How to support parents of children with autism spectrum disorder to become an effective part of the therapeutic process

Effectively serving students with autism spectrum disorders (ASDs) requires professionals to possess specialized knowledge, skills, and understanding. When students with ASDs are from culturally or linguistically diverse (CLD) families, the professionals assessing and providing services to the students need the additional dimension of how cultural and linguistic differences may affect identification, assessment, and treatment strategies.

“A developmental disability that hinders the normal functioning of the brain, affecting, in varying degrees, communication skills and social interaction. Repetitive behaviours, and different ways of learning, paying attention, or reacting to things are often distinctive signs”. This standard definition of autism fails to describe the complexity of a condition that ranges in its manifestations from severe intellectual impairment to superior cognitive skills, like in the Asperger syndrome. To comprise such diversity, autism disorders are now covered under the umbrella term “autism spectrum disorder” (ASD). In most cases, ASD manifests during the first 5 years of life, with boys significantly more likely to be diagnosed than girls. ASD usually goes together with several other problems that frequently include anxiety, sleep disorders, or epilepsy. No cure exists; treatment, such as speech therapy, just attempts to alleviate specific deficits of autistic patients. > Nothing is simple in autism. Even the real number of people affected is uncertain. Nothing is simple in autism. Even the real number of people affected is uncertain. The US CDC estimates that about 1 in 68 (or 1.5%) of children in the USA are living with ASD (http://www.cdc.gov/ncbddd/autism/data.html). The WHO has a more conservative estimate, last revised in January this year, of 1 in 160 children, based on a larger set of epidemiological surveys (http://www.who.int/mediacentre/factsheets/autism-spectrum-disorders/en/). Needless to say, most studies were conducted in developed countries, and the prevalence of ASD in many low‐ and middle‐income countries remains largely unknown. > Along the years, many potential causes have been indicated, including genetic and environmental factors, exposure to toxins during pregnancy, wide gaps between parent ages, and so on Although the general consensus is that prevalence rates are increasing globally, this point is debated too. Some analyses indicate that a large percentage of the increase in ASD owes to improved awareness and …

Objective:Concerns that exposure to more than one language in the home might negatively impact language development in young children with autism spectrum disorder (ASD) are common among caregivers. Although research directly examining the impact of a multilingual home environment in ASD is scarce, emerging evidence shows that language outcomes might be equivalent or better in children with ASD exposed to more than one language (Romero & Uddin, 2021). However, no evidence to date exists on whether exposure to more than one language affects early brain functional development in children with ASD. The current study aims to examine the (1) cross-sectional and (2) longitudinal associations between home language environment (exposure to one v. multiple languages at home, H1l vs. H>1l) and receptive and expressive language skills in young children with and without ASD, and (3) to investigate links between home language environment and brain functional network organization.Participants and Methods:Participants included young children with ASD (n=67, mean age: 35±13 months, H>1l n=43) and typically developing (TD) children (n=39, mean age: 32±16 months, H>1l n=17) enrolled in a longitudinal study of early brain markers of autism. A subset of children with ASD for whom longitudinal behavioral data from two study visits were available (n=21, H>1l n=11) were used for exploratory analysis. Receptive language (RL) and expressive language (EL) skills were assessed by the Mullen Scales of Early Learning at each study visit. Data from 42 children with ASD (H>1l n=27) and 38 TD children (H>1l n= 15) for whom functional MRI data were acquired during natural sleep were included in functional connectivity (FC) analysis. ANCOVAs were employed to examine the effect of diagnosis, home language environment (H1l vs. H>1l) and its interaction on RL and EL skills while controlling for socioeconomic variables (i.e., maternal education level, income-to-needs ratio) and gestational age at birth. Linear mixed models were applied to explore the longitudinal effect of home language environment on RL and EL skills across two study visits in the ASD group. Lastly, FC analysis was conducted to compare functional connectivity across 7 canonical brain networks in children with and without ASD who were raised in H1l and H>1l.Results:We found significant diagnosis by home language environment interaction effect on EL skills, with children with ASD and H1l exhibiting the lowest EL skills. Longitudinal analysis identified a significant home language environment by study visit interaction effect on EL skills in children with ASD. Specifically, children with ASD and H1l showed lower EL skills at study visit 1 but equivalent EL skills at study visit 2 compared to children with ASD and H>1l. FC analysis revealed that children with ASD and H>1l displayed more typical brain network organization (similar to TD children) compared to those with H1l, specifically for FC between language, frontoparietal, and default mode networks.Conclusions:These results suggest that early exposure to more than one language in the home may be linked with better expressive language skills in young children with ASD. Results of functional connectivity analysis also suggest that exposure to more than one language may be associated with more neurotypical functional network organization, particularly involving language and high-order networks.

