Perceived Anxiety in Family Caregivers of Individuals with Autism Spectrum Disorder, Down Syndrome and Williams Syndrome during the Lockdown of the First COVID-19 Wave in Spain.

The lockdown during the first wave of COV- ID-19 in Spain has been related to higher levels of anxiety in the general population. However, the emotional impact on Spanish caregivers of individuals with neurodevelopmental disorders (NDD) has not been studied so far.

Efficacy of coping mechanisms used during COVID-19 as reported by parents of children with autism.

The COVID-19 pandemic's alterations to daily life have been especially challenging for families with Autism Spectrum Disorder (ASD), worsening the core features of ASD and overall mental health. With the increased need for effective coping, the current retrospective study used data from a survey regarding parent reports of how often their child with ASD used certain coping strategies (frequency), as well as the extent to which they felt their child benefitted from their use (efficacy) in mitigating stress during the pandemic. This retrospective study Repeated measures ANOVAs were conducted to evaluate whether there were significant differences in both frequency and efficacy ratings for each coping strategy, for the entire sample as well as for three children's age groups. Using Spearman's rank-order correlations, correlation coefficients between the frequency and efficacy of each coping strategy were explored. Results revealed that maladaptive strategies were used more frequently than adaptive strategies, while parent routine as the most frequently used and efficacious for all age groups. Additionally, for adaptive strategies, humor and focusing on the positive had the strongest correlations between frequency and efficacy ratings amongst all age groups. Of the maladaptive strategies, repetitive behaviors, rumination, and isolation had the strongest correlations for the youngest, middle, and oldest age groups, respectively. Further, for each age group, the adaptive coping strategies had stronger correlations between frequency and efficacy than the maladaptive ones. It is our hope that the results of this study will lay the foundation for developing adaptive coping strategies to alleviate stress in children with ASD. Further investigations using a larger cohort are warranted to determine effective coping strategies for individuals with ASD across a range of situations, including acute stressors (such as future public health emergencies and natural disasters), as well as common daily stressors.

An approach for prevention planning based on the prevalence and comorbidity of neurodevelopmental disorders in 6-year-old children receiving primary care consultations on the island of Menorca.

BACKGROUND: Few studies have estimated the real prevalence of neurodevelopmental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) in Spain and worldwide. However, there are disparate prevalence figures. We consider research in this field essential to improve early detection, secondary prevention, and health planning. METHODS: The Minikid ADHD and TICS-Mini International Neuropsychiatric Interview for Children and Adolescents, the Autism Spectrum Quotient (Children's version, AQ- Child) and a protocol of general medical questions were administered for screening purposes. The PROLEXIA battery for children aged from 4 to 6 years was used for direct assessments. Parents provided information on emotional, medical, and school aspects. The final population evaluated using these tools consisted of 291 6-year-old subjects. RESULTS: The overall risk of presenting with a neurodevelopmental disorder was 55.4%. A 23.4% risk of presenting with attention-deficit/hyperactivity disorder (ADHD) in any modality (inattentive, hyperactive-impulsive and combined), a 2.8% risk of developing autism spectrum disorder (ASD), a 30.6% risk of presenting with a learning disorder with reading difficulties, a 5.5% risk of tics and a 22.5% risk of language problems (incomprehensible language or minor language problems) were detected in the sample. The most common combination of disorders was learning and language difficulties, accounting for 6.9% of the sample. The second most frequent combination was the presence of learning and language difficulties and ADHD, accounting for 4.5% of the sample. CONCLUSIONS: The prevalence of risks detected in our sample seems to be consistent with national and international studies. A significant proportion of our sample had never been previously diagnosed (85%), so early detection programs are recommended.

Commentary: Best practices and processes for assessment of autism spectrum disorder - the intended role of standardized diagnostic instruments.

