Autism Spectrum Disorders In Taiwan Research Articles

Association between motor skills and executive function of children with autism spectrum disorder in Taiwan and the United States.

The purpose of this study was to examine the relationship between parent ratings of motor skills and executive function (EF) in children with autism spectrum disorder (ASD) in the United States and Taiwan. One hundred and seventy-two parents/legal guardians of children (4-6 years and 11 months old) with ASD were recruited from two countries, Taiwan (n = 100) and the United States (n = 72). The parents or guardians of the child with ASD completed a questionnaire including demographic information, child's motor skills (using Children Activity Scale - Parents, ChAS-P), and child's EF (using Childhood Executive Functioning Inventory, CHEXI). A series of hierarchical multiple regressions were conducted to determine whether ChAS-P (total motor score, fine motor skills, and gross motor skill) was associated with CHEXI (total EF score, working memory, and inhibition), after controlling for covariates (i.e., age, gender, race, body mass index, whether children received physical activity or cognitive training, parental education level). Total motor skills, fine motor skills, and gross motor skills were significantly associated with EF in both working memory and inhibition as rated by parents in both countries (β = 0.21-0.57, p < 0.01), with the exception of a non-significant association between parent-rated total motor skills, fine motor skills, and gross motor skills, and inhibition among Taiwanese children with ASD. In addition, the associations between parent ratings of motor skills (i.e., fine motor and gross motor skills) and EF (i.e., working memory and inhibition) were similar between the two countries. Positive associations with specific aspects of parent ratings of fine motor and gross motor skills and working memory and inhibition were found in children with ASD from both countries. These findings have implications for future interventions and programs focused on improving early motor skills and EF development for young children with ASD from Taiwan and the United States.

11 Using the Chinese Version of Computerized Tower Test and Teacher-Filled BRIEF-2 to Assess the Executive Functions of Children With Autism Spectrum Disorder in Taiwan

Objective:Many studies supported that children with autism spectrum disorder (ASD) have worse executive functions (EFs) when compared to typically developmental (TD) children in many domains, such as planning, flexibility, inhibition, and self-monitoring. The current study aims to use an adapted version of the computerized tower test to investigate the EFs of children with ASD. Furthermore, the researcher also assessed children's EFs-related behaviors in their schools using a teacher-filled behavior rating inventory of executive function, 2nd edition (BRIEF-2).Participants and Methods:61 Children aged 7 to 12 years old (M = 9.23) were included in the current study. 29 of them were in the ASD group, and 31 of them were in the TD group. All participants conducted an adapted computerized tower test. All participants' teachers completed BRIEF-2 to investigate their EFs-related behaviors in their schools.Results:The results indicated that there were no significant differences in the tower test between the ASD group and TD group in all indexes. Therefore, it implied that the current indexes might not be sensitive enough to distinguish whether a child has ASD or not. In addition, we further investigate the correlations between the tower test and the teacher-filled BRIEF-2. We found the different patterns in the two groups. In the ASD group, we found that the task-monitor index was positively correlated with total-number-of-rule-violations, total-complete-time, and total-rule-violations-per-item-ratio. The task-monitor index was negatively correlated with total-achievement-score, implying that poorer ability to monitor tasks leads to a longer completion time, more rule violations, and a lower total achievement score. Moreover, we also found a high correlation between the organization-of-materials in BRIEF-2 and total-complete-time in the tower test, suggesting the long problem-solving time in ASD groups is highly related to the disability of keeping working space ordered. In addition, we found that the shift index is positively correlated with total-complete-time and total-rule-violations-per-item-ratio. Hence, it indicates that those with poor flexibility in solving problems tend to need more time to complete tasks and violate more rules in ASD groups. In the TD group, we only found the correlation effects were significant between inhibition and self-monitor in the BRIEF-2 and the total-rule-violations-per-item-ratio in the tower test. It suggested that individuals with behavioral regulation problems, such as impulse control and monitoring problems are more likely to make rule violations. The result indicated that behavioral regulations play a more significant role in the TD group. In contrast, cognitive and emotional regulations are more critical in ASD children.Conclusions:Our findings found no significant difference in the computerized tower test between children with and without ASD, suggesting that the current indexed might not be sensitive enough to differentiate children with or without ASD. However, the results of the correlation between the tower test and teacher-filled BRIEF-2 showed that different patterns might be the cause of the EF performances between the two groups, indicating that there might be a different domain of EFs the children used in the tower test between two groups.Therefore, further research could focus on developing new indexes in the Tower test and finding the EF mechanism of ASD children with different approaches.