Poor phonological development adversely affects language development and interpersonal communication abilities in children with Autism Spectrum Disorders (ASD). However, the characteristics of phonological development in children with ASD who speak Putonghua (the official standard spoken form of modern Mandarin Chinese) remain largely unknown. This study aims to investigate phonological acquisition and development among Putonghua-speaking children with ASD. Data were collected from participants recruited in Shanghai, China. Two experiments were conducted. In experiment I, phonological acquisition was compared between 16 children with ASD aged 3–6 years and 16 age-matched typically developing (TD) children. In experiment II, phonological acquisition was compared between 26 children with ASD over 6 years old and 26 receptive-language-age-matched TD children. Picture naming was applied to measure participants’ phonology – the 21 initials, 36 finals and four tones of Putonghua. Paired-samples t-tests and Fisher’s exact tests were applied. In experiment I, scores on initials, finals, tones and total phonology of children with ASD aged 3–6 years were significantly lower than those of age-matched TD children. The pronunciation accuracy rates for initials such as/x, th, l/, finals such as/jaʊ, joʊ, wo/ and Tone 3 (the low-rising tone) in the ASD group were significantly lower than in the TD group. In experiment II, there was no significant difference in overall phonological developmental level between children with ASD over 6 years old and receptive-language-age-matched TD children. Phonological development of Putonghua-speaking children with ASD was significantly lower than that of age-matched TD children but closer to that of receptive-language-age-matched TD children. Further, participants with ASD showed atypical development sequences in both initials and finals.

