AUTISM SPECTRUM DISORDERS KNOWLEDGE: RESULTS FROM AN ITALIAN NURSING STUDENTS MULTICENTER CROSS-SECTIONAL STUDY

Background: Although screening for early signs of autism spectrum disorder (ASD) using the Modified Checklist for Autism in Toddlers (M-CHAT) has been recommended by the Brazilian Ministry of Health since 2014, the feasibility of this intervention and its effects in primary care have not been sufficiently investigated. Objectives: (1) to verify the feasibility of implementing the M-CHAT in the Brazilian Unified Health System, through routine childcare vaccination; (2) to evaluate the level of knowledge and practices of nursing professionals in Brazilian primary health care in relation to ASD to check the expertise to apply M-CHAT to verify early signs of this condition; (3) to verify, after implementation, the frequency of children with possible early signs of ASD using the M-CHAT. Methods: This is an observational, cross-sectional study conducted in a medium-sized city in southeastern Brazil. A total of 97 nursing professionals from 21 health facilities participated. The professionals answered a questionnaire on knowledge and practices regarding ASD, attended training on early signs of ASD and for the use of M-CHAT. Finally, they administered the M-CHAT to 267 parents of children aged 16 to 57 months in primary care settings. Results: Insufficient knowledge of ASD was identified among the nursing professionals evaluated. Approximately 80% agreed that the training was satisfactory, and 88% agreed that they felt competent to use the M-CHAT; 74% agreed with the benefits of using the M-CHAT to detect early signs of ASD in public health settings. However, 91% of the professionals reported that incorporating the M-CHAT into the day care routine overloaded their work, and less than 50% agreed that the instrument should continue to be used in the day care routine. Sixty-seven (25.09%) children screened positive for possible early signs of ASD by M-CHAT. Conclusions: The insufficient level of knowledge on ASD found among nursing professionals suggests gaps in Brazilian academic and professional training in this area. Although most participants recognized the importance of early detection of signs of ASD in primary care settings, the implementation of the M-CHAT in the routine primary care settings was not well accepted for most participants due to work overload, which indicates the need for public health policies to offer working conditions that minimize the overload of professionals, maintaining early screening interventions for ASD in Brazilian primary care institutions.

To (1) estimate the proportion of people in the community who could correctly recognize autism spectrum disorders (ASD); (2) describe the attitudes towards various treatments for ASD; and (3) identify factors associated with ASD recognition. A population-based cross-sectional survey was conducted in Harbin, China (n=4,947). We estimated the proportions of participants who were at different levels of knowledge about ASD and of their attitudes towards mental health service use. Multivariate logistic regression modeling was used to identify factors associated with the recognition of ASD. Overall, 2,786 (57.8%) of the respondents could recognize the ASD. Recognition of autism depended on gender, residing areas, age and educational levels. With respect to the attitudes towards mental health service use for ASD, 4,007 respondents (84.6%) chose to visit a health organization for treatment; 2,470 (68.2%) made the choice of consulting a psychotherapist. There is a large room for improvement in awareness about ASD and treatment in the Chinese communities. Insufficient knowledge about ASD and inappropriate attitudes towards mental health service use may impede the efforts of early identification and intervention. Health education and promotion are needed to improve people's knowledge about ASD and available mental health services.

Supporting youth mental health during the COVID-19 pandemic.