Development of standardized diagnostic instruments has facilitated the systematic characterization of individuals with autism spectrum disorders (ASD) in clinical and research settings. However, overemphasis on scores from specific instruments has significantly detracted from the original purpose of these tools. Rather than provide a definitive "answer," or even a confirmation of diagnosis, standardized diagnostic instruments were designed to aid clinicians in the process of gathering information about social communication, play, and repetitive and sensory behaviors relevant to diagnosis and treatment planning. Importantly, many autism diagnostic instruments are not validated for certain patient populations, including those with severe vision, hearing, motor, and/or cognitive impairments, and they cannot be administered via a translator. In addition, certain circumstances, such as the need to wear personal protective equipment (PPE), or behavioral factors (e.g., selective mutism) may interfere with standardized administration or scoring procedures, rendering scores invalid. Thus, understanding the uses and limitations of specific tools within specific clinical or research populations, as well as similarities or differences between these populations and the instrument validation samples, is paramount. Accordingly, payers and other systems must not mandate the use of specific tools in cases when their use would be inappropriate. To ensure equitable access to appropriate assessment and treatment services, it is imperative that diagnosticians be trained in best practice methods for the assessment of autism, including if, how, and when to appropriately employ standardized diagnostic instruments.

Investigating the impact of disposable surgical face-masks on face identity and emotion recognition in adults with autism spectrum disorder.

With the outburst of the COVID-19 pandemic, disposable surgical face-masks (DSFMs) have been widely adopted as a preventive measure. DSFMs hide the bottom half of the face, thus making identity and emotion recognition very challenging, both in typical and atypical populations. Individuals with autism spectrum disorder (ASD) are often characterized by face processing deficits; thus, DSFMs could pose even a greater challenge for this population compared to typically development (TD) individuals. In this study, 48 ASDs of level 1 and 110 TDs underwent two tasks: (i) the Old-new face memory task, which assesses whether DSFMs affect face learning and recognition, and (ii) the Facial affect task, which explores DSFMs' effect on emotion recognition. Results from the former show that, when faces were learned without DSFMs, identity recognition of masked faces decreased for both ASDs and TDs. In contrast, when faces were first learned with DSFMs, TDs but not ASDs benefited from a "context congruence" effect, that is, faces wearing DSFMs were better recognized if learned wearing DSFMs. In addition, results from the Facial affect task show that DSFMs negatively impacted specific emotion recognition in both TDs and ASDs, although differentially between the two groups. DSFMs negatively affected disgust, happiness and sadness recognition in TDs; in contrast, ASDs performance decreased for every emotion except anger. Overall, our study demonstrates a general, although different, disruptive effect on identity and emotion recognition both in ASD and TD population.

Mental health issues in parents of children with autism spectrum disorder: A multi-time-point study related to COVID-19 pandemic.

Given the unpredictability and challenges brought about by the 2019 novel coronavirus (COVID-19) pandemic, this study aimed to investigate the impact trend of the prolonged pandemic on the mental health of parents of children with autism spectrum disorder (ASD). The 8112 participants included parents of children with ASD and parents of typically developing (TD) children at two sites (Heilongjiang and Fujian province, China). The parents completed a set of self-report questionnaires covering demographic characteristics, influences related to COVID-19, COVID-19 concerns and perceived behaviors, as well as the Connor-Davidson resilience scale (CD-RISC), self-rating anxiety scale (SAS), and self-rating depression scale (SDS) by means of an online survey platform. Data were collected by three cross-sectional surveys carried out in April 2020 (Time 1), October 2020 (Time 2), and October 2021 (Time 3). The results of quantitative and qualitative comparisons showed that: (i) parents of children with ASD had lower levels of resilience, and more symptoms of anxiety and depression than parents of TD children at each time point (all P < 0.05); and (ii) there were significant time-cumulative changes in resilience, anxiety, and depression among all participants (all P < 0.05). The logistic regression analyzes after adjusting for demographic characteristics revealed that the following factors were significantly associated with poor resilience and a higher rate of anxiety and depression in parents of children with ASD: time-point, the effect of COVID-19 on children's emotions and parents' emotions, changes in relationships, changes in physical exercise, changes in daily diet during the COVID-19 pandemic, and COVID-19-related psychological distress. In conclusions, the parents did not report improvements in resilience, anxiety, or depression symptoms from Time 1 to Time 2 or 3, indicating that cumulative mental health issues increased when, surprisingly, the COVID-19 restrictions were eased. The psychological harm resulting from the COVID-19 pandemic is far-reaching, especially among parents of children with ASD.