Probiotic intervention in young children with autism spectrum disorder in Taiwan: A randomized, double-blinded, placebo-controlled trial

BackgroundThe impact of psychobiotics on ASD is unclear. MethodIn this double-blinded, randomized, placebo-controlled trial, 86 children (aged 2.5–7 years) with ASD were recruited and assigned randomly to either the probiotic or placebo group to explore the effects of the probiotic Lactobacillus plantarum PS128 (PS128). During the first 2 months of the study, the children received either the probiotic or placebo. After that, all of the children received PS128 for 2 more months. We categorized individuals who took PS128 for the entire 4-month duration as the “PS128 early use group” (E group), while those who initially received the placebo for 2 months and then took PS128 for the subsequent 2 months were classified as the “PS128 late use group” (L group). ResultsAfter adjusting for possible confounders, the results showed that the anxious/depressed subscale score of the Achenbach System of Empirically Based Assessment significantly improved in the E group after the first 2-month intervention (P = 0.044) when compared to the L group. In the subsequent 2 months, the L group showed a significant improvement in this subscale (P = 0.017). While the improvement observed during the first two months was not sustained on average in the E group from V2 to V3, this variability can be attributed to the influence of an outlier. Upon analyzing the hyperactivity subscale of the Attention-Deficit/Hyperactivity Disorder Test, no significant differences were found across multiple time points. ConclusionsThe results support that PS128 has beneficial effects on behavioral and emotional problems in young children with ASD.

Exploring Coping Strategies of Parents of Children With Autism Spectrum Disorder in Taiwan: A Qualitative Study.

Children with autism spectrum disorder (ASD) experience impairments in their social interactions, language communication, and stereotypical patterns of behavior. Parents of children with ASD experience higher levels of stress and more depression and anxiety than parents of children with other disabilities or typically developing children. Parents of children with disabilities develop coping strategies to counteract the stresses associated with raising a child with special needs. Understanding coping strategies to help counteract the stresses associated with parenting a child with ASD may enhance well-being in parents of children with ASD, improve the quality of care provided to these children, and foster better parent-child relationships. The purpose of this study was to explore the coping strategies used by parents in Taiwan parenting a child with ASD. In this descriptive qualitative study, thematic analysis was conducted on data collected during face-to-face interviews. Fourteen parents of children with ASD were recruited using purposive sampling. Researchers employed a teamwork approach for data analysis to increase the dependability and consistency of the transcribed interviews. Team members discussed coding and identified the themes collaboratively. Taiwanese parents of children with ASD coped with the psychological impacts of parenting by employing problem-focused and emotion-focused strategies. Problem-focused strategies included communication, support, and management, whereas emotion-focused strategies included acceptance and adaptation. Findings showed that both coping strategies were useful in addressing specific situations and circumstances. Social and clinical support improved parents' mental health and children's external behaviors. Healthcare providers should evaluate how parents are coping with the stresses related to raising a child with ASD and consider the cultural factors that might influence how they accept and adapt to parenting children with ASD. Understanding these variables may be used to tailor strategies appropriate to reducing stress and improving the well-being of parents and their children. Support and resource referrals should be considered, including parent support groups, books, web-based services, and recommendations for professional consultations with social workers or therapists.

A Longitudinal Study of Joint Attention, Motor Imitation and Language Development in Young Children with Autism Spectrum Disorder in Taiwan.