Tracing the Origins of Autism: A Spectrum of New Studies

Adolescents in some countries and U.S. states are required to perform community service, and many national and nongovernmental agencies promote such service. Van Goethem, van Hoof, Orobio de Castro, van Aken, and Hart (p. 2114) find that while community service has broad benefits for adolescents, it's particularly effective when the activities are accompanied by reflection. They assessed findings from 49 studies from around the world conducted from 1980 to 2012 that involved almost 24,500 participants ages 12–20, focusing on identifying how reflection contributed to community service. While community service positively affected such areas as grades, self-esteem, and civic responsibility, structured reflection was found to be crucial to the benefits gained, especially when it was integrated with school curricula. Educators and families agree that parental involvement in adolescents' education is important. But it's unclear what parents do and what works to support adolescents' academic, behavioral, and mental health outcomes throughout middle and high school. Wang, Hill, and Hofkens (p. 2151) find that parental involvement in adolescents' education isn't as simple as more is better: Different types of involvement strategies are important for different types of outcomes. There are also important differences in the patterns of involvement and the effectiveness of involvement strategies between African American and European American parents. The results of this study of almost 1,500 ethnically diverse families (including adolescents in seventh, ninth, and eleventh grades) pave the way for developing targeted interventions and for providing strategic support to families and their teens. Omega-3 fatty acids, a group of nutrients that are found only in food, are important for good health. Some research shows that, in young children, more Omega-3 fatty acids in the diet are connected with better performance on tests of memory, ability to concentrate, and other mental processes. However, Omega-3 fatty acids might affect brain development even before birth. Rees, Sirois, and Wearden (p. 2131) considered whether the level of an Omega-3 fatty acid (DHA) in mothers' diet during pregnancy was connected with better performance by young children when they were 22 months old. About 70 women from high-income families were asked questions when they were 21–28 weeks pregnant, then again at 35–37 weeks of pregnancy, and their foods were recorded. Babies were tested at 22 months on a task involving memory, concentration, and understanding objects. On average, babies of mothers who had high DHA in the third trimester of pregnancy performed better than babies of mothers who had low DHA during that period. Since most women don't have enough DHA in their diet during pregnancy, the findings have implications for advising pregnant women about their DHA intake, especially during the last 3 months of pregnancy. Imitation isn't just the most sincere form of flattery; it's a great way to learn. that's what Nielsen, Mushin, Tomaselli, and Whiten (p. 2169) find in their study of about 175 children ages 3–6 from three different cultures (urban Australia, remote Australian Aboriginal, and South African Bushman communities) and a range of economic backgrounds. The work builds on research showing that children are prone to blanket copy something new they see an adult do, down to details that seem irrelevant. They find that while children from different cultures overimitate, most can transfer what they learned to different but related problems—though the Bushman children were less able to do so, perhaps for reasons related to poverty or cultural factors. Rather than being the expression of an immature mind, then, children's overimitation may be a key part of learning. By showing that imitation isn't restricted to the objects on which actions are learned but, for most, can transfer to other similar objects, the findings have implications for learning. As adults, we understand that what we prefer at age 20 may differ from what we will prefer at age 60. Without an awareness of such differences, planning for the future would be difficult. Although research has shown that children's ability to talk about and formulate simple plans for the future improves between ages 3 and 5, we know little about their understanding that preferences may change over time. Bélanger, Atance, Varghese, Nguyen, and Vendetti (p. 2419) find that 3-year-olds tended to believe that they would always prefer “child” items (e.g., Kool-Aid) over “adult” items (e.g., coffee), while 5-year-olds were able to envision their own grown-up selves, or the grown-up self of another child, preferring coffee. In this study of 240 Canadian children from predominantly White, middle-class backgrounds, 3- and 4-year-olds also found it easier to predict that another child's preferences would change than that their own preferences would. The study adds to research on future thinking and can inform how we understand development. How do people remember emotionally salient events and information? Dykas, Woodhouse, Jones, and Cassidy (p. 2185) examined how the way adolescents talk about their early attachment-related experiences affects their memory for emotionally salient events and information. They interviewed about 190 primarily White, middle-income eleventh graders to determine how they reflected on and discussed their childhood relationships with caregivers; how people think and talk about the attachment-related parts of such relationships may be relevant to how memory is formed. Results suggest that individuals recall and store emotionally salient information in memory in a biased way, and that these biases relate to how individuals talk about their early experiences. The findings show that individuals' memory for emotional and parent-related information may indeed be shaped and altered by attachment-related representations. As such, they have implications for clinicians, psychologists, and people in the legal system. According to self-socialization theories, once children develop an understanding of their gender identity, like little “gender detectives,” they seek out information relevant to their gender and undergo the process of becoming what they think it means to be a girl or a boy. While research has confirmed that children's early understanding of gender categories (e.g., girl, boy) is linked to an increased interest in play with gender-typed toys, the exact type of knowledge that matters for the development of gender-typed play is unclear. Zosuls, Ruble, and Tamis-LeMonda (p. 2202) looked at more than 210 toddlers from low-income, ethnically diverse homes (children were African Americans born in the United States, or of Dominican or Mexican ethnicity). They find that only once children develop an intergroup understanding of gender—one that involves the idea that their own gender (the ingroup) contrasts with the other gender (the outgroup)—do they change their play behaviors to become increasingly aligned with gender stereotypes. The study highlights how children develop an awareness of us and them that shapes their behavior while they're still quite young. Is identity—how we perceive ourselves, who we want to be, and how we think we're perceived by others—important for success in school? Students' ability to identify with the purposes and values of their school can affect their academic motivation, but different students may identify with academics in different ways. In their study of 600 urban African American and Latino American adolescents in sixth, eighth, and tenth grades, Matthews, Banerjee, and Lauermann (p. 2355) find that identity when it's defined as internal values (e.g., “Education is important to how I think of myself”) differs from identity when it's defined as social belonging (e.g., “The people in my school make me feel like I belong”). And for students who have low confidence in their academic abilities, perceptions of social belonging are especially important for academic effort and motivation. By illustrating the importance of belonging among students who have historically contended with disconnectedness in school, the study can inform educators' efforts. An estimated 1 in 68 children in the United States are affected by autism spectrum disorders (ASDs), and gaps in our knowledge about these disorders limit our ability to detect and treat children early in life. Across two experiments with 6-month-olds, Libertus, Sheperd, Ross, and Landa (p. 2218) examined how almost 130 infants played with and manipulated small objects, and how long about 40 infants were able to grasp toys. Compared to infants in a control group, infants later diagnosed with ASD or with an older sibling with ASD showed reduced grasping and less mature manipulation of objects. The findings, among the first to suggest measurable differences in the motor domain between high- and low-risk children at 6 months, confirm and extend previous research identifying motor weaknesses in infants later diagnosed with ASD or at increased risk for ASD. As such, they have implications for paying attention to manual abilities as part of early detection and intervention of autism and related disorders, which have increased tenfold in the last decade. When does young children's drawing begin to show distinctively human characteristics? Saito, Hayashi, Takeshita, and Matsuzawa (p. 2232) compared drawing in about 60 human children and six chimpanzees, humans' closest living relatives. According to their longitudinal study, humans tended to complete the missing parts on an imperfect face even with immature motor control, while chimpanzees never completed the missing parts, instead marking the existing parts or tracing the outlines with fine motor control. This study, one of few directly comparing chimpanzees and human children on drawing, suggests that the differences aren't due to inadequate motor ability, but to conceptual issues: Both species put pen to paper and draw, but young children show signs of representational skill. Figures on paper may trigger imagination in humans and lead them to complete the missing parts, and this cognitive tendency may be absent in chimpanzees, the study suggests. Improving the academic skills needed for school entry could reduce inequalities in educational achievement, according to Chittleborough, Mittinty, Lawlor, and Lynch (p. 2247). They used information from almost 12,000 families in England to examine differences in educational achievement between 15-year-olds from poor backgrounds and those from more