Resilience and Coping with Stress and Marital Satisfaction of the Parents of Children with ASD during the COVID-19 Pandemic.

Raising and caring for a child with ASD is a challenge for the parents' marriage relationship. Caring for a disabled child changes the functioning of the family and requires greater involvement in care and specialist therapy. The respondents' answers show that such parents experience higher levels of stress related to the upbringing and future of the child. However, parenting challenges need not be a negative experience if the parents support each other. The process of bringing up children in the family are related, inter alia, to the quality of their parents 'marriage, which is influenced by the partners' personal resources. The resilience of the partners and coping with this situation contribute to marital satisfaction. The aim of the study is to find out about the relationship between spouses' resilience and coping styles and their assessment of marriage satisfaction. In total, 50 married couples participated in the study-50 mothers of children with ASD and 50 fathers, the partners of these mothers (N = 100). The following tools were used: the Resilience Scale (SPP-25), the Coping Inventory for Stressful Situations (CISS) and the Well-Matched Marriage Questionnaire (KDM-2), as well as a survey questionnaire (data on respondents). The results show that the gender of the parent of a child with ASD does not differentiate the overall assessment of the quality of marriage (the overall score on the scale indicates a low level of satisfaction with the relationship). When analyzing in detail the dimensions of individual scales of satisfaction with the relationship, one statistically significant difference was noted for the sex of the respondents in the disappointment dimension, showing that the level of disappointment in the quality of the relationship is higher in wives than in husbands. In the other dimensions of satisfaction with marriage: intimacy, personal fulfillment, similarity, there were no statistically significant differences in terms of gender of the respondents. The resilience of the spouses positively correlates with their assessment of marriage satisfaction, and in particular, openness, perseverance and determination to act increase the level of Task-oriented coping (SSZ) with difficult situations. All resilience factors negatively correlate with the emotional coping style (SSE). In both the studied groups, openness is a significant predictor of intimacy, and persistence is a predictor of self-fulfilment in a relationship. A predictor of disappointment in women is managing using substitute activities (ACZ), while in men it is the Emotion-oriented coping (SSE) style. The results indicate the need to support married couples raising a child with ASD during the pandemic.

Changes in Mental Health during Three Waves of the COVID-19 Pandemic in Slovakia: Neurotypical Children versus Children with Autism Spectrum Disorder and Their Parents.

The main goal of our research was to monitor changes in the mental health of Slovak families with children with autism spectrum disorder (ASD) compared to families with neurotypical children during three waves of the COVID-19 pandemic. We focused on the prevalence of depression, anxiety, stress and different stressors of parents. In children, we explored maladaptive behavior and the availability of interventions for children with ASD. The data were collected using an extensive questionnaire including the Depression, Anxiety, and Stress Scale-42 questionnaire (DASS-42) and two subscales of the Vineland Adaptive Behavior Scales (VABS-3). The research sample consisted of a total of 506 parents, 236 of whom have a child with ASD. Parents of children with ASD reported elevated anxiety during the first wave, while changes were found in parents of neurotypical children. During the second wave, the prevalence of anxiety, depression and stress experienced by parents in both groups increased, but significantly more in parents with ASD children. The internalizing maladaptive behavior of children with ASD also increased. During the third wave, no significant differences between the groups of parents were found in stress and anxiety, but parents of ASD children scored higher in depression. Externalized maladaptive behavior of neurotypical children increased, with minimal changes in children with ASD, which can be explained by the improved therapy availability for children with ASD, also observed in our study.

Autistic children and adolescents with frequent restricted interest and repetitive behavior showed more difficulty in social cognition during mask-wearing during the COVID-19 pandemic: a multisite survey.

