Autism Spectrum Disorder In China Research Articles

Prevalence of autism spectrum disorder in mainland china over the past 6 years: a systematic review and meta-analysis

BackgroundCoupled with its rising prevalence, Autism spectrum disorder (ASD) has become a globally recognized public health concern. Nevertheless, large-scale, multicenter studies that analyze the epidemiology of ASD in China are relatively scarce.MethodsLiterature searches were conducted in PubMed/Medline, Embase, the Cochrane Library, Wanfang Data Knowledge Service Platform, China Biology Medicine database (CBM), China Science and Technology Journal Database (CSTJ), and China National Knowledge Infrastructure (CNKI) to retrieve studies published before April 8, 2023, related to ASD prevalence among children aged 0 to 14 years in mainland China. Meta-analysis was conducted using RevMan 5.2 and Stata 14.0.ResultsTwenty-one articles were included. The ASD prevalence among children in mainland China has been 0.7% (95% confidence interval(CI): 0.006–0.008) since 2017. The prevalence of ASD among boys was 1.0% (95% CI: 0.008–0.011), which was significantly higher than that among girls at 0.2% (95% CI: 0.002–0.003), with a statistically significant difference (OR = 3.198, 95% CI: 2.489–4.109, P = 0.000). Among the included studies, 18 reported an ASD prevalence of 0.8% (95% CI: 0.007–0.010), while 3 studies reported an autistic disorder (AD) prevalence of 0.7% (95% CI: 0.006–0.008). The prevalence of autism among urban children was 23.9% (95% CI: 0.149–0.328), and in rural areas, it was 0.7% (95% CI: 0.002–0.013), with no statistically significant difference (OR = 1.342, 95% CI: 0.258–6.975, P = 0.727). Regression analysis showed that factors such as region (P = 0.000), age (P = 0.000), study period (P = 0.000), sample size (P = 0.000), sampling method (P = 0.002), population source (P = 0.000), disease type (P = 0.000), quality score of the study (P = 0.000), and diagnostic criteria (P = 0.000) might have contributed to the heterogeneity in ASD prevalence.ConclusionThe prevalence of ASD in China from 2017 to 2023 was 7/1000, showing an upward trend compared to that before 2017 (26.50/10,000). The male-to-female prevalence ratio was 5:1.The overall prevalence remained significantly lower than that reported in foreign countries.

Single-Subject Study on the Effects of Social Stories on the Social Interaction of a Child with Autism Spectrum Disorder in China

ABSTRACT Intervention using social stories is a widely used strategy for children with autism spectrum disorder. However, empirical studies on the efficacy of social stories in improving social interaction have yielded mixed results, and such research in China is scarce. This study examined the effectiveness of social stories for increasing social interaction, particularly initiation and response, verbal exchange, body language, eye contact, and combined interaction of a child with autism spectrum disorder. A single-subject experimental study was conducted with two baseline sessions, two intervention phases, and a follow-up period. The results demonstrated immediate and maintained effects after utilising social story intervention. The participant’s response behaviours improved more than initiation, and body language as well as eye contact improved more than verbal and combined interaction. Social validity findings revealed positive evaluations of the participant’s mother and head teacher. Social story intervention is a promising strategy for improving the social interaction of children with autism spectrum disorder and that should be explored further in future research.

Maternal stress, parenting, and mother-child interactions in unaffected siblings of children with autism spectrum disorder in China.

Maternal stress, parenting, and mother-child interactions in unaffected siblings of children with autism spectrum disorder in China.