well-off backgrounds if academic skills at age 5 could be improved through interventions (providing extra support to parents and high-quality preschool for children have been found to improve children's ability to get the most out of school). Children born into poorer families were twice as likely as those born into the most affluent families to have a poor educational outcome at age 15. This difference was cut by about 15% when effective interventions were provided for all families, with more intensive support for those from poorer backgrounds. Millions of children in the United States live in homes where there is violence between parents. This kind of domestic violence increases children's chances of having difficulties in social, cognitive, and behavioral development. However, many children adapt well despite their exposure to family violence, raising questions about what factors contribute to healthy development in violent environments. Manning, Davies, and Cicchetti (p. 2263) took a longitudinal look at about 200 mother–toddler pairs in which income was low and there was, in two-thirds of the cases, some level of violent interactions with a male romantic partner who had had regular contact with both the mother and child over the past year. They sought to determine how sensitive parenting when the children were 2 altered children's emotional and social development 2 years later. They find that violence predicted later behavior problems only when children didn't have sensitive parenting as toddlers. Children who had sensitive parenting had fewer angry emotional responses to conflicts between their parents, which led to fewer behavior problems and more positive social behaviors over time. The findings can inform intervention efforts. Children who have been exposed prenatally to substances such as cocaine, alcohol, and opiates are at greater risk for developing problem behavior than children who haven't been exposed. But how does this happen, and why do some children who have been exposed do well despite growing up in adverse early environments? Conradt et al. (p. 2279) studied 860 primarily African American 11-year-olds from a mix of economic backgrounds—some had been exposed to substances prenatally and some hadn't. Findings: The way African American children respond to stress (as measured by their cortisol response) may explain how they develop problem behavior and how well they adapt to their early environments. Being exposed to substances prenatally led to exposure to more adversity early in life, which in turn was related to a flattened cortisol response and more externalizing behavior and delinquency. Less exposure to substances prenatally was related to less exposure to early adversity and greater reactivity to cortisol, which in turn was related to more positive student–teacher relationships and better executive functioning. The results have implications for public health, early intervention, and prevention. Biracial youth (children with parents of two different races) are the fastest-growing youth population in the United States. We know relatively little about how educational and social outcomes might be different for these youth. In their study, Gaither et al. (p. 2299) looked at almost 250 monoracial and biracial 3- to 8-year-olds from middle- to upper-income families: Monoracial children were White, Black, and Asian; biracial children were Black/White and Asian/White. They find that a child's racial group membership may influence learning and social preferences more for biracial children because these children have multiple racial group affiliations with which to identify. This may allow them to identify with a larger diversity of teachers, for example. Racial identity malleability has the potential to open up options for learning through expanded opportunities for affiliating with teachers and classroom peers from different backgrounds. The study is the first to offer evidence that the racial identity malleability known to exist for biracial adults is also present and developing early in childhood. Although adolescents often experience ethnic-racial discrimination, little is known about whether they experience discrimination from adults and peers in the same manner or to the same degree during middle school. Niwa, Way, and Hughes (p. 2339) looked at 585 low-income Dominican, Chinese, and African American urban public middle school students in grades 6–8 to determine whether different patterns of discrimination from adults and peers existed among ethnically diverse adolescents over time. They find no universal patterns of ethnic-racial discrimination: While some adolescents experienced no adult discrimination, others consistently experienced low discrimination from adults during middle school, with boys at a higher risk for membership in that group. And most adolescents were in groups who experienced high and moderate, but declining, discrimination from peers. The findings challenge the assumption of universal patterns of discrimination during middle school, and they illustrate the potential role of race and ethnicity in peer victimization and bullying. Head Start, the largest federally funded preschool program for disadvantaged children, is designed to prepare children academically and socially for kindergarten. Research has shown relatively small impacts overall on cognitive and social skills, which has led to controversy over its effectiveness and cost benefit. Using a new statistical technique, Cooper and Lanza (p. 2317) investigated data from the national, federally funded Head Start Impact Study, which was done to determine the program's effectiveness. They sought to determine whether certain types of children benefit more or less from the program. Findings: The most consistent, positive effect was on short-term cognitive outcomes (specifically, reading skills), but these didn't last. Bilingual children whose moms were married and had low levels of education also saw a positive effect, with benefits lasting into first grade. And children of single moms had more positive benefits. For other groups, there was little to no effect. If replicated with other groups, this study and its findings could inform policy, especially decisions related to which low-income children should be given priority for early education services. Children of immigrants are among the nation's fastest-growing demographic subgroups. Young children of immigrants are more likely to live in poverty and to enter school with fewer of the kindergarten readiness skills needed for early academic success. One way to promote readiness for this large and vulnerable group of children is the federal child care subsidy program. Johnson, Han, Ruhm, and Waldfogel (p. 2140) tested whether subsidies received in the preschool year are associated with immigrant children's school readiness in kindergarten. Although research has found negative or neutral effects of subsidies on child outcomes in the general population, this study finds some positive associations between subsidies and reading skills for children of immigrants, but only if the subsidy was used in a center rather than a home-based setting. The study used data on 2,900 kindergarten children from the nationally representative Early Childhood Longitudinal Study-Birth Cohort whose parents had low incomes when the children were preschoolers; the children were either native-born or children of immigrant parents. Keeping a secret can be challenging for children, both socially and cognitively. In their study of more than 100 Canadian 4- to 12-year-olds and their parents from a range of economic backgrounds, Gordon, Lyon, and Lee (p. 2374) find an association between children's social and cognitive development, on the one hand, and their ability to keep a secret for a parent, on the other. Overall, older children were more likely to keep the secret than younger children, and children who agreed verbally to promise to keep the secret were more likely to do so. Children who kept the secret throughout two interviews showed more trust in their parents and were rated more highly by their parents in executive functioning than children who didn't keep the secret. The findings suggest that the development of children's ability to keep secrets coincides with the development of other social and cognitive skills. The results can inform forensic situations as well as our general understanding of trust and secret keeping in children. Part of what makes us human is our ability to understand that people's behavior is motivated by what goes on in their minds, or theory of mind (TOM). While we understand that TOM develops in the preschool years and is related to social competence, we know less about how children's inferences about others' mental states relate to an understanding of how their own minds work. Lecce, Bianco, Demicheli, and Cavallini (p. 2404), in their study of about 60 Italian children ages 4 and 5 from a mix of socioeconomic backgrounds, find that it's possible to help young children develop TOM through dedicated training. Specifically, promoting children's understanding of others' minds helps them understand how their own minds work in a cognitive task, such as memory, and the effects of the training last 2 months. By identifying TOM understanding as a cognitive tool to enable children to develop sophisticated forms of knowledge about mental phenomena, the study has implications for teachers and parents. Positive peer relationships in childhood have been shown to affect later well-being and academic performance. Understanding the factors that contribute to healthy peer relationships is key for supporting how children initiate and maintain friendships. An important part of children's cognitive development that influences peer relationships is TOM understanding, that is, the ability to take someone else's perspective. In their longitudinal work, Fink, Begeer, Hunt, and de Rosnay (p. 2389) find that TOM understanding plays a particularly important role when children enter into a new peer group, such as during the first year of school—it helps them establish and maintain social relations with peers. However, once social position is established, it becomes largely self-maintaining and children's later TOM understanding no longer exerts a strong influence on their social position. This study looked at about 115 middle-class Australian 5-year-olds, most of whom were followed up a year later. The findings can inform the timing and design of interventions that help promote positive social interactions for children at risk of isolation and rejection by classmates.