BACKGROUND: The public health measures enacted in order to control the coronavirus disease (COVID-19) pandemic have caused considerable changes to daily life. For autistic children and adolescents, adapting to the "new normal," including mask-wearing, may be difficult because of their restricted interest and repetitive behavior (RRB) characteristics. We aimed to examine the relationships between RRB characteristics and the impact of mask-wearing on their social communications during the pandemic. METHODS: We recruited participants with a clinical diagnosis of autism spectrum disorder based on DSM-5 diagnostic criteria from two outpatient clinics in Tokyo, Japan, between November 2020 and April 2021 using a convenience sampling methodology. As a result, the participants consisted of 102 children and adolescents (mean (SD) age = 11.6 (5.3)). We collected data on RRB characteristics frequency before and during the pandemic using the CoRonavIruS Health Impact Survey (CRISIS) - Adapted for Autism and Related Neurodevelopmental conditions (AFAR). We then conducted factor analyses to compute the RRB severity composite scores, which are divided into lower- (e.g., sensory seeking), and higher-order (e.g., restricted interest). We also investigated mask-wearing culture using a bespoke questionnaire, and using Spearman's rank correlation analyses, we examined the relationships between before pandemic RRB characteristics, and the impact of mask-wearing on social communications during the pandemic. RESULTS: We found that children and adolescents who exhibited lower-order RRB before the pandemic had difficulties in going-out with mask-wearing (rho = -0.25, q = .031), more challenges with mask-wearing (rho = - 0.34, q = .0018), and difficulty in referring to others' emotions while wearing masks (rho = - 0.36, q = .0016). We also found an association between higher-order RRB before the pandemic and an uncomfortable sensation (rho = - 0.42, q = .0002) and difficulties in referring to other's emotions while wearing masks (rho = - 0.25, q = .031). CONCLUSIONS: We revealed that various behaviors, such as sensory seeking, repetitive motor mannerisms and movements, and rituals and routines, undertaken before the pandemic could be important predictors of difficulties with mask-wearing and social communication for autistic children and adolescents during the pandemic. Caregivers and teachers wearing masks may need to provide extra support for social communication to autistic children and adolescents showing RRB characteristics frequently.

Feasibility of a virtual nutrition intervention for adolescents with autism spectrum disorder.

LAY ABSTRACT: Adolescents with autism spectrum disorder are at an increased risk of unhealthy eating behaviors and obesity compared to their typically developing peers. Many nutrition interventions for this population focus on improving autism spectrum disorder symptoms or managing weight rather than addressing participants' healthy eating self-efficacy. The purpose of this study was to examine a virtual implementation of a new intervention for adolescents with autism spectrum disorder, Bringing Adolescent Learners with Autism Nutrition and Culinary Education. We used fidelity checklists, engagement records, and field notes to measure implementation. We also examined the feasibility of assessing outcome measures, including a food frequency questionnaire (FFQ), psychosocial survey, height, and weight. We recruited adolescents with autism spectrum disorder aged 12-21 years. Six groups of 2-7 adolescents (27 total) participated in the intervention and pre-/post-intervention measurements. Bringing Adolescent Learners with Autism Nutrition and Culinary Education consisted of eight weekly lessons: exploring taste, flavor, and texture; mealtimes and rules; food groups and nutrients; moderation; beverages; cooking; well-being; sustaining healthy eating habits. The virtual implementation was feasible based on lesson attendance, participation, homework completion, fidelity, and prevalence of technical difficulties. Evaluation was also feasible based on response rate, completion, and data quality for the food frequency questionnaire, psychosocial survey, and height and weight measurements. Bringing Adolescent Learners with Autism Nutrition and Culinary Education may be used in virtual settings to reach diverse populations of adolescents with autism spectrum disorder. Future research is needed to evaluate the impact of Bringing Adolescent Learners with Autism Nutrition and Culinary Education on dietary behavior and obesity outcomes.

Impact of COVID-19 pandemic on families living with autism: An online survey.