Relationship Between Mindfulness and Affiliate Stigma in Parents of Children with Autism Spectrum Disorder in China: The Mediating Role of Coping Styles

PurposeThis study aims to investigate the current status of affiliate stigma among parents of autistic children, analyze the influencing factors, explore the relationship among mindfulness, coping styles, and affiliate stigma, and verify the mediating role of coping styles between mindfulness and affiliate stigma in parents of children with autism in China. MethodBetween February and April 2023, the Child Development Behaviour Centre of a public hospital in China recruited 345 parents of children with autism. These parents completed the general information questionnaire, the Mindful Attention Awareness Scale, the Affiliate Stigma Scale, and the Simple Coping Style Questionnaire. We then adapted the Hayes Process Macro and Bootstrap methods to examine the mediating effects of coping styles between mindfulness and affiliate stigma. Results(1) The total affiliate stigma score of parents of children with autism was 48.53 (standard deviation:: 10.74). Parents' age, monthly family income, duration of care, mindfulness, and coping styles were the influencing factors of parental affiliate stigma. (2) Mindfulness was positively correlated with positive coping style (r = 0.33, p < .01) and negatively correlated with negative coping style, affiliate stigma (r = −0.38, −0.39, p < .01), whereas affiliate stigma was negatively correlated with positive coping style (r = −0.34, p < .01) and positively correlated with negative coping style (r = 0.41, p < .01). (3) Positive coping style and negative coping style play a parallel mediating role between mindfulness and affiliate stigma of parents of autistic children. ConclusionsParents of children with autism experience significant levels of affiliate stigma. Mindfulness has a direct impact on associated stigma in parents of children with autism and also indirectly predicts associated stigma through the intermediary influence of positive and negative coping styles. Healthcare professionals could perform mindfulness interventions from an optimistic psychology viewpoint to boost parents' mindfulness and coping abilities, thereby accomplishing the objective of mitigating affiliate stigma.

Prenatal, perinatal and parental risk factors for autism spectrum disorder in China: a case- control study.

Autism spectrum disorder (ASD) is heritable neurodevelopmental disorders (NDDs), but environmental risk factors have also been suggested to a play a role in its development. Prenatal, perinatal and parental factors have been associated with an increased risk of ASD in children. The aim of the present study was to explore the prenatal, perinatal, and parenting risk factors in children with autism spectrum disorder (ASD) from Beijing, China by comparing them with typically developing (TD) children. A sample of 151 ASD children's parents who from rehabilitation institutions in Beijing were enrolled in this study, and an additional 151 children from kindergartens in Beijing were recruited as a control group (child age: mean = 4.4 years). TD children were matched according to age, sex and maternal education. We explored the maternal AQ (Autism Spectrum Quotient) scores (mean:19.40-19.71, no significant difference between two groups) to referring the genetic baseline. This study evaluated 17 factors with unadjusted and adjusted analyses. Birth asphyxia was associated with a more than a thirteen-fold higher risk of ASD (adjusted odds ratio (AOR) = 13.42). Breastfeeding difficulties were associated with a higher risk of ASD(AOR = 3.46). Parenting influenced the risk of ASD, with low responding (LR) and harsh or neglectful parenting associated with a higher risk of ASD in offspring (AOR = 2.37 for LR, AOR = 3.42 for harsh parenting and AOR = 3.01 for neglectful parenting). Maternal fever during pregnancy was associated with a higher risk of ASD in offspring (AOR = 3.81). Many factors were associated with ASD in offspring. Further assessment is needed to elucidate the role of modifiable environmental factors to inform prevention strategies.

Socioeconomic disparities in education placement for children of primary school age with autism spectrum disorder in China.

Relatively little is known about education placements for children with autism spectrum disorder (ASD) in China. While disparities in ASD diagnoses and services for the population broadly are often documented, the presence and determinants of differences in the educational placement of ASD children are less studied and understood. By identifying who is likely to be in segregated settings, we can discern how to best support them and facilitate a possible transition to a less restrictive setting. This study describes four placements (regular schools, special schools, institutions, homes) and their influencing factors retrospectively in a large sample (n = 2,190) of Chinese primary school-aged children (6-12 years old). We divided ASD into severe and mild to moderate categories for analysis. Children with ASD were more likely to study in a regular school (48.60%), while 13.88% were in a special school. Children with severe ASD were placed in less regular settings than children with mild to moderate ASD. However, families with higher socioeconomic status (SES) were more likely to place their children in regular schools than lower SES families if their children experienced mild to moderate symptoms. Children with severe ASD were more likely to be placed in expensive institutions for families with higher SES than those with lower SES. SES disparities in educational placement existed and had two manifestations. It is important to characterize educational placements of students with ASD to determine the extent to which they are placed in general education settings, which are often the preferred placement.