This longitudinal study examined early predictors of language development in 74 young children with Autism Spectrum Disorder (ASD) in Taiwan. Participants were assessed twice (initial age between 17 and 35 months) on responding to joint attention (RJA), initiating joint attention (IJA), motor imitation with objects (object imitation; OI) and without objects (manual imitation; MI), and receptive and expressive language. The two assessments were 18 months apart. Results showed that both RJA and MI concurrently and longitudinally predicted receptive and expressive language across the two assessments. These findings were not entirely consistent with the limited and mixed findings of Western longitudinal studies. However, they have implications for early interventions aiming to facilitate language development in children with ASD internationally.

Association of early childhood constipation with the risk of autism spectrum disorder in Taiwan: Real-world evidence from a nationwide population-based cohort study.

Autism spectrum disorder (ASD) is a neurodevelopmental problem that presents with limited interests, repetitive behaviors, and deficits in reciprocal communication and social interactions. Mounting evidence indicates that an imbalanced gut microbiota contributes to autism via the gut-brain axis. Constipation may result in alteration of the gut microbiota. The clinical influence of constipation on ASD has not been fully researched. Thus, in this study we aimed to evaluate whether early childhood constipation influenced the risk of developing ASD using a nationwide population-based cohort study. We identified 12,935 constipated children aged 3 years or younger from the National Health Insurance Research Database (NHIRD) in Taiwan from 1997 to 2013. Non-constipated children were also selected from the database and propensity score matching of age, gender, and underlying comorbidities was conducted with a ratio of 1:1. Kaplan-Meier analysis was applied to determine different levels of constipation severity and cumulative incidence of autism. Subgroup analysis was also applied in this study. The incidence rate of ASD was 12.36 per 100,000 person-months in the constipation group, which was higher than the rate of 7.84 per 100,000 person-months noted in the non-constipation controls. Constipated children had a significantly higher risk of autism when compared to the non-constipation group (crude relative risk = 1.458, 95% CI = 1.116-1.904; adjusted hazard ratio = 1.445, 95% CI = 1.095-1.907).Moreover, among constipated children, a higher number of laxative prescriptions, male gender, constipation during infancy, and atopic dermatitis were significantly associated with higher risks of ASD when compared to the non-constipation group. Constipation in early childhood was correlated with a significantly increased risk of ASD. Clinicians should pay attention to the possibility of ASD in constipated children. Further research is necessary to study the possible pathophysiological mechanisms of this association.

The Performance of Visual, Auditory, and Motor Cognitive Flexibility for Children with Autism Spectrum Disorder in Taiwan.

PurposeFew studies have tested the cognitive flexibility, specifically auditory and motor flexibility of children with ASD. This study was conducted to understand the relationship between cognitive flexibility and visual, auditory, and motor development in young children with ASD and autistic behaviors.Participants and methodsA purposive sampling approach was used to screen nineteen four- to five-year-old ASD children. Tests included the Autism Behavior Checklist-Taiwan Version and Cognitive Flexibility Test, which included visual, auditory, and motor cognitive flexibility subtests.ResultsAt the pre-switch and post-switch of three subtests, there were considerable variations in the number of ASD passing. According to the findings, children aged five had more visual cognitive flexibility than children aged four, but the lack of significant differences for the other flexibilities. The negative correlation of the three cognitive flexibilities with autistic behaviors was −0.57~-0.64.ConclusionChildren with ASD have significant difficulties in switching rule tasks characterized by visual, auditory, and motor cognitive flexibility. The results suggest that visual cognitive flexibility had an age effect. The negative correlation of the three cognitive flexibilities with autistic behaviors was moderate.