The behavioural and cognitive difficulties of some adults with autism spectrum disorder (ASD) may increase their risk of contact with the criminal justice system (CJS) as a potential suspect. There has been limited investigation of ASD and offending and available evidence is mixed. A retrospective review was completed of medical records of 1570 adults (17–75 years old) who were referred for an ASD assessment over a 17-year period (April 2003 to February 2020). Of the adults diagnosed with ASD, 23% had previous contact with the CJS. Being male or diagnosed with co-occurring attention-deficit hyperactivity disorder (ADHD) and/or psychotic disorder were risk factors for CJS contact. However, the rates of contact with the CJS or for specific offences in the ASD group were never higher than adults referred to our service but not diagnosed with ASD. We did not include a general population comparison group, therefore cannot say how rates of CJS contact in ASD compare with the general population. Further health services research for adults with ASD is warranted, as modifying the treatable risk factors (i.e. ADHD) could reduce contact with the CJS. In addition, joint working between CJS and mental health services could reduce the risk of adults with ASD having CJS contact.Lay abstractThere has been growing interest in offending and contact with the criminal justice system (CJS) by people with autism spectrum disorder (ASD). However, it is not clear whether people with ASD offend more than those without ASD. Studies have started to look at whether there are particular offences people with ASD are more likely to commit and whether there are any factors that can affect whether someone comes into contact with the CJS as a potential suspect. This study looked at the patients who attended an ASD diagnostic service over a 17-year period to see the rate of contact with the CJS of those who were diagnosed with ASD and whether there were any particular factors that might increase the risk of CJS contact. Nearly a quarter of the ASD group had some contact with the CJS as a potential suspect. Factors that seemed to increase whether someone with ASD was more likely to have contact with the CJS were being male, being diagnosed with ADHD, and being diagnosed with psychosis. This study is one of the largest studies to investigate the rate of CJS contact as a potential suspect in a sample of adults with ASD in an attempt to give a clearer picture of what might influence someone with ASD to engage in offending behaviour in order to try to see what mental health services can offer to reduce the likelihood of someone with ASD coming into contact with the CJS, for example, treatment for another condition or support.

To compare health care utilization patterns and cost among insured adults with autism spectrum disorder (ASD), adults with attention-deficit and hyperactivity disorder (ADHD), and adults with neither condition (general population [GP] controls). We conducted a case-control study among adults (≥18 years) who were members of Kaiser Permanente Northern California (KPNC) for at least 9 months each year from 2008 to 2012. Cases (N = 1507) were adults with an ASD diagnosis (ICD-9-CM 299.0-299.8) recorded in the electronic medical record on at least two separate occasions by December 31, 2012. Two control groups, adults with ADHD (N = 9042) defined by ICD-9-CM code 314 and GP (N = 15,070), were randomly selected and frequency matched to cases on gender and age. Health care utilization and cost data were obtained from KPNC databases for the year 2012. Compared with adults with ADHD, adults with ASD had significantly higher utilization of outpatient visits for primary care (74.2% vs. 66.6%), mental health (43.3% vs. 33.2%), and laboratory services (60.9% vs. 54.4%). Hospitalizations for ambulatory care sensitive diagnoses (5.4% vs. 2.3%) were less frequent overall but more common among adults with ASD than with ADHD. Group differences were larger comparing adults with ASD with GP controls. Gynecology visits and screening for cervical cancer were significantly less common among women with ASD than among women with ADHD (35% vs. 50%) or GP (35% vs. 49%). Total annual mean healthcare costs for adults with ASD were 20% higher than costs for adults with ADHD and double costs for GP. Adults with ASD had significantly higher rates of utilization across most health care service areas compared with adults with ADHD or GP; however, women with ASD were significantly less likely to have gynecology visits and have screening for cervical cancer. We conducted a study among adults (≥18 years) who were members of Kaiser Permanente Northern California (KPNC) from 2008 to 2012. We compared how often people attended different types of health care and costs of health care among adults with autism spectrum disorder (ASD), adults with attention-deficit and hyperactivity disorder (ADHD), and adults with neither condition (general population [GP] controls). The study included 1507 adults with ASD, 9042 with ADHD but not ASD, and 15,070 GP controls with no ASD or ADHD. Health care and cost data were obtained from KPNC databases for the year 2012. The study found that adults with ASD used more outpatient visits for primary care, mental health, and laboratory services than adults with ADHD. Gynecology visits and screening for cervical cancer were less common among women with ASD than among women with ADHD or GP. Health care costs for adults with ASD were higher than costs for adults with ADHD and costs for GP. In conclusion, adults with ASD had higher rates of use of most health care service areas than adults with ADHD or GP; however, women with ASD were less likely to have gynecology visits and have screening for cervical cancer.