Alteration of the gut microbiota profile in children with autism spectrum disorder in China.

Autism spectrum disorder (ASD) is associated with alterations in the gut microbiome. However, there are few studies on gut microbiota of children with ASD in China, and there is a lack of consensus on the changes of bacterial species. Autism spectrum disorder (ASD) is associated with alterations in the gut microbiome. However, there are few studies on gut microbiota of children with ASD in China, and there is a lack of consensus on the changes of bacterial species. We used 16S rRNA sequencing to analyze ASD children (2 to 12 years), HC (2 to 12 years). Our findings showed that the α-diversity, composition, and relative abundance of gut microbiota in the ASD group were significantly different from those in the HC groups. Compared with the HC group, the α-diversity in the ASD group was significantly decreased. At the genus level, the relative abundance of g_Faecalibacterium, g_Blautia, g_Eubacterium_eligens_group, g_Parasutterella, g_Lachnospiraceae_NK4A136_group and g_Veillonella in ASD group was significantly increased than that in HC groups, while the relative abundance of g_Prevotella 9 and g_Agathobacter was significantly decreased than that in HC groups. In addition, KEGG pathway analysis showed that the microbial functional abnormalities in ASD patients were mainly concentrated in metabolic pathways related to fatty acid, amino acid metabolism and aromatic compound metabolism, and were partially involved in neurotransmitter metabolism. This study revealed the characteristics of gut microbiota of Chinese children with ASD and provided further evidence of gut microbial dysbiosis in ASD.

Parent-implemented interventions in Chinese families of children with autism spectrum disorder

This study aims to test the effects of the parent-implemented interventions (PIIs) on children with autism spectrum disorder (ASD) in China and to explore the effects of PIIs on the family quality of life of families of children with ASD in China. This study adopted a randomized controlled trial (RCT) design based on PIIs. Participants is divided into intervention group (N(parents) = 35, Age(M ± SD) = 35.69 ± 3.45; N(children) = 35, Age(M ± SD) = 5.49 ± 2.74) and control group (N(parents) = 35, Age(M ± SD) = 36.06 ± 4.28; N(children) = 35, Age(M ± SD) = 5.71 ± 3.25); parents in intervention group were trained with PIIs and required to implement family interventions for their children with ASD as they learned. This study will provide data to support the development and improvement of PIIs, and will also benefit the well-being and sustainability of children with ASD and their families. Compared to control group, the children in intervention group had a significant improvement in social communication ability (p < 0.05), and the families in intervention group had a significant enhancing in family quality of life (satisfaction) (p < 0.001). This study found that PIIs are effective in enhancing the social communication ability of children with ASD in China and the family quality of life (satisfaction) of their families. PIIs is a good and cost-effective complement to rehabilitation training in professional institutions, and have positive significance for the well-being and sustainability of children with ASD and their families.

Developing a new questionnaire of positive contributions to Chinese families by children with autism spectrum disorder.