A Pilot Study on Efficacy of a Play-Based Social Skills Training Group for First-Grade Elementary Children with Autism in Taiwan

ABSTRACT A social skills training has previously resulted in positive improvements in social skills among children and adolescents with autism spectrum disorder (ASD). This pilot study developed a play-based social skills training protocol for first-grade elementary children with ASD in Taiwan and determined its efficacy. Using a single-group pretest-posttest design, this study recruited seven first-grade elementary children with ASD aged 6–7 years. Seven children enrolled in a regular classroom participated in a 12-week play-based social skills training program which was led by an occupational therapist. The improvement of social skills was evaluated by occupational therapists through video coding and goal attainment scales. Caregivers and teachers were asked to complete the communication and socialization domains of the Vineland Adaptive Behavior Scale-Third Edition. The results showed significant improvements in the children’s social skills performance between the pretest and posttest based on video coding and goal attainment scale. Significant improvements in the Vineland Adaptive Behavior Scale-Third Edition growth scale values of receptive and written language subdomains were observed. This study established an intervention protocol for first-grade children with ASD that could be used as a guide by clinical professionals who work with children with ASD who experience problems adapting to elementary school.

Urban-Rural Disparity in the Incidence of Diagnosed Autism Spectrum Disorder in Taiwan: A 10-Year National Birth Cohort Follow-up Study.

Autism spectrum disorder (ASD) is reportedly more prevalent in urban areas partly because of better accessibility and affordability to healthcare. With universal health insurance coverage in Taiwan, a previous study has shown no urban-rural disparity in the utilization rate of a child's preventive healthcare. Under this circumstance, we followed a birth cohort of 176,273 live births from 2006 to 2015 to detect the differences in ASD incidence between urbanicities. After adjusting for socioeconomic factors, children were 1.28 (95%confidence interval (CI):1.13-1.44) and 1.54 (95%CI:1.36-1.75) more likely to acquire ASD in satellite and urban areas compared with those in rural areas, respectively. A gradient association between parental educational attainment and ASD incidence was also noted. Greater ASD incidences in more urbanized areas and more advanced educated parents' children were detected under a circumstance with low barriers to healthcare.

Knowledge and Attitudes toward Genetic Testing for Autism Spectrum Disorders among Parents of Affected Children in Taiwan.

The prevalence of autism spectrum disorders (ASD) in Taiwan has been increasing, and genetic testing for ASD has been available and provided to parents of children diagnosed with ASD in Taiwan. However, there is still limited understanding of Taiwanese parents’ knowledge of and attitudes toward such testing. Therefore, the present study addressed this gap by assessing the attitudes toward as well as actual and perceived knowledge of ASD genetic testing among Taiwanese parents of children diagnosed with ASD. A sample of 443 parents of children with ASD recruited from 236 public schools in Taiwan completed a paper-and-pencil survey. Although parents generally held favorable attitudes toward ASD genetic testing, they had deficient knowledge of such test (with only a 31.4% average correct rate on the actual knowledge scale). Tailored health education materials should be developed to improve the knowledge of ASD genetic testing among parents with affected children in Taiwan.

Attitudes toward Pursuing Genetic Testing among Parents of Children with Autism Spectrum Disorder in Taiwan: A Qualitative Investigation

Background: The diagnosis of autism spectrum disorder (ASD) cases is increasing in Taiwan. Genetic testing for children with ASD offers several potential benefits and is available with out-of-pocket expenses. Parents play a pivotal role in having their children with ASD tested; therefore, understanding their perceptions of, and perceived barriers to genetic testing is vital. Methods: Semi-structured interviews were conducted with 39 parents of children with ASD in Taiwan. Interviews were recorded and transcribed verbatim. NVivo 12 software (QSR International, Doncaster, Australia) was used to facilitate an inductive coding methodology. Results: The majority of participants (74.4%) supported ASD genetic testing for their children with ASD, citing reasons such as clarifying ASD etiology, well-informed family planning, contributing to ASD research, and early ASD detection and intervention. Others indicated that they were either against such testing (17.9%), or unsure (7.7%) about whether to take their children with ASD for genetic testing. Those who were opposed reported that their main concerns related to perceptions of no value of genetic testing, potential for family conflict, and financial difficulties. Conclusions: Most of the parents of children with ASD that we interviewed expressed favorable views of ASD genetic testing. There exists a need to increase parental access to education and counseling, and to include testing coverage in Taiwanese national health insurance.

Increased Diagnostic Yield of Array Comparative Genomic Hybridization for Autism Spectrum Disorder in One Institution in Taiwan.

