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.

Student perspectives of simulated learning to improve their dysphagia management.

BACKGROUND:  The use of simulation to enhance knowledge translation and bridge the theoretical-clinical gap to enhance clinical training and competency in health professions has received mixed reviews in the literature. OBJECTIVES:  This research examined student perspectives of a simulation laboratory in speech therapy to improve students' clinical competency when working with adults with communication and dysphagia impairments. METHOD:  An exploratory descriptive pilot study was conducted in 2022 with 16 third-year speech-language therapy students. This mixed-methods study involved students completing purposefully developed pre-and post-surveys to explore their experiences with simulated teaching and learning and their perceptions of confidence. Data were analysed using an independent t-test. Following the surveys, the students participated in a focus group discussion about their simulation experience, and data were analysed using thematic analysis. RESULTS:  Student ratings of clinical skills improved from pre to post-simulation significantly overall and across six out of the eight items. The focus group revealed insights into students' experiences, highlighting increased confidence, the benefits of making mistakes in a safe environment and improved preparedness to work with dysphagia in patients. CONCLUSION:  While simulation serves as a valuable tool in enhancing clinical skills and building confidence, it must be used as an adjunct to real-life exposure and not as a replacement.Contribution: The integration of both simulated and real-life experiences is essential to provide a comprehensive and practical learning environment for students.

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.

'We are in this together' voices of speech-language pathologists working in South African healthcare contexts during level 4 and level 5 lockdown of COVID-19.

BACKGROUND: SARS-CoV-2 (COVID-19) has had a significant impact on every South African but more specifically healthcare professionals, including speech-language pathologists (SLPs). In response to the COVID-19 pandemic, South Africa implemented a nationwide lockdown as confirmed cases continued to rise. Understanding the impact of COVID-19 on SLPs has a three-fold purpose: to re-evaluate service provision, service delivery platforms and to identify the need for support to SLPs during a time of crisis. It is also crucial in guiding how policies and interventions need to be modified. OBJECTIVES: The study aimed to better understand how the workspace of SLPs in hospitals was impacted by COVID-19, how they experienced this process and the implications for them as healthcare professionals in both the private and public sector throughout South Africa. METHODOLOGY: An exploratory cross-sectional study design was used to meet the aims of the study. Thirty-nine SLPs from different provinces in South Africa, working in government and private hospitals during COVID-19, responded to the online survey. Results were analysed using descriptive statistics and thematic content analysis. RESULTS: SLPs' roles, responsibilities and service delivery were impacted by COVID-19. It was necessary for typical outpatient therapy services to be modified; there were changes to the role of the SLP in the hospital and inpatient services were curtailed. CONCLUSION: This study provides insightful information to SLPs employed in hospitals to know that they are experiencing similar challenges. It also confirms the resilience of healthcare professionals, including SLPs, when faced with novel and unprecedented situations.

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

BACKGROUND: Evidence suggests that caregivers of children with autism spectrum disorder (ASD) and associated feeding difficulties have specific mealtime challenges in the home environment because of the limited interventions that are appropriate and responsive to the needs of the child as well as the family. OBJECTIVES: To describe: (1) common feeding difficulties in children with ASD, (2) mealtime challenges for the caregiver and (3) mealtime strategies used by the caregiver. METHOD: Forty caregivers were purposively sampled to participate in the study. Participants were recruited through ASD-specific schools in Johannesburg, South Africa. Participants completed an online questionnaire focusing on their mealtime experiences with their child with ASD. RESULTS: Findings from the data after thematic analysis indicated the multitude of challenges caregivers have when feeding their child with ASD as well as their individualised way of dealing with these difficulties. CONCLUSION: The findings emphasised the importance of incorporating the family's beliefs, values and needs into feeding management and highlight the importance of a holistic approach to intervention. The study also provided information about mealtime strategies that are being used in the home environment to support the child as well as the caregiver. This information can be used to inform management to improve therapeutic outcomes and feeding challenges in the home environment.