A literature review of both Eastern and Western literature regarding families of children with autism spectrum disorder (ASD) revealed limited empirical research that examines ASD in China. Furthermore, most research in this area comes from a deficit model and there is a lack of research that comes from a strengths background. No previous study in China has looked at the positive contributions of children with ASD to their families. The present study came from a strengths-based perspective and aimed to develop a new questionnaire to evaluate the positive contributions made to families by children who have ASD in China and are raised by their respective families. It considered the severity level of the children's disorder and the impact this had on the parents. Besides examining the children's impairment levels, the study also examined positive contributions and their relationship with socio-demographic elements such as family income and employment status of the parents, which also seem to be related to the positive contributions experienced by the parents. First, based on the literature review, an initial qualitative interview protocol was developed and administered to 10 parents of children with ASD. Then, based on the analyses of the interviews, a quantitative questionnaire was developed to assess the positive contributions of children with ASD to their families. The questionnaire was then administered to 156 parents of children with ASD. The internal structure of the questionnaire was analyzed by factor analysis. The questionnaire's reliability and validity were also examined. The data were then analyzed with multiple correlation comparisons and an independent sample T-test. Six factors emerged for families of children with ASD. The results showed that the cumulative explanatory variance of the six dimensions of the questionnaire was 65.42%. The Cronbach's coefficient of each dimension was between 0.7 and 0.9, and the combined Cronbach's coefficient of the total questionnaire was 0.945. This study found that the overall average positive contribution to families by children with ASD was 3.32, which is at a medium level, and all six dimensions were at a medium-to-high level. This study also found that the family's monthly income contributed to the overall positive contribution, intimacy and happiness, and gaining more special knowledge through experience dimensions. Furthermore, it was found that moderate severity of ASD, high income, and parental employment were all associated with more positive contributions. This new questionnaire appears to have good reliability and validity and seems suitable for assessing the positive contributions to families by children with ASD in China. The present study may be helpful for the parents of children with ASD and will likely help them focus on the strengths of their children rather than their shortcomings. The study might also benefit counselors and researchers who would be able to use the new questionnaire to evaluate the positive contributions made to families by children who have ASD.

Relationship between perceived discrimination and social anxiety among parents of children with autism spectrum disorders in China: The mediating roles of affiliate stigma and perceived social support

BackgroundSocial anxiety among parents of children with autism spectrum disorders (ASD) is a critical issue because it could lead to adverse consequences for psychological and social functioning. Research shows that there is a positive correlation between perceived discrimination and social anxiety. Affiliate stigma and low levels of perceived social support, which may stem from experiences of discrimination, can produce negative emotions, such as social anxiety. Additionally, the negative effects of affiliate stigma on perceived social support have also been documented. Therefore, this study explored the mediating role of affiliate stigma and perceived social support between perceived discrimination and social anxiety among parents of children with ASD in China. Method396 parents of children with ASD participated in a cross-sectional online survey that included measures of perceived discrimination, affiliate stigma, perceived social support, and social anxiety. The results were analyzed by SPSS 21.0 and AMOS 26.0. Results(1) Perceived discrimination, affiliate stigma, and perceived social support were significantly correlated with the social anxiety of parents of children with ASD; (2) Affiliate stigma and perceived social support may mediate the association between perceived discrimination and social anxiety, respectively; (3) Affiliate stigma and perceived social support may mediate the relationship between perceived discrimination and social anxiety. ConclusionsThe findings suggest that experiences of discrimination by parents of children with ASD are associated with relatively high affiliate stigma and lower perceived social support, which may contribute to social anxiety. Although there are limitations in the analyses of cross-sectional data, the findings show preliminary implications for the prevention and intervention of social anxiety among parents of children with ASD.

The economic burden of autism spectrum disorder with and without intellectual disability in China: A nationwide cost-of-illness study