Autism Spectrum Disorder (ASD) is a developmental disability characterised by impairments in communication, socialisation, and thinking and behaviour. Parents of children with an ASD face increased challenges when parenting these children, mainly due to the severity of impairment, as well as the potential for disruptive behaviour. This thesis investigates the capacity of parents to generalise strategies from a parenting program designed for children with disabilities to typically developing siblings of children with ASD. Additionally, this research aimed to develop current understanding regarding the experiences of children who have a sibling with an ASD. In Study One, quantitative data was gathered at pre-, post-, and follow-up intervention from 18 parents who completed a 9-week parenting program, Stepping Stones Triple P (SSTP). Prior research indicates that SSTP is effective for families where there is a child with an ASD. The current study investigated whether SSTP could be effective for both a child with ASD, as well as a typically developing child. In Study Two, 12 typically developing children were interviewed to explore their experiences of having a sibling with ASD. Information regarding parental perceptions of sibling relationships was collected via a questionnaire. This sought to document parents’ views regarding the relationship between their typically developing child and their child with ASD. Children were also administered this same questionnaire, which investigated their perception of their sibling relationship. Additionally, children were interviewed at pre- and post-intervention (SSTP), regarding their experiences of having a sibling with an ASD, and other family experiences. Study One hypotheses were partially supported, with results revealing a significant decrease in the intensity of behavioural problems in children with ASD, but not typically developing children. As expected, parental confidence in managing behavioural and emotional problems with both children increased significantly from pre-intervention to 6-week follow-up. Other findings showed a significant decrease in dysfunctional parenting practices over time, as well as a decrease in parental conflict over child-rearing issues. In Study Two, the quantitative results of the sibling questionnaire demonstrated a significant increase in warmth and closeness between siblings with an ASD and typically developing siblings, as well as a decrease in conflict between these children. Outcomes from the qualitative analyses showed an increase in child knowledge of ASD, improved parental management of misbehaviour, a number of positive aspects of having a sibling with an ASD, some difficulties of having a sibling with an ASD, a need for typically developing children to spend time with their parents, and children’s emotional responses to distress in their siblings with ASD. Results have been discussed in the context of their theoretical and practical implications, with reference to the research questions and hypotheses.