This research is entitled “Knowledge on Autism Spectrum Disorders in School Teacher at Government School of Pokhara”. The aim of the study is to assess the level of knowledge on Autism Spectrum Disorders (ASD) among school teachers of selected government schools and find out the association between selected demographic variables and level of knowledge on ASD. A descriptive cross sectional research design was used in eight government schools in Pokhara. A sample size of 114 was selected by complete enumeration sampling technique and data was collected through self -administrated structured questionnaire. Data was analyzed and interpreted using descriptive statistical methods such as frequency, percentage, mean and standard deviation. Chi square test was used to find out association between selected background variables and level of knowledge. The study revealed that 46.5 percent had medium level of knowledge, 43.9 percent had low level of knowledge and only few 9.6 percent had high level of knowledge. The mean score of teacher’s knowledge on ASD was 19.8772±5.0188 and range was 12-34. There was no statistically significant association between selected background variables and level of knowledge on ASD (P >0.05). The finding of the study concluded that less than ten percent of the respondent had high level of knowledge on ASD which means lack of knowledge on ASD among school teachers. Only one teacher had training on ASD. So, there is a need of formal training and awareness program on ASD to teachers for early identification of autistic problems and to enhance the children’s condition. This will help teachers to disseminate knowledge on ASD in communities as they are ‘broadcasting agents’ of social changes and development.

Background: Sufficient and thorough knowledge in early recognition of symptoms and proper management of ASD is of utmost importance to medical graduates in the initial years of their learning in medical school. Their knowledge regarding ASD will be helpful when they become health care professionals as it will be easy for proper management of ASD. Our aim is to evaluate and analyze medical undergraduate student Method: Total of 221 undergraduate medical students studying in Preclinical, para clinical and early clinical phase of MMMC, participated in this questionnaire based survey study. Close ended questionnaire which was validated and proved to be reliable was given to students to assess their level of knowledge about ASD. Results of data were analyzed using SPSS software Results: Total mean score for the preclinical students was 5.91±2.90, for para-clinical it was 7.30±3.00 and that for clinical year students (students in 3rd year of medical school) it was 9.42±2.20 out of 14. The knowledge about ASD among the students significantly increased alongside their curricular levels (p<0.05). Conclusions: Overall knowledge of medical undergraduate students about the ASD at their preliminary curricular stages is inadequate. But, there was a significant improvement as their curriculum progresses which reflect the academic up gradation among the medical students and their positive attitude towards ASD.

Autism Spectrum Disorder (ASD) is a growing social health issue. Primary healthcare institutions are where children most commonly seek help, and family physicians in primary care play a crucial role in early ASD detection. This study aims to assess the knowledge level, behaviours, and attitudes of family physicians and family medicine residents across Turkey, identify factors affecting their knowledge, and raise awareness among physicians. This descriptive cross-sectional study was conducted between March and June 2022, with the participation of family medicine specialists, residents, and practicing physicians in Turkey. A 50-question survey was administered face-to-face and digitally. The survey comprised 31 questions on sociodemographic information, factors influencing knowledge, attitudes and behaviours about ASD. The second part included a 19-question "Knowledge about childhood autism among health workers" (KCAHW) questionnaire. The study included 392 physicians with a mean age of 32.8 ± 7.9; 60.7% were women. Among the participants, 50.3% were family medicine residents, 21.7% were family medicine specialists, 17.0% were family physicians and 11.0% were contracted family medicine residents. The physicians' mean KCAHW score was 14.1 ± 2.6. Screening for ASD and following ASD were significantly associated with the perception of knowledge level (p = 0.004; p = 0.028, respectively). A statistically significant relationship was found between paediatric rotation, education about ASD, patient follow-ups and the KCAHW scores. Moreover, 98.2% of physicians believed children with ASD should receive special education, while 79.6% thought ASD carried a social stigma, and 52% believed an ASD diagnosis could lead to discrimination. The study found that participants lacked knowledge about comorbidities with ASD, atypical presentations of ASD, and guiding individuals with ASD. However, having a paediatric rotation, receiving ASD training and following up on children with ASD were associated with increased knowledge levels. Screening for and following up on children with ASD also boosted physicians' self-confidence.