ObjectiveThe economic burden of autism spectrum disorder (ASD) on individuals, their families and society as a whole is poorly understood. Accurate figures are crucial for economic estimates and service planning. MethodsThe total lifetime individual costs and annual societal costs of ASD in China were estimated with a prevalence-based, gross cost of illness approach and data from multiple sources. The direct medical costs in outpatient and inpatient settings from the electronic health records (EHRs) of hospitals, and direct nonmedical costs from a national survey were included. The indirect costs were from both the national survey and the estimation using human capital methods. Age-specific lifetime incremental societal costs were measured. Comorbidity-related and unrelated costs were analyzed separately. ResultsThe discounted lifetime cost for an individual with ASD in China was $2.65 million (at 2020 prices, $) for those without intellectual disability (ID) and $4.61 million (at 2020 prices, $) for those with ID. The total cost of ASD amounted to $41.8 billion in 2020. Productivity loss were major cost drivers for ASD individuals without ID. Direct nonmedical costs (rehabilitation or adult care costs etc.) were major drivers for ASD individuals with ID. In a lifetime course, the total annual costs for middle aged and elderly (>42 years) were highest, followed by transitional adults (18–29 years) and preschoolers, both for individuals with or without ID. The distribution of costs over the lifespan varied by the cost category. ConclusionsASD imposes a substantial economic burden on families and health care systems. Sectors and services coordination should be given policy considerations.

Difficulties and Recommendations for the Implementation of Learning in Regular Classrooms among Children with Autism Spectrum Disorders in China

Developmental disability, known as autism spectrum disorder (ASD), is brought on by variations in the brain. People with ASD struggle with repetitive activities or interests, as well as communication and social engagement. Nowadays, there is an increasing number of children with ASD in China. They are gradually gaining public attention on the improvement in their societal situation from all aspects. Learning in Regular Classrooms (LRC) is the most direct and effective way for children with ASD to overcome social communication barriers and integrate into society. However, educational problems related to LRC arose as well. In this paper, the author studies issues in the implementation of LRC among children with ASD and gives recommendations accordingly. Conclusions can be drawn that issues lie in teachers professionalism, family education, school culture, and social prejudice, and achieving a high-quality implementation requires the joint efforts of schools, society, and the government.

The complex information needs of Chinese parents of children with autism spectrum disorder

PurposeThis study aims to explore the information needs of Chinese parents of children with Autism Spectrum Disorder (ASD) and how these needs evolve as their children develop.Design/methodology/approachThis study collated 17,122 questions regarding raising children with ASD via the Yi Lin website until November 2021.FindingsThe information needs of parents of children with ASD were classified into two categories: 1) Cognition-motivation: related to children with ASD; and 2) Affection-motivation: related to their parents. Child development causes the adaptation of information needs of these parents. Within the first three years, nine different topics of these parents' information needs were identified. Major information needs at this stage are as follows: intervention content, intervention methods and pre-diagnosis questions. During the ages of three to six years, there were 13 topics of information needs for parents, focusing on three areas: intervention content, intervention methods and diagnosis and examination. There are eight topics of information needs post six years. Parents are more concerned with the three topics of intervention content, life planning and intervention methods.Originality/valueThis novel study indicates the complex and changing information needs of parents of children with ASD in China. It may enhance the understanding of the information needs of these parents at theoretical and practical levels, provide support for them to understand their own information needs and provide a reference for relevant government and social organisations to provide targeted information services for them.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/OIR-04-2022-0247

Exposure to greenness during pregnancy and the first three years after birth and autism spectrum disorder: A matched case-control study in shanghai, China

Causes of autism spectrum disorder (ASD) have not been fully understood. Previous studies have linked environmental factors with ASD. However, evidence for the greenness-ASD association is limited, especially in China. To fill this gap, we conducted a matched case-control study to examine the association between greenness and ASD in China. Participants in this study were 84,934 children aged 3−12 years in Shanghai, China, selected using a multi-stage cluster sampling method. ASD cases were firstly screened by questionnaires completed by both children's parents and teachers, and were then confirmed by clinical examinations. Further, 10 healthy controls were randomly selected to match each ASD case by age and sex. The final analyses included 146 ASD cases and 1460 healthy controls. Participants' exposure to greenness before and after birth was assessed by normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI) from NASA's Earth Observing System according to their residential locations. We used conditional logistic regression to examine the ASD-greenness association. Per interquartile range (IQR) increase in EVI500m and NDVI500m during the year before birth were associated with lower risks of ASD with adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of 0.96 (95%CI: 0.946, 0.975, IQR = 0.074) and 0.937 (95%CI: 0.915, 0.959, IQR = 0.101). Exposure to greenness during the first 3 years after birth was also significantly associated with lower risk of ASD [IQR ORs for EVI500m and NDVI500m were 0.935 (95%CI: 0.91, 0.962, IQR = 0.06) and 0.897 (95%CI: 0.861, 0.935, IQR = 0.09), respectively]. Air pollution showed mediation effects on thegreenness-ASD association. Greenness was observed to have stronger beneficial effects on children without historical diseases and term birth. More greenness exposure before and after birth were significantly associated with lower risks of ASD in children. Our results highlight the importance of greenness in urban planning.

