, adapting, and accepting the situation. Healthcare professionals should be prepared and positioned to educate families and siblings on various aspects of ASD. There is a need for active, continued research on families within most countries of World Health Organization Afro-region.

The Unmasking of Autism in South Africa and Nigeria

This review is of interest to researchers, policymakers, and healthcare professionals working in the field of autism in Africa. The review aims to describe autism in sub-Saharan Africa, focusing on South Africa and Nigeria regarding prevalence, incidence, identification, treatment, and attitudes towards autistic children. There are several challenges, such as lack of awareness, limited access to professional support and diagnostic tools, and cultural considerations in establishing the autism prevalence in the African region compared to other parts of the world. Additionally, South Africans and Nigerians exhibit diverse perspectives and attitudes that significantly influence the provision of treatment, including stigma and misconceptions held by healthcare professionals themselves. As a result, it is difficult to determine prevalence in South Africa and Nigeria. However, research has indicated that autism prevalence is rising globally, and in these contexts. Rising prevalence highlights the need to increase access to services, rehabilitation, and provide support to families of children with autism. Furthermore, research has emphasized the inequitable support and access available to families living in low-and high-income households and the need to provide contextually relevant and responsive interventions, education and training, research and policy in these countries.

Feeding children with autism in South Africa: The teachers' perspectives

Background

Over 80% of children diagnosed with autism spectrum disorders (autism) exhibit disruptive behaviours during mealtimes, highlighting the need for personalised care. In South Africa, teachers often take on the responsibility of feeding due to resource constraints and the time children spend at school. Moreover, children with autism have unique and individualised feeding requirements, which many teachers may not have the necessary training or skills to address adequately.

Objectives

To explore the ways in which teachers of autistic children manage feeding difficulties in the classroom.

Method

A qualitative research design was employed using semi-structured interviews. Eight teachers were interviewed on feeding autistic children between the ages of 3 years - 9 years in Johannesburg, South Africa. Data were transcribed and analysed using thematic analysis.

Results

The findings revealed that teachers encountered distinct challenges when it came to feeding autistic children in the classroom, particularly concerning the management of associated feeding difficulties. Teachers employed several strategies to encourage eating in the classroom setting including: (1) bolus modification, (2) behaviour modelling, (3) positive reinforcement and (4) offering choices and alternatives.

Conclusion

The study concludes the need for specialised support and training for teachers to address the individualised feeding needs of children with autism. Implementing targeted interventions and providing resources for teachers could enhance their abilities to effectively support children with autism during mealtimes and promote a more inclusive classroom environment.

Contribution

This study highlighted the importance of including the teacher in the multidisciplinary team when managing the feeding challenges in children with autism.

Nutritional status and eating behavior of children with autism spectrum disorders in Vietnam: A case-control study

Background: Atypical eating behaviors and feeding issues are common in children with autism spectrum disorder (ASD). Aim: This study aims to evaluate the nutritional status and eating behavior of the ASD and typically developing groups. Methods: A case-control study was conducted from January to April 2019 in Nghe An, Vietnam. A total of 93 children in each group participated in the study with their main caregivers. We applied the Children's Eating Behavior Inventory (CEBI) to evaluate the eating behaviors of children. Results: Overweight and obesity in ASD children accounted for 41.9%. The CEBI score and %CEBI of the ASD group was higher than that of the control group (104.0 ± 14.2 and 91.3 ± 8.3; 24.1 ± 21.4 and 5.0 ± 11.8, respectively). Most of the adverse mealtime behaviors of ASD children focused on excessive duration (52.7%), distraction (40.9%), and food refusal (39.8%). In total 88.2% of caregivers had to comfort their ASD children at every meal, followed by threatening, scolding, or punishing children if they refused to eat (57.0%). Conclusion: Being overweight/obese and having eating behavior difficulties were prevalent among ASD children in Vietnam. Safer alternatives, such as lifestyle measures and seeking help from a nutritional therapist, can help ASD children reduce weight and modify their erroneous feeding habits.