The prevalence of both bilingual children and children with autism spectrum disorder (ASD) is growing rapidly, and early childhood educators may be increasingly likely to encounter bilingual children with ASD in their classrooms. Because ASD significantly affects communication, many parents and professionals may have questions or concerns about the impact of bilingualism on language development in children with ASD. The present article presents a systematic review of the literature comparing monolingual to bilingual development in children with ASD. Seven articles were included, covering a wide variety of languages and involving predominantly young, simultaneously bilingual children with ASD. Results generally showed small, varied differences in both receptive and expressive language outcomes for bilingual and monolingual children with ASD, thus providing tentative support for the idea that bilingualism does not have a consistent or large negative effect on language development in children with ASD. Implications for research and practice are discussed.

Autism Spectrum Disorder (ASD) affects social communication and behavior, requiring specialized approaches for health education. Parental involvement and the type of learning media play a significant role in health education outcomes for children with ASD. This study examines the relationship between parental involvement, learning media (digital vs. traditional), and health education outcomes for children with ASD. A cross-sectional study was conducted with 83 parents of children diagnosed with ASD. Data were collected through structured questionnaires assessing parental involvement and the type of learning media used. Bivariate analysis was performed to examine associations between these variables. Most parents (78.3%) were female, and 55.4% used digital learning media. Children with high parental involvement had significantly higher self-care scores (mean = 7.6, p< 0.01) compared to those with lower involvement (mean = 6.3). Digital media was more effective than traditional media, with children using digital tools showing a 30% increase in health knowledge (p= 0.02). The combination of high parental involvement and digital media use produced the best educational outcomes (mean = 8.1, p = 0.001). High parental involvement and the use of digital learning media are positively associated with better health education outcomes in children with ASD. Interventions targeting increased parental engagement and enhanced access to digital learning media could improve health education for children with ASD.

Parental involvement (PI) in education contributes to numerous positive outcomes in children, including educational outcomes and social competence. The goal of the present study was to examine differences in PI mechanisms between parents of children with autism spectrum disorder (ASD) and parents of typically developing (TD) children. An additional goal was to examine factors affecting PI mechanisms in education in parents of children with ASD. The sample for this study consisted of 50 parents of children with ASD and 50 parents of TD children. The results of this study indicate that parents of children with ASD had lower levels of PI mechanisms in education than parents of TD children. The strongest predictors of PI mechanisms in education in parents of children with ASD were subjective well-being and child’s emotional reactivity. Implications for future research and practice are discussed.