A pilot study of several environmental endocrine disrupting chemicals in children with autism spectrum disorder in south China.

Autism spectrum disorders (ASD) is a group of heterogeneous neurodevelopmental disorders. Evidence has implied that environmental pollutants are important factors related to ASD. In this study, several environmental endocrine-disrupting chemicals, including parabens, benzophenone-type ultraviolet filters, hydroxyl polycyclic aromatic hydrocarbons, triclosan and tetrabromobisphenol A were analyzed in blood plasma in ASD children (n = 34) and the control children (n = 28). The results showed that parabens were the most concentrated chemicals (2.18 ng/mL, median value), followed by hydroxyl polycyclic aromatic hydrocarbons (0.73 ng/mL), benzophenone-type ultraviolet filters (0.14 ng/mL), triclosan (0.13 ng/mL) and tetrabromobisphenol A (0.03 ng/mL). ASD children accumulated significantly lower 2-hydroxy-4-methoxybenzophenone, 2,4-dihydroxybenzophenone, 4-hydroxybenzophenone and triclosan but higher 2-hydroxyphenanthrene and tetrabromobisphenol A than the control children (0.02/0.09 ng/mL of 2-hydroxy-4-methoxybenzophenone, p < 0.05; 0.04/0.07 ng/mL of 2,4-dihydroxybenzophenone, p < 0.05; 0.03/0.04 ng/mL of 4-hydroxybenzophenone, p < 0.05; 0.13/1.22 ng/mL of triclosan, p < 0.01; 0.03 ng/mL/not detected of 2-hydroxyphenanthrene, p < 0.05; 0.03/0.004 ng/mL of tetrabromobisphenol A, p < 0.05). Gender differences in certain environmental endocrine-disrupting chemicals were evident, and the differences were more inclined toward boys. Positive associations between 2-hydroxy-4-methoxybenzophenone and triclosan, and tetrabromobisphenol A and 2-hydroxyphenanthrene were found in ASD boys. Binary logistic regression analysis showed that the adjusted odds ratio value of 2-hydroxyphenanthrene in ASD boys was 11.0 (1.45-84.0, p < 0.05). This is the first pilot study on multiple environmental endocrine-disrupting chemicals in children with ASD in China.

How do autistic severity and family functioning influence parental stress in caregivers of children with autism spectrum disorder in China? The important role of parental self-efficacy.

Parental stress among primary caregivers of children with autism spectrum disorder (ASD) is a significant concern. While previous research indicates that both family and child factors substantially influence parental stress, a few studies have comprehensively examined these factors from family, parent, and child perspectives. Moreover, the psychological mechanisms underlying parental stress remain underexplored. This study obtained a valid sample of 478 primary caregivers of children diagnosed with ASD in China and employed mediation and moderated mediation analyses to investigate the relationships between family adaptability and cohesion (FAC), ASD severity, parental self-efficacy, and parental stress. Results revealed that higher FAC was linked to reduced parental stress through increased parental self-efficacy. The indirect effect of parental self-efficacy was more substantial for caregivers of children with severe symptoms than those with mild symptoms. These findings offer insights into how FAC influences parental stress and underscore the importance of parental self-efficacy as a coping resource for mitigating parental stress. This study provides valuable theoretical and practical implications for understanding and addressing parental stress, particularly in families raising children with ASD.