Background and Objectives: Chromosomal microarray offers superior sensitivity for identification of submicroscopic copy number variants (CNVs) and is recommended for the initial genetic testing of patients with autism spectrum disorder (ASD). This study aims to determine the diagnostic yield of array comparative genomic hybridization (array-CGH) in ASD patients from a cohort of Chinese patients in Taiwan. Materials and Methods: Enrolled in this study were 80 ASD children (49 males and 31 females; 2–16 years old) followed up at Taipei MacKay Memorial Hospital between January 2010 and December 2020. The genomic DNA extracted from blood samples was analyzed by array-CGH via the Affymetrix GeneChip Genome-Wide Human single nucleotide polymorphism (SNP) and NimbleGen International Standards for Cytogenomic Arrays (ISCA) Plus Cytogenetic Arrays. The CNVs were classified into five groups: pathogenic (pathologic variant), likely pathogenic (potential pathologic variant), likely benign (potential normal genomic variant), benign (normal genomic variant), and uncertain clinical significance (variance of uncertain significance), according to the American College of Medical Genetics (ACMG) guidelines. Results: We identified 47 CNVs, 31 of which in 27 patients were clinically significant. The overall diagnostic yield was 33.8%. The most frequently clinically significant CNV was 15q11.2 deletion, which was present in 4 (5.0%) patients. Conclusions: In this study, a satisfactory diagnostic yield of array-CGH was demonstrated in a Taiwanese ASD patient cohort, supporting the clinical usefulness of array-CGH as the first-line testing of ASD in Taiwan.

Air Pollution during Pregnancy and Childhood Autism Spectrum Disorder in Taiwan.

Air pollutants have been linked to some diseases in humans, but their effects on the nervous system were less frequently evaluated. Autism spectrum disorder (ASD) is a group of neurondevelopmental disorders of which the etiology is still unknown. We conducted a study in Taiwan to evaluate the possible associations between prenatal exposure to air pollutants and ASD. From a random sample of one million people in the National Insurance Research Database, we identified all the infants born between 1996 and 2000. We followed them till the end of 2013 and identified cases of ASD. We traced back the mothers’ residence and assessed the exposure to air pollutants using the data obtained from the air quality monitoring database maintained by the government, which included ozone (O3), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and particulate matters with diameter less than 10 µm (PM10). Cox proportional hazard models were constructed to evaluate the associations between childhood ASD and exposures to the pollutants in the three trimesters and the whole gestation. We identified a total of 63,376 newborns and included 62,919 as the study cohort. After adjusting for other risk factors, we observed trimester-specific associations between levels of CO, NO2, and PM10 and the risk of childhood ASD. An increase of 1 ppm of CO in the first, second, and third trimester was associated with a hazard ratio (HR) of 1.93 (95% confidence interval [CI]: 1.55–2.39), 1.77 (95%CI: 1.41–2.22), and 1.75 (95%CI: 1.39–2.21), respectively. An increase of 10 ppb in the level of NO2 in the first, second, and third trimester was associated with an HR of 1.39 (95%CI: 1.22–1.58), 1.25 (95%CI: 1.10–1.42), and 1.18 (95%CI: 1.03–1.34), respectively. In conclusion, we found that exposures to CO and NO2 in all three trimesters were associated with increased risks of developing ASD.

Perinatal exposure to air pollution and childhood autism spectrum disorder in Taiwan

Perinatal exposure to air pollution and childhood autism spectrum disorder in Taiwan

Effects of Lactobacillus plantarum PS128 on Children with Autism Spectrum Disorder in Taiwan: A Randomized, Double-Blind, Placebo-Controlled Trial.