- Parents play an important role in sexual education for their children. The role also owned by parents who have children with autism spectrum disorder (ASD). However, information about sexual education for children with ASD is limited. This condition caused parents feel confused about when and how to provide sexual education to their children who have ASD. This study aims to determine the level of parental knowledge about sexual education in children with ASD. The measuring instrument used in this study was a test of knowledge about sexual education in children with ASD. Respondents in this study involved 80 parents who had children with ASD in Surabaya. The results showed that 28% of respondents had a moderate level of knowledge regarding sexual education in children with ASD. Nearly half or 48% of respondents have a good level of knowledge, and 15% of respondents have a lack of knowledge. Most parents have insufficient knowledge in terms of understanding sexuality, the stage of sexual development, and the topic of sexual education that is appropriate for the age of the children with ASD. Keywords: sexual education, parental knowledge, autism spectrum disorder Abstrak – Orangtua memegang peranan penting dalam pendidikan seksual bagi anaknya. Termasuk orangtua yang memiliki anak dengan gangguan spektrum autis (GSA). Akan tetapi, informasi tentang pendidikan seksual bagi anak dengan GSA ini terbatas. Kondisi tersebut mengakibatkan orangtua merasa bingung tentang kapan dan bagaimana memberikan pendidikan seksual pada anaknya yang memiliki GSA. Penelitian ini bertujuan untuk mengetahui tingkat pengetahuan orangtua tentang pendidikan seksual pada anak GSA. Alat ukur yang digunakan dalam penelitian ini adalah tes pengetahuan tentang pendidikan seksual pada anak GSA. Responden dalam penelitian ini adalah 80 orangtua yang memiliki anak GSA di Surabaya. Hasil penelitian menunjukkan bahwa 28% responden memiliki tingkat pengetahuan yang sedang mengenai pendidikan seksual pada anak dengan GSA. Hampir separuh atau 48% responden memiliki tingkat pengetahuan yang baik, dan 15% responden memiliki tingkat pengetahuan yang kurang. Sebagian besar orangtua memiliki pengetahuan yang kurang dalam aspek pengertian seksualitas, tahap perkembangan seksual, dan topik pendidikan seksual yang sesuai dengan usia anak GSA. Kata kunci: pendidikan seksual, pengetahuan orangtua, gangguan spektrum autisÂ

The Centers for Disease Control (CDC) estimated the Autism Spectrum Disorder (ASD) prevalence to be 1 in 59 individuals (CDC, 2018). With the increase in diagnosis of ASD comes the awareness of the unique needs of individuals with an ASD. Yet colleges of education rarely have an Autism specialization within their special education teacher preparation programs. Even though many students with ASD are served in the general education environment (Malaysia Special Education Division, 2019), few general education teachers receive any training for evidence-based practices for students with ASD. To better understand the current state of knowledge of ASD among special education teachers in training in North Malaysia, we surveyed knowledge and attitudes of special education teachers in training in north Malaysia regarding the disorder. 54 of 3rd year special education teachers in training in a teachers training institute in north Malaysia completed questionnaires assessing participant demographics, knowledge of typical child development and knowledge of ASD. Overall, the level of knowledge of ASD was moderate for the respondents in this research based on knowledge test and self evaluation. Inferential statistik showed demographic factors i.e. gender, level of education, school location and etc did not affects the knowledge about ASD. Majority of the respondents raised the needs of special training involving teaching strategy for ASD students.