Efficacy of Children Neuropsychological and Behavioral Scale in Screening for Autism Spectrum Disorders through a Combination of Developmental Surveillance.

This study aimed to explore the clinical value of Children Neuropsychological and Behavioral Scale-Revision 2016 (CNBS-R2016) for Autism Spectrum Disorder (ASD) screening in the presence of developmental surveillance. All participants were evaluated by the CNBS-R2016 and Gesell Developmental Schedules (GDS). Spearman's correlation coefficients and Kappa values were obtained. Taking GDS as a reference assessment, the performance of the CNBS-R2016 for detecting the developmental delays of children with ASD was analyzed with receiver operating characteristic (ROC) curves. The efficacy of the CNBS-R2016 to screen for ASD was explored by comparing Communication Warning Behavior with Autism Diagnostic Observation Schedule, Second Edition (ADOS-2). In total, 150 children aged 12-42 months with ASD were enrolled. The developmental quotients of the CNBS-R2016 were correlated with those of the GDS (r=0.62-0.94). The CNBS-R2016 and GDS had good diagnostic agreement for developmental delays (Kappa=0.73-0.89), except for Fine Motor. There was a significant difference between the proportions of Fine Motor, delays detected by the CNBS-R2016 and GDS (86.0% vs. 77.3%). With GDS as a standard, the areas under the ROC curves of the CNBS-R2016 were above 0.95 for all the domains except Fine Motor, which was 0.70. In addition, the positive rate of ASD was 100.0% and 93.5% when the cut-off points of 7 and 12 in the Communication Warning Behavior subscale were used, respectively. The CNBS-R2016 performed well in developmental assessment and screening for children with ASD, especially by Communication Warning Behaviors subscale. Therefore, the CNBS-R2016 is worthy of clinical application in children with ASD in China.

Dance/Movement Therapy for Children with Autism Spectrum Disorder in China: Clinical Case Study

Dance/Movement Therapy for Children with Autism Spectrum Disorder in China: Clinical Case Study

Parental Perception of the Importance of Friendship and Other Educational Outcomes in Children with Autism Spectrum Disorder in China.

This study examined parental perception of the importance of friendship and five other educational outcomes from 101 Chinese parents of children with autism spectrum disorders between the ages of 3 and 12 years. Results showed Chinese parents considered friendship less important than social skills, emotional development, and physical skills and motor development. Unlike the results from previous studies, Chinese parents ranked friendship as the second least important outcome. Children's age rather than educational setting impacted parental perceptions. The findings suggested cultural contexts may have influenced parental perceptions of the importance of different educational outcomes, and future research on the influence of cultural contexts is warranted.

Direct and indirect costs for families of children with autism spectrum disorder in China.

This is the first comprehensive national study to explore the direct and indirect costs for families of children with autism spectrum disorder in China. The increasing prevalence of autism spectrum disorder highlights a growing need for resources to provide care for families of children with autism spectrum disorder. The medical and nonmedical costs and parents' productivity loss have caused a serious burden on their families. Our objective is to estimate the direct and indirect costs for the families of children with autism spectrum disorder in China. The target population was parents of children with autism spectrum disorder. We analyzed the costs using cross-sectional data from a Chinese national family survey with children aged 2-6 years (N = 3236) who were clinically diagnosed with autism spectrum disorder. Family data from 30 provinces in China were obtained. Cost items included direct medical costs, direct nonmedical costs, and indirect costs. In this study, we found that the largest part of family costs for autism spectrum disorder are nonmedical costs and productivity loss. Autism spectrum disorder has imposed a huge economic burden on parents having children with autism spectrum disorder in China, who need more support than the current health care system provides.