Early identification and intervention services for children with autism in Vietnam

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.

Burden, impact, and needs of caregivers of children living with mental health or neurodevelopmental conditions in low-income and middle-income countries: a scoping review

This scoping review synthesises previous research on caregivers' experiences and perspectives of caring for a child with a mental health or neurodevelopmental condition while living in low-income and middle-income countries (LMICs). 35 studies done across 15 LMICs were included in this Series paper. Most studies were done in the Africa region. Child and adolescent mental health and neurodevelopmental conditions were perceived by caregivers to have both biomedical and traditional or spiritual causes and help-seeking was aligned to these explanatory beliefs. Caregivers commonly described reduced quality of life, which they attributed to their children's mental or neurodevelopmental condition, and additional reports of family disruption, caregiver psychological distress, and financial hardship. To strengthen mental health outcomes of young people, better mental health promotion information for caregivers is required along with improved engagement with communities and increased sensitivity to caregiver wellbeing and needs when developing interventions for children and adolescents.

The Performance of Emotion Classifiers for Children With Parent-Reported Autism: Quantitative Feasibility Study

BACKGROUND

Autism spectrum disorder (ASD) is a developmental disorder characterized by deficits in social communication and interaction, and restricted and repetitive behaviors and interests. The incidence of ASD has increased in recent years; it is now estimated that approximately 1 in 40 children in the United States are affected. Due in part to increasing prevalence, access to treatment has become constrained. Hope lies in mobile solutions that provide therapy through artificial intelligence (AI) approaches, including facial and emotion detection AI models developed by mainstream cloud providers, available directly to consumers. However, these solutions may not be sufficiently trained for use in pediatric populations.

OBJECTIVE

Emotion classifiers available off-the-shelf to the general public through Microsoft, Amazon, Google, and Sighthound are well-suited to the pediatric population, and could be used for developing mobile therapies targeting aspects of social communication and interaction, perhaps accelerating innovation in this space. This study aimed to test these classifiers directly with image data from children with parent-reported ASD recruited through crowdsourcing.

METHODS

We used a mobile game called Guess What? that challenges a child to act out a series of prompts displayed on the screen of the smartphone held on the forehead of his or her care provider. The game is intended to be a fun and engaging way for the child and parent to interact socially, for example, the parent attempting to guess what emotion the child is acting out (eg, surprised, scared, or disgusted). During a 90-second game session, as many as 50 prompts are shown while the child acts, and the video records the actions and expressions of the child. Due in part to the fun nature of the game, it is a viable way to remotely engage pediatric populations, including the autism population through crowdsourcing. We recruited 21 children with ASD to play the game and gathered 2602 emotive frames following their game sessions. These data were used to evaluate the accuracy and performance of four state-of-the-art facial emotion classifiers to develop an understanding of the feasibility of these platforms for pediatric research.

RESULTS

All classifiers performed poorly for every evaluated emotion except happy. None of the classifiers correctly labeled over 60.18% (1566/2602) of the evaluated frames. Moreover, none of the classifiers correctly identified more than 11% (6/51) of the angry frames and 14% (10/69) of the disgust frames.

CONCLUSIONS

The findings suggest that commercial emotion classifiers may be insufficiently trained for use in digital approaches to autism treatment and treatment tracking. Secure, privacy-preserving methods to increase labeled training data are needed to boost the models' performance before they can be used in AI-enabled approaches to social therapy of the kind that is common in autism treatments.

The reliability and validity of the social responsiveness scale to measure autism symptomology in Vietnamese children

The Social Responsiveness Scale (SRS) has been validated in high-income countries but not yet in low- and middle-income countries. We aimed to assess the reliability of the SRS in a community sample and its validity to discriminate between children with and without autism spectrum disorder (ASD) in Vietnam. We used a three-phase study: piloting the translated SRS, reliability testing, and validation of the SRS in 158 Vietnamese caretakers and their children (ages 4-9 years). We examined reliability, validity and sensitivity, and specificity to ASD diagnosis. We applied receiver operator characteristic (ROC) analysis to determine optimal cutoff scores discriminating the children with ASD from those without ASD. We also assessed the performance of the SRS short form. We found that reliability was good with high internal consistency (0.88-0.89), test-retest reliability (0.82-0.83), sensitivity (93%), and specificity (98%) for identification of children with ASD. The ROC curves were similar for total raw score and total T-score, with the area under the curve (AUC) values reaching 0.98 and the optimal cutoff of 62 for raw scores and 60 for T-scores. The SRS short form also performed well in distinguishing children with ASD from children without ASD, with high AUC (0.98), sensitivity (90%), and specificity (98%) when using a raw score of 15 as a cutoff. In conclusion, the translated and culturally adapted SRS shows good reliability, validity, and sensitivity for identification of children with ASD in Vietnam. Both SRS long and short forms performed adequately to discriminate between children with and without ASD. Autism Res 2019, 00: 1-13. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Middle-income countries often lack validated tools to evaluate autism symptoms. The Social Responsiveness Scale (SRS) translated to Vietnamese was reliable and performed well to distinguish between children with and without autism spectrum disorder in Vietnam. The Vietnamese SRS, and translations of the tool to other languages with this methodology, may be useful in pediatric practice, potentially allowing providers to make more appropriate referrals for diagnostic evaluations and identify children for intervention to help them fulfill their developmental potential.