This four-week, randomized, double-blind, placebo-controlled study investigated the effects of Lactobacillus plantarum PS128 (PS128) on boys with autism spectrum disorder (ASD) aged 7–15 in Taiwan. All subjects fulfilled the criteria for ASD diagnosis of DSM-V and the Autism Diagnostic Interview-Revised (ADI-R). Questionnaires used for the primary outcome measure include the Autism Behavior Checklist-Taiwan version (ABC-T), the Social Responsiveness Scale (SRS) and the Child Behavior Checklist (CBCL). The Swanson, Nolan, and Pelham-IV-Taiwan version (SNAP-IV) and the Clinical Global Impression-improvement (CGI-I) were used for the secondary outcome measure. The results showed that PS128 ameliorated opposition/defiance behaviors, and that the total score of SNAP-IV for younger children (aged 7−12) improved significantly compared with the placebo group. Additionally, several elements were also notably improved in the PS128 group after 28-day consumption of PS128. Further studies are needed to better clarify the effects of PS128 for younger children with ASD on broader symptoms.

Stressors experienced by children with autism spectrum disorder in Taiwan: Perspectives of children and their parents.

Autism spectrum disorder has only recently been recognized as a developmental disability in Taiwan. We conducted an exploratory qualitative descriptive study with children (n = 14, mean age = 13.57 years) and their parents to understand stressors experienced by children with autism spectrum disorder in Taiwan. An analysis of face-to-face interviews revealed that children with autism spectrum disorder experienced stressors of daily living, which included environmental stimuli, academic and behavioral expectations, deviations in routine, behavioral expectations, and emotional control, and stressors of socializing, which included bullying, communication, personal interactions, conflict resolution, and difficulty understanding others' emotions. Stressors resulted from the core symptoms and characteristic behaviors of autism spectrum disorders, and also Taiwanese cultural expectations. Our findings could help develop individualized educational plans and culturally-sensitive behavioral interventions. Facilitation of these interventions could be used by nurses and health-care professionals to help facilitate problem solving and communication skills, which could reduce the stress for children with autism spectrum disorder in Taiwan.

Air Pollution and Childhood Autism Spectrum Disorder in Taiwan

Air pollutants have been linked to some diseases in human, including those of the respiratory and cardiovascular systems. However, their effects on the nervous system were less frequently evaluated...

Correction: Air Pollution and Newly Diagnostic Autism Spectrum Disorders: A Population-Based Cohort Study in Taiwan.

[This corrects the article DOI: 10.1371/journal.pone.0075510.].

Information needs in genetic testing: A needs assessment survey among Taiwanese parents of children with autism spectrum disorders.

We conducted the first needs assessment study by examining the information needs in genetic testing for autism spectrum disorders among parents of children with autism spectrum disorders in Taiwan. Parents of children with autism spectrum disorders in 236 public elementary schools with special education services were invited to complete a survey. About two-thirds of participants (65.7%) had never heard about genetic testing for autism spectrum disorders. Yet, the majority (71.4%) expressed an interest in learning about this testing. The top three topics participants identified to assist them in making informed decisions before undergoing genetic testing (for themselves, their affected children, or other family members) were testing accuracy (79.7%), genetic causes of autism spectrum disorders (79.4%), and the link between testing and treatment (79.4%). A health education brochure (47.2%) was the most desired educational approach. Our results can be utilized to develop information and counseling materials for genetic testing for autism spectrum disorders in Taiwan as well as to address the needs of parents of children with autism spectrum disorders, particularly in informed decisions-making. Moreover, to promote better communication between the providers and parents, when discussing genetic testing for autism spectrum disorders with Taiwanese parents of children with autism spectrum disorders, healthcare professionals' priorities should be in line with the preferred topics identified in this study.

Timing of the Diagnoses of Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorder in Taiwan.

ADHD comorbidity has been associated with delayed diagnosis of ASD, but no study has investigated this association in an Asian country. Children with ASD were included and divided into three groups: ADHD before ASD, ADHD same/after ASD, and ASD only. Timing of ASD and ADHD diagnoses were assessed. The logistic regression model was performed to investigate the likelihood of being diagnosed with ASD after 6years of age between three groups. ADHD before ASD (OR 10.93) group was more likely to being diagnosed with ASD after 6years of age compared with ADHD same/after ASD (OR: 1.37) and ASD only groups. ADHD comorbidity would delay the diagnosis of ASD in the general clinical settings in Taiwan.