A 34-year-old man with a diagnosis of schizophrenia is referred for an autism spectrum disorder assessment. He was diagnosed with schizophrenia at age 24 on the basis of persecutory ideation, and he has been taking an atypical antipsychotic since then. He is a high achiever and graduated with a Bachelor’s degree, but as an adult, he has been unable to secure employment and has remained isolated with no known social contacts. Developmental information from his parents, with whom he lives, indicates that he has never formed friendships or relationships and has preferred to follow a fairly solitary existence. Further information about his persecutory symptoms indicates that he has always been a rigid thinker and held beliefs with total conviction, and he has been sensitive to comments made by others. The diagnosis of schizophrenia was based on the presence of these persecutory symptoms in association with negative symptoms, including flat affect and poor motivation. However, more detailed developmental information about his formative years is consistent with a diagnosis of autism spectrum disorder. A significant number of adults may have an undiagnosed autism spectrum disorder. Some of these will have been managed in mental health services and treated for a psychotic disorder, usually on the evidence of delusional thinking on a background of “negative symptoms.” Although it is reasonable to believe that a number of these people may indeed have schizotypal disorder (i.e., a disorder nosologically related to schizophrenia), some probably have an autism spectrum disorder without comorbidity and may have therefore been misdiagnosed with schizophrenia. It is true to say that, at a phenomenologic level, there is considerable overlap between autism spectrum disorders and schizoidal type personalities. Some recent genetic studies indicate that this overlap may represent shared genetic mechanisms. Antipsychotic medication is unlikely to have an impact on the thought patterns that are characteristic of autism spectrum disorders, and people with these disorders seem to be very sensitive to the side effects of all psychotropic medications. Thus, making a distinction is important to avoid the unnecessary use of medication and to fully appreciate the prognosis, which is more likely to be positively impacted by social skills interventions. Moreover, in the absence of a treatment response, it is not unusual for people with autism spectrum disorder to be taking high doses of antipsychotics or a combination of several antipsychotics. Diagnostic clarity about the presentation and characteristics of autism spectrum disorders in adults has improved in recent years, particularly for higher functioning individuals, such as those described as having Asperger Syndrome. The core characteristics of this disorder include lifelong impairments in social interaction and communication and a tendency for routine and ritualistic patterns of behaviour, including the pursuit of circumscribed patterns of interest. Although these features also characterize schizoidal and schizotypal personalities, differentiating from these can usually be achieved by obtaining a developmental history: people with autism spectrum disorder have an onset of the full clinical picture before 3 years of age, whereas those with schizoid or schizotypal personality disorder have relatively typical development as children but become symptomatic as adolescents. In addition, unlike those with schizoidal and schizotypal disorders, people with autism spectrum disorders are not necessarily aloof, but instead may be socially motivated but clumsy, naive and inappropriate in their attempts to engage with others. Although the beliefs among people with autism spectrum disorders may sometimes appear persecutory and thereby lead to an assumption of psychosis, the origin of such beliefs is likely due to a lack of “theory of mind.” Without this theory, it is difficult to determine irony and sarcasm and to understand the motivation behind other people’s behaviours. This, coupled with an inherent difficulty decoding nonverbal communicative information, may lead to misinterpretations and misunderstandings that may present as beliefs of a paranoid nature. Although comorbidity is a possibility in autism spectrum disorders, the prevalence of schizophrenia has been consistently shown to be low. Following re-evaluation, our patient was diagnosed with an autism spectrum disorder and slowly weaned off antipsychotic medication without any problems. He was put in touch with an autism spectrum disorder support group, and through a service for adults with autism spectrum disorder, he was able to engage in supervised employment.

Background: There has been a worldwide reported increase in the prevalence of Autism spectrum disorder (ASD). There is also an international recognition of the value of early diagnosis and intervention of children with ASD. A lack was identified in the literature in KSA regarding assessing ASD knowledge among medical consultants. Aims: firstly, to assess ASD knowledge among medical consultants in KSA. Secondly, to investigate if there is any differences between medical consultants based on their years of experience and subspecialties. Method: KCAHW questionnaire was utilized to collect data from 53 consultants at a university hospital in KSA. Results: the level of ASD knowledge among medical consultants in KSA was low. Moreover, years of practice as consultants were discovered to be non-significantly correlating with ASD knowledge. Finally, the level of ASD knowledge was significantly affected by subspecialties in all the domains of KCAHW. Conclusion: more formal training on ASD and the integration of it in medical curriculum is needed to increase the level of knowledge in medical staff for early and better detection of ASD.