Prevalence of Autism Spectrum Disorder in Preterm Infants: A Meta-analysis

CONTEXT

Evidence is emerging that preterm infants are at risk for autism spectrum disorder (ASD).

OBJECTIVES

To conduct a systematic review and meta-analysis to estimate the prevalence of ASD in preterm infants.

DATA SOURCES

Medline (via PubMed and Ovid), Embase, PsycINFO, and relevant conference proceedings were searched in May 2017.

STUDY SELECTION

Original studies in which researchers report on the prevalence of ASD using diagnostic tests in children born preterm were included. Studies in which researchers used only ASD screening tools were excluded.

DATA EXTRACTION

Relevant data were extracted independently by 3 authors.

RESULTS

Researchers in a total of 18 studies (3366 preterm infants) used ASD diagnostic tools. The median gestation, birth weight, and age at assessment were 28.0 weeks (range: 25.1-31.3 weeks), 1055 g (range: 719-1565 g), and 5.7 years (range: 1.5-21 years), respectively. Meta-analysis revealed that the overall prevalence rate for ASD was 7% (95% confidence interval: 4% to 9%). The funnel plot and Egger's test revealed that there was probably no evidence of publication bias.

LIMITATIONS

The limitations were significant heterogeneity and a lack of studies from middle- and low-income countries.

CONCLUSIONS

The prevalence of ASD is significantly high in the preterm population. Adequate resources are needed to improve the outcomes of these children.

[Evaluation of quality of service in Early Intervention: A systematic review]

INTRODUCTION

Early Intervention (EI), as a paediatric service, has the duty of quantifying the results and the quality of its services provided. The accessibility of valid and reliable tools allows professionals to evaluate the quality of these services.

MAIN OBJECTIVE

The aim of this study is to review the scientific literature on tools used to measure the methodological and service quality in EI.

METHODS

A search was made in different databases: Medline (from PubMed), Web of Science, PsycINFO, Cochrane, Scopus, ERIC and Scielo. The methodological quality of the studies was tested using the COSMIN scale.

RESULTS

A total of 13 manuscripts met the criteria to be included in this review. Ten of them received a "good" or "reasonable" score based on the COSMIN scale.

CONCLUSIONS

Despite its importance, there is no consensus among authors on the measurement of service quality in EI. It is often the family of the children attended in EI that are considered the target to study, although the opinion of professionals carries more weight and completes the information.

Characteristics of Agencies Providing Support Services for Children with Autism Spectrum Disorders in Vietnam

As in virtually all countries, in Vietnam there has been a general trend towards apparent increased rates of Autism Spectrum Disorder (ASD). To address the needs of families and children with ASD, many agencies providing support services have been opened throughout Vietnam over the last two decades. Although agencies in general appear to strive to provide good quality service, the actual quality of operations is unknown. The present article collected and analyzed secondary data from 68 agencies across Vietnam from different information sources, using the nine criteria published by Tran, Weiss, and Pham (in press) [1] and Nguyen, Hoang, Nguyen, Pham, and Tran (2017) [2] to evaluate agency quality. Results of this review suggest that a significant number of centers do not have appropriate legal status, are not following basic ethical standards, are using non-evidence based intervention methods, and are unclear in regards to the intervention procedures or intervention plans they use. Although the current study has a number of limitations, it provides important initial information regarding the current status of ASD services in Vietnam.

Barriers to early identification of autism in Brazil

OBJECTIVE

Parents of children with autism spectrum disorders (ASD) seem to perceive that their child's development is not following the normal pattern as early as the first year of life. However, ASD children may not receive a diagnosis until they are of preschool age, especially in low- and middle-income countries. The objective of this study was to evaluate the pathway between initial parental concerns about atypical child development and ASD diagnosis in Brazil.

METHODS

Nineteen mothers whose children had been diagnosed with ASD participated and were interviewed. The ASD group consisted of two girls and 17 boys, with a mean age of 93.0 months (SD 48.4 months; range 39-197 months).

RESULTS

Mothers had their first concerns regarding ASD when children were 23.6±11.6 months old, but formal diagnosis occurred at a mean ± SD age of 59.6±40.5 months, corresponding to a 3-year delay. Most mothers felt discouraged to address their concerns due to negative experiences with health professionals.

CONCLUSION

In Brazil, mothers perceived the first signs of ASD in their children at an age similar to that reported in other countries, but the diagnosis of ASD seemed to be delayed. Consistent with the literature, mothers reported negative experiences with health professionals during the pathway to achieving ASD diagnosis.