BACKGROUND: The current SARS-CoV-2 global pandemic presents a great challenge for governments, health care professionals and the general population. Individuals with autism spectrum disorder (ASD) might be especially vulnerable to restrictions imposed by the crisis. AIM: The objective of the study was to examine the impact of the SARSCoV- 2 pandemic on children with ASD and their families. METHODS AND PROCEDURES: We conducted an online survey two months after the beginning of lock-down (18th of May to 5th of July 2020) in Germany and Austria. We investigated behavioral and emotional changes of children related to the lock-down alongside parental stress and intrafamilial burden OUTCOME AND RESULTS: Of the 216 participating families with an autistic child (mean age: 12.23 years), nearly 50% reported aggravation of autistic symptoms and heightened parental stress. Families reported discontinuation of therapy, more intrafamilial conflicts and increase of psychopharmacological medication of the child. CONCLUSIONS AND IMPLICATIONS: Our report on short-term detrimental effects of the pandemic calls for thorough investigation of long-term sequalae for children and families.

Psychosocial Functioning and the Educational Experiences of Students with ASD during the COVID-19 Pandemic in Poland.

Due to their individual developmental and learning needs, adolescents with autism spectrum disorder (ASD) benefit from a variety of educational, medical, and therapeutic services. During the COVID-19 pandemic, these services were discontinued or significantly reduced, which may have resulted in increased difficulties in coping with various areas of life. The purpose of this study was to explore how the pandemic affected the psychosocial and educational functioning of students with ASD. A qualitative, problem-focused interview method was used. The obtained material was subjected to interpretive phenomenological analysis. The study involved 10 secondary school students diagnosed with ASD. The assessment of the effects of the pandemic on the functioning of people with ASD is inconclusive. The respondents noted both negative and positive effects of lockdown. On the positive side, they were able to spend time with their family, isolate themselves from difficult social relationships and feel better. Among the negative effects, adolescents point to difficulties in emotional functioning-increased levels of stress and anxiety, as well as increased feelings of loneliness and difficulties with online education. The study showed the varied experiences of young people with autism during the pandemic, highlighting the significant need to support some of them in terms of their emotional, social and educational functioning.

Quality of Life among Mothers of High Functioning Autism Spectrum Disorder (HFASD)Adolescents.

Autism Spectrum Disorder (ASD) has become more prevalent globally. The disorder is predominantly characterised by low social skills noted explicitly in people with High Functioning Autism Spectrum Disorder (HFASD). The individuals usually possess a normal or superior intelligence quotient (IQ) but the disability impedes the achievement of their actual high potential, hence compromising their quality of life (QoL). Managing adversities encountered by children with HFASD often compromises the QoL of the entire family. Thus, this study aimed to identify specific domains of QoL among mothers of high-functioning autistic adolescents. The study assessed seven mothers of adolescents with HFASD using a semi-structured interview format. A thematic qualitative analysis was conducted to analyse the data. The results suggested that mothers perceived their QoL based on physical and emotional well-being, material well-being, interpersonal relationship, and environmental well-being. Intervention for HFASD is multidisciplinary, which targets a broad spectrum of symptoms and skills deficits and customises the programme to meet each individual's different needs. Nonetheless, intervention facilities in Malaysia are seriously limited, particularly in supporting QoL for children with HFASD. Therefore, by identifying the domains of QoL would improve the mothers' resilience in raising their children with HFASD.

The Effect of Sleep-Wake Routines on the Negative Emotional States and Aggressive Behaviors in Adults with Autism Spectrum Disorders (ASD) during the COVID-19 Outbreak.