BackgroundMothers of children with autism spectrum disorder (ASD) have reported a higher level of depression than mothers of children with other neurodevelopmental disorders in both developed and developing countries. Mothers are the lifetime caregivers of children with ASD, and a high burden of depression can negatively impact their ability to provide care. However, access to mental health services in primary care is limited, given the scarcity of qualified providers in Bangladesh.ObjectiveWe aim to pilot the feasibility of integrating mental health services for the mothers of children with ASD attending schools offering ASD care and improve skills of mothers for child care through a home-based training program.MethodsThe study will be conducted in two selected schools in Dhaka in Bangladesh that have been offering services for ASD for more than 10 years. A female psychologist will be deployed at the schools to offer nonpharmacological services for all mothers having a depressive episode. Referral for pharmacological treatment will be made at the discretion of supervising psychiatrists. An ASD special educator will provide training to the mothers for enhancing their child care skills at home on a monthly basis. The proposed intervention package will be implemented over a period of 4-6 months, and the feasibility of the intervention will be assessed through a pre- and postintervention evaluation by obtaining the perspectives of various stakeholders involved in the implementation of mental health services and maternal training. The primary outcome will include assessment of acceptability, adaptability, demand, practicality, implementation, and integration of the package intervention in the school settings. The secondary outcomes will include assessment of: 1) the prevalence of maternal depression; 2) children’s behavioral, social, and communication skills; and 3) the intervention participation costs incurred by institutions and families.ResultsBetween February and March 2017, 188 mothers of children with ASD were screened for depression following a written informed consent. Based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), the Structured Clinical Interview for the DSM-IV (SCID-1) was administered to 66 mothers. In-depth interviews were conducted with 10 mothers and 8 various stakeholders. Between January-June 2017, the team finalized a draft psychosocial counseling module and a maternal training module. Between April-May 2017, mental health services were provided by psychologists to 41 mothers who attended the counseling centers at each school. Three special educators have been trained in June 2017 to initiate training of the participating mothers.ConclusionsThis is the first study of a mental health intervention for mothers of children with ASD to reduce their burden of depression and improve the outcomes of their children. The findings will inform the provision of services for children with ASD and their mothers in Bangladesh and similar settings.

Suicide risk in adults with Asperger's syndrome

BackgroundDespite a growing number of adolescents and adults diagnosed with autism spectrum disorder (ASD), little is known about service needs and barriers to services in this population. Existing research shows that youth with ASD are more underserved as they approach final years of their high school education and that adequate services for individuals with ASD after transition to adulthood are even scarcer. However, few studies have directly compared differences in service availability between adolescents and adults with ASD, and even fewer studies are published on service use outside Anglo-Saxon countries. The purpose of the present study was to examine service access, perceived barriers, and unmet needs, as reported by parents of adolescents and young adults with ASD in Poland.MethodsThe study used a subsample of parents of young people with ASD (aged 12–38 years; N = 311) from the Polish Autism Survey – a survey covering different areas of functioning of people with ASD in Poland, based on a convenience sample. Responding parents were recruited via different service providers, social media, and press, and completed a survey using a web platform or a paper-and-pencil questionnaire.ResultsAs expected, adults used services less often than adolescents, with 80.1% of adolescents and 61.1% of adults with ASD using services in the previous 12 months. Mental health services were among the most used and the most needed services, followed by educational services, while needs for sensory/motor services remained largely unmet. Young people with a coexisting intellectual disability used more services than those without it. Non-governmental organizations, private clinics, and schools were the most common service providers. Parents indicated that most of young people with ASD had unmet service needs for services (93.5%) and faced barriers to access them (82.7%). Low-income families and those living outside large cities were at the highest risk of facing barriers to service access.ConclusionsThe results confirm still a thin body of evidence from different countries suggesting that adolescents and adults with ASD were both largely underserved populations. Policy-makers should address economic, regional, and age-related inequities in access to services for individuals with ASD.