Background Attention-Deficit/Hyperactivity Disorder (ADHD) is the most common neurodevelopmental disorder in children (Polanczyk, Willcutt, Salum, Kieling, & Rohde, 2014) and is highly comorbid with Autism Spectrum Disorder (ASD) (Green et al., 2015; Kotte et al., 2013). Although it is well established that children with ADHD or ASD and their families experience poorer functioning including child and parent mental health problems, child peer problems, poorer family quality of life (FQoL) and parenting difficulties, it is unknown how comorbid ASD symptoms contribute to child and family functioning in children with ADHD. It is important to understand which comorbidities contribute to poorer child and family functioning to guide treatment planning. Aims This study aimed to examine the prevalence of ASD symptoms in children with ADHD and the association between ASD symptoms and child and family functioning across three connected studies. The specific aims of each study are outlined below. Study 1. To examine the prevalence and type of ASD symptoms (social interaction, communication and stereotyped behaviour) in children with ADHD and non-ADHD controls. Within the ADHD group only, we also examined the relationship between ADHD subtype, hyperactive/impulsive and inattentive symptoms, ADHD symptom severity and child gender and ASD symptom severity. Study 2. To examine the association between ASD symptoms and (a) social functioning; (b) mental health; (c) quality of life and (d) sleep, in children with and without ADHD. Study 3. To examine the association between ASD symptoms (measured dimensionally) in children with and without ADHD and a broad range of family functioning variables and to examine differences between ADHD+ASD, ADHD and control groups on family functioning variables. Methods Participants were 6-10 year old children (164 ADHD; 198 non-ADHD control) attending 43 schools in Melbourne, Australia, who were participating in the Children’s Attention Project. ADHD was assessed in two stages using the parent and teacher Conners’ 3 ADHD index and the Diagnostic Interview Schedule for Children IV (DISC-IV). ASD symptoms were identified using the Social Communication Questionnaire (SCQ). Child functioning measures were social functioning (Strengths and Difficulties Questionnaire (SDQ), mental health (DISC-IV, SDQ), quality of life (QoL: Pediatric Quality of Life Inventory 4.0) and sleep problem severity. Family functioning outcome variables were parent mental health, family quality of life (FQoL), and scales assessing couple conflict, couple support and parenting behaviours. Unadjusted and adjusted linear and logistic regression examined continuous and categorical outcomes, respectively. Results Study 1. Children with ADHD had more ASD symptoms than non-ADHD controls (adjusted mean difference = 4.0, 95% confidence interval (CI) 2.8; 5.3, p < 0.001, effect size = 0.7). Boys with ADHD had greater ASD symptom severity than girls with ADHD (adjusted mean difference = 2.9, 95% CI 0.8; 5.2, p = 0.01, effect size = 0.4). Greater ADHD symptom severity was associated with greater ASD symptom severity (regression co-efficient = 1.6, 95% CI 1.2; 2.0, p < 0.001). No differences were observed by ADHD subtype. Greater hyperactive/impulsive symptoms were associated with greater ASD symptoms (regression coefficient = 1.0; 95% CI 0.0; 2.0, p = 0.04) however, this finding attenuated in adjusted analyses, which accounted for parent educational attainment, socioeconomic status, child internalising and externalising comorbidities (p = 0.45). Study 2. Each standard deviation (SD) increase in SCQ scores was associated with a 6.7 unit reduction in QoL (p < 0.001) and greater parent and teacher-reported peer problems, emotional and conduct problems. For every SD increase in SCQ scores, internalising (OR = 1.8, 95% CI 1.3, 2.6, p = 0.001) and externalising disorders (OR = 1.5, 95% CI 1.1, 2.1, p = 0.02) increased, as did moderate/severe sleep problems (OR = 1.5, 95% CI 1.0, 2.2, p = 0.04). Most findings held in analyses adjusting for socio-demographic factors, ADHD symptom severity, and comorbidities (when not the outcome), with the exception of externalising disorders and sleep problems. Study 3. In unadjusted dimensional analyses, higher ASD symptoms were associated with more couple conflict (p = 0.04) and poorer FQoL for all subscales (p ≤ 0.001), with non-significant trends for less couple support (R2 = 0.10, p = 0.06), more hostile parenting (R2 = 0.02, p = 0.06) and poorer parent mental health (R2 = 0.02, p = 0.07). In adjusted dimensional analyses, higher ASD symptoms were only associated with poorer FQoL, across all subscales only (p ≤ 0.01). The trend association between ASD symptoms and parent mental health attenuated due to meaningful associations with comorbid internalising disorder (p = 0.003) and ADHD symptom severity (p = 0.05). The trend association between ASD symptoms and hostile parenting attenuated due to significant associations with comorbid externalising disorders (p = 0.002), lower parent education attainment (p = 0.03) and greater ADHD symptom severity (p = 0.04). Less couple support attenuated due to a significant association with socioeconomic status (p = 0.004). In unadjusted categorical analyses, parents of children with ADHD+ASD reported more couple conflict (p = 0.04), less couple support (p = 0.001), poorer FQoL (p <0.001) and a non-significant trend for greater mental health difficulties (p = 0.07), compared to the ADHD group. In adjusted categorical analyses, parents of children with ADHD+ASD had poorer parent self-efficacy (p = 0.02), poorer FQoL (p < 0.05) (p < 0.05) and a non-significant trend for less couple support (p = 0.06), compared to parents of children with ADHD. In unadjusted categorical analyses, family functioning was significantly poorer for the ADHD and ADHD+ASD groups, compared to controls for most outcomes (p <0.001). In adjusted categorical analyses, all findings attenuated except FQoL was significantly poorer for the ADHD and ADHD+ASD groups, compared to controls. Conclusion ASD symptoms are common, and associated with poorer functioning in children with ADHD. It is important for clinicians working with children with ADHD to identify and manage ASD symptoms, given that they exacerbate functional impairments in this already vulnerable group. The relationship between ASD symptoms and broader family functioning appears to be largely driven by internalising and externalising disorders, ADHD severity, and socioeconomic status. Poorer FQoL appears to be independently associated with ASD symptoms in children with ADHD.