Disruption in routine may be related to experiencing negative emotional states and to aggressive behaviors in individuals with Autism Spectrum Disorder (ASD). The lockdown because of COVID-19 contributed to the disruption of individuals' routines, including the sleep-wake cycle. The current study tested a relationship between the adherence to the sleep-wake routine and aggressive behaviors via the mediation role of negative emotional states (i.e., anxiety and anger). Forty-three parents of adults with ASD completed a web-based questionnaire about their life condition during the first lockdown (April-May 2020). Preliminary analyses showed a worsening in the adults' aggressive behaviors during the lockdown in comparison to before it (Z = -3.130; p = 0.002). In the mediation models, the relationship between the adherence to the sleep-wake routines and aggressive behaviors was significant. The models showed the hypothesized mediated relationships among the adherence to the sleep-wake routines, negative emotional states, and aggressive behaviors (Model 1: F (1, 41) = 10.478, p < 0.001; Model 2: F(1, 41) = 9.826, p = 0.003). The findings confirmed the potential protective role of the adherence to the sleep-wake routines for the emotional and behavioral adjustment of adults with autism. Theoretical and practical contributions of the study were discussed; indeed, our results may inform parent-coaching as well as intervention programs for individuals with ASD given that adequate sleep hygiene may contribute to improvements in internalizing/externalizing behaviors.

Using evaluative frameworks to examine the implementation outcomes of a cognitive behavioral therapy program for autistic students with anxiety within public school settings.

LAY ABSTRACT: Cognitive behavioral therapy helps to treat anxiety symptoms in autistic youth, but it is difficult for families to access cognitive behavioral therapy in the community. Training school providers to deliver cognitive behavioral therapy may help autistic youth and their families to access these programs. Unfortunately, we do not know how cognitive behavioral therapy programs can be delivered by school providers and how these programs help the autistic students who access them. This study addressed this gap and was part of a larger study that looked at the effectiveness of Facing Your Fears-School-Based in 25 public schools. The study goals were to understand whether Facing Your Fears-School-Based helped students and the factors that made it easy or difficult to deliver Facing Your Fears-School-Based in schools. Thirty providers participated in interviews guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Participants shared information that fell into several major categories that included (1) delivering Facing Your Fears-School-Based to many different students; (2) the positive impact of Facing Your Fears-School-Based on students' school participation; and (3) plans to continue using Facing Your Fears-School-Based. School providers also shared that Facing Your Fears-School-Based was easy to use for non-mental health providers and reported adapting Facing Your Fears-School-Based to meet student needs. The results of this study suggest that Facing Your Fears-School-Based may help autistic students and highlight the importance of using mental health programs in schools that are flexible, able to be adapted, and that are able to be used by many different types of school providers.

[Analysis of the impact of COVID-19 on youngsters with autistic spectrum disorder]. / Análisis del impacto de la COVID-19 en menores de edad con trastorno del espectro autista.

INTRODUCTION: The state of emergency and national lockdown declared in Spain over the coronavirus pandemic markedly impaired routines and access towards health services supports for children with Autism Spectrum Disorder (ASD). This population is of particular vulnerability towards sudden changes and is distinguished by their complex management. OBJECTIVES: The main goal was to qualitatively assess the psychosocial and mental state of children diagnosed with ASD affiliated to the Hospital Clinic de Barcelona, during and after the first lockdown period. PATIENTS AND METHODS: A survey was administered to relatives of 65 boys and girls with a main diagnosis of ASD. RESULTS: A worsening of key A symptoms was reported during lockdown. In addition, the use of new technologies, intake between meals, and anxiety symptoms increased. Recovery after lockdown was not complete in our sample. CONCLUSIONS: These results highlight the need for planning specific supports for minors with ASD and for resources to reverse the effects on routines, habits, and school returnal.

TITLE: Análisis del impacto de la COVID-19 en menores de edad con trastorno del espectro autista.Introducción. La declaración del confinamiento domiciliario a raíz de la pandemia de la COVID-19 alteró profundamente las rutinas y el acceso a soportes sociosanitarios en menores de edad con trastorno del espectro autista (TEA). Esta población se distingue por su elevada complejidad de manejo y vulnerabilidad ante cambios. Objetivos. Evaluar cualitativamente el estado psicosocial en menores con TEA atendidos en el Hospital Clínic de Barcelona durante el confinamiento y pasado éste. Pacientes y métodos. Se administró una encuesta, elaborada específicamente para este estudio, a los cuidadores principales de 65 niños y niñas con diagnóstico principal de TEA. Resultados. Se observó una regresión en la sintomatología nuclear del TEA. Además, aumentó el uso de nuevas tecnologías y la ingesta entre comidas, y apareció una sintomatología ansiosa. La recuperación tras el confinamiento no fue total en nuestra muestra. Conclusiones. Los resultados ponen de relieve la necesidad de planificación de soportes específicos para los menores con TEA y de recursos para revertir las afectaciones en las rutinas, los hábitos y la incorporación escolar.

How parents of children with autism spectrum disorder experience the COVID-19 pandemic: Perspectives and insights on the new normal.

BACKGROUND: Considering the fact that family members necessarily spend more time together during the pandemic, this study aims to reveal the perceptions of parents with children who have autism spectrum disorder of the COVID-19 pandemic in Turkey and their experiences of the difficulties during the pandemic. METHOD: A qualitative phenomenology design was used in the study. Seven mothers and one father gave their consent and participated in the study. Data were collected through semi-structured interviews and analyzed using content analysis. RESULTS: The results of the analysis were collected in two broad themes using 68 codes. The perspective of the parents, who evaluated the pandemic process positively in the beginning, became negative as lockdown lengthened. The issues and adverse effects of the pandemic that they most talked about were the increasing roles and responsibilities of parents, the deep impact on their mental health, and the problems experienced in distance education. CONCLUSIONS: During this period, parents who were psychologically depressed wanted to feel that they were not alone. Parents made many suggestions and recommendations so that others would not have the same experience.

Life under lockdown for children with autism spectrum disorder: Insights from families in South Africa.

BACKGROUND: Children with Autism Spectrum Disorder (ASD) remain vulnerable during the Covid-19 outbreak due to significant changes to their daily routines, social interactions and diets. In addition, these challenges may be exacerbated for children living in low- and middle-income countries (LMIC) such as South Africa where there are already barriers such as poverty, access to resources and availability of support. Understanding the impact of the Covid-19 outbreak on children with ASD is imperative in order to create awareness as well as provide equitable services and support to both children with ASD and their families. PURPOSE: The study aimed to explore family-reported changes for children with ASD and their reactions and responses to the Covid-19 restrictions in South Africa. METHOD: A qualitative research design was employed. Twelve families consisting of different family compositions with a total of 21 family members (mothers, fathers and grandmothers) participated in the current study using semistructured interviews. Data were transcribed and analysed using a framework method for thematic analysis. RESULTS: Findings indicated that children with ASD present with unique challenges related to Covid-19. Negative themes such as children's obstructive reactions due to the immediate changes to their routines, increases in emotional dysregulation as well as loss of previously acquired skills as a result of lack of access to services during lockdown were reported. However, families also reported on positive changes such as improved social interactions as children became more accustomed to their new lockdown routines. IMPLICATIONS: The Covid-19 response has had a negative impact on children with disabilities, specifically around access to services and support for both children with ASD and their families. While the future of the virus and impending lockdown measures is unknown, clinicians, providers and educators need to ensure that provisions are made for children's current adjustments as well as further adjustments to their current routines both during and after the pandemic.

The Brief Observation of Symptoms of Autism (BOSA): Development of a New Adapted Assessment Measure for Remote Telehealth Administration Through COVID-19 and Beyond.

Interest in telehealth assessment for autism has increased due to COVID-19 and subsequent expansion of remote psychological services, though options that are easy for clinicians to adopt and available through the lifespan are limited. The Brief Observation of Symptoms of Autism (BOSA) provides a social context with standardized materials and activities that can be coded by clinicians trained in the Autism Diagnostic Observation Schedule. The current project examined psychometric properties to determine optimal use for each BOSA version. Three hundred and seven participants with 453 BOSAs were included to determine best performing items for algorithms, validity, sensitivity, specificity, recommended cut-offs, and proposed ranges of concern. While preliminary, the BOSA provides a promising new option for telehealth-administered assessment for autism.