In this commentary, we describe a novel theoretical perspective on vocabulary delays in children with autism spectrum disorder (ASD)-a perspective we refer to as auditory-visual misalignment. We synthesize empirical evidence that: (a) as a result of differences in both social and nonsocial visual attention, the auditory-visual statistics available to children with ASD for early word learning are misaligned; (b) this auditory-visual misalignment disrupts word learning and contributes to the vocabulary delays shown by children with ASD; and (c) adopting a perspective of auditory-visual misalignment has important theoretical and clinical implications for understanding and supporting vocabulary development in children with ASD. Theoretically, the auditory-visual misalignment perspective advances our understanding of how attentional differences impact vocabulary development in children with ASD in several ways. By adopting the point of view of the child, we provide a framework that brings together research on social and domain-general visual attention differences in children with ASD. In addition, the auditory-visual misalignment perspective moves current thinking beyond how misalignment disrupts vocabulary development in the moment, and considers the likely consequences of misalignment over developmental time. Finally, considering auditory-visual misalignment may assist in identifying active ingredients of existing language interventions or in developing new interventions that deliver high quality, aligned input. Future research is needed to determine how manipulating auditory-visual alignment changes word learning in ASD and whether the effects of auditory-visual misalignment are unique to ASD or shared with other neurodevelopmental disorders or sources of language impairment. Autism Research 2018, 11: 1621-1628. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This article describes a new way of thinking about vocabulary delays in children with autism spectrum disorder (ASD). We suggest that children with ASD may have difficulty learning words because their attention is not tuned in to what is most important for learning, creating a mismatch between what they see and what they hear. This perspective brings together research on different types of attentional differences in people with ASD. It may also help us to understand how language interventions work.

Autism spectrum disorder (ASD) is a developmental disorder that affects the way people perceive the world. The learning, thinking, and problem-solving abilities of people with ASD can range from gifted to very challenging. Some people with ASD need a lot of help in their daily lives, while others need less.
 Symptoms of ASD range from mild to severe. Children with ASD may have delays in developing basic skills. For example, some children with ASD may be able to talk. Others may communicate in other ways or have trouble relating to other people. People with ASD may also limit their behaviors or have repetitive behavioral patterns. Children with autism spectrum disorder (ASD) often have delayed motor skills, limited coordination, and poor postural control. They also have to work harder to learn imitation skills. This can make it difficult to develop social skills. The task of a physical therapist is to help children with ASD develop gross motor skills, basic motor skills and improve their quality of life. Intervention programs, including physical therapy, have benefits for children with ASD, but the lack of reliable diagnostic tools makes it difficult to assess children with ASD in the context of their holistic development and provide timely therapy. In order to design an effective rehabilitation program, a physical therapist needs to qualitatively assess physical development using standardized tools, so it is important to understand what assessment tools and indicators a physical therapist can use. Only after assessing and identifying impairments in movement or aspects of motor skills that are delayed in a child's development can a physical therapist set functional goals with the parents (guardians) of a child with ASD to optimize the child's functional mobility in the most effective way.
 The aim of the research: to determine which assessment tools and indicators are most commonly used by researchers to evaluate the effectiveness of physical therapy and rehabilitation of children with autism.
 Materials and Methods. A search for systematic reviews related to physical therapy, rehabilitation, exercise and physical activity in children with ASD in the Cochrane, PubMed and Pedro libraries over the past 10 years was conducted and 11 of them were selected, which included 225 scientific studies.
 Results. The analysis of scientific studies based on 11 systematic reviews ensured the use of high-quality data and the consideration of modern and relevant assessment tools for children with ASD. From the 286 assessment tools and indicators used, six groups of assessment criteria were formed in the following main areas: mental functions (97 assessment tools), motor development (127 tools and indicators), life activities (21 tools), quality of life (12 tools) and assessment of children with ASD (12 tools) and comprehensive assessment (17 tools). We divided motor development into three subgroups, which included questionnaires/observations of motor skills development (23 instruments), clinical tests for assessing motor skills and physical qualities (43 instruments), balance and vestibular function (61 instruments).
 Conclusions. In our study, the examination of children with ASD covered several areas that are important and allow a specialist to comprehensively assess the child, but since their large number and their repeatability in studies is insignificant, it is very difficult to choose those that will be effective in the use of a physical therapist.

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Autism Spectrum Disorder

Impact of the ESDM on the development of children with ASD in a European French-speaking population: First results of the intervention implementation