Guest Editor:
Cecilia A Essau, HBA, MA, PhD, Habilitation, SFHEA, CPsychol, FBPsS
Chair, Organizing and Scientific Committees of the ICCAP2023
Exploring Roles of Digital Technology in Sustaining Mental Health Among Parents of Children With Autism Spectrum Disorders (ASD) During Covid-19 Pandemic: A Preliminary Qualitative Study
Kartini Ilias
1, Nur Azma Amin2, & Shafiah Rosli1
1UiTM Cawangan Selangor, Kampus Puncak Alam, Malaysia
2Universiti Kuala Lumpur Institute of Medical Science Technology, Malaysia
Background: Children with ASD appear to have limitations to perform daily living activities and may require lifelong support to facilitate their disability. Covid-19 has disrupted the children’s routine hence intensifying the parent’s stress. Lack of knowledge on the disorders, and treatment of ASD contributes to deteriorating and affecting the parents’ mental health. A digital approach has been gradually promoted as part of seeking information tools for them.
Aims: This study aims to explore the roles of digital technology and its impact on the mental health of parents of children with ASD in Malaysia.
Methods: An in-depth interview was conducted with three pairs of parents of children with ASD (two Malay, one Chinese parent). The interview guideline was prepared following the objectives of the study.
Results: Three themes emerged for the roles of digital technology in sustaining mental health among parents with ASD children were identified: (i) the digital technology as support tool to cope with ASD children (ii) mental health and Covid-19 and (iii) strategy in coping and seeking-help of parent. Digital technology benefits in providing information, buying therapeutic tools, fulfilling parent personal interest to release stress (e.g., online games, cooking channel), sharing emotions and experience virtually with other parents of ASD children.
Conclusion: Most parents explained that the pandemic made digital technology a search tool despite control of usage. This study contributes to further evidence on the digital technology and mental health of parents of children with autism in the Malaysian context.
Mental Health Literacy Survey Among Parents of Children With Autism Spectrum Condition: A Preliminary Study
Siti Amirah Syarafana Shalihin
1, Kartini Ilias1, Nur Azma Amin2, & Ahmad Zamir Che Daud1
1Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, Malaysia
2Universiti Kuala Lumpur Kajang Selangor, Malaysia
Background: Mental health literacy (MHL) research are growing widely in the literature. However, research on MHL in Malaysia are very limited and MHL of the caregivers often being overlooked. Moreover, parents of children with Autism Spectrum Condition (ASC) are often diagnosed with mental health problems such as depression and anxiety. Study found that mental health literacy was significantly associated with mental well-being.
Aims: This study was conducted to identify mental health literacy of parents of children with Autism spectrum condition (ASC).
Methods: This preliminary cross-sectional study recruited 61 parents of children with ASC from selected therapy centres located in Klang Valley.
Results: The level of mental health literacy scores of participants was presented using descriptive statistic, with a mean score 119.28 (SD=9.52). Majority of the respondents were mothers, Malay and Muslim group, and attended formal education up to the tertiary level.
Conclusions: The study showed that most participants were aware with the description of mental illness. The participants also had stigmatized belief on social interaction with people with mental illness, likewise when it comes to marriages. Additional research should be conducted in the future to further explore the association of other variables with mental health literacy among parents to children with ASC in specific and to the Malaysian parents whose children do not have ASC because good literacy is crucial towards a good health and well-being.
Prevalence of Early Regulatory Problems in Children With Autism Spectrum Disorder (ASD)
Pek Sern Lim
1, Norazlin Kamal Nor1, Sathyabama Ramachandram2, & Yang Wai Wai1
1The National University of Malaysia, Kuala Lumpur, Malaysia
2Hospital Pulau Pinang, Malaysia
Background: Early regulatory problems (RPs) are difficulties infants have in adjusting to the environment, regulating behavior and in self-calming. Previous studies suggest RPs may represent an early risk factor for ASD. There are no published studies on the prevalence of RPs in ASD children in the local population.
Aims: To determine the prevalence and patterns of RPs in children with ASD.
Methods: In this case-control study, children aged between 30 months to six years followed-up in Child Development Centres at UKM Specialist Children’s Hospital and Hospital Pulau Pinang from 1st June 2021 to 31st January 2023 were recruited. Parents were interviewed using ALSPAC questionnaire to assess RPs. The study population were 74 ASD children and 73 typically developing (TD) children.
Results: The prevalence of RPs in ASD compared to TD children was 48.7% vs 34.3% at 6 months, 52.8% vs 34.2% at 15 – 18months, and 66.2% vs 41.1% at 24 – 30 months. ASD children had significantly more multiple RPs at 15 - 18months [RR 2.60; 95% CI (1.2-5.4)]. At 24 – 30 months, ASD children also displayed more sleeping [RR 3.2; 95% CI (1.2- 8.2)] and crying problems [RR 2.1; 95%CI (1.3-3.3)]. Multiple Linear Regression showed children with ASD had 1.27 times greater odds of having RPs.
Conclusions: ASD children have a higher prevalence rate of RPs. When parents seek help for RPs in young children, clinicians should consider neurodevelopmental conditions like ASD as a possible cause.
Associations Between Autistic Traits and Behavioral Measures of Executive Functions Amongst Two- and Three-Year-Olds With a Family History of Autism or ADHD
Alexandra Hendry
1, Emily Jones2, Mark H. Johnson3, Tony Charman4, & the BASIS STAARS team
1University of Oxford, UK
2Birkbeck University of London, UK
3University of Cambridge, UK
4Institute of Psychiatry, Psychology & Neuroscience, King’s College London, UK
Background: Executive Functions (EFs) enable us to work towards goals by co-ordinating thought and action. Autistic children often experience EF difficulties, but it is not known how early in development these difficulties emerge, due to a paucity of appropriate measures of early EF to date.
Aims: We examine whether EF-autism associations are evident at age two or three years, in a sample at elevated likelihood of showing autistic traits, using a novel battery of EF behavioral measures.
Methods: Children with a first-degree relative with autism/ADHD completed EF tasks at age two (n=125), and three years (n=123): an inhibitory control Prohibition task, a touchscreen working memory game and, at age three only, a working memory table-top task and touchscreen games measuring inhibitory control, and cognitive flexibility. Children were assessed with the Autism Diagnostic Observation Schedule, and parents completed the Quantitative Checklist for Autism in Toddlers (age 2), and the Social Responsiveness Scale (age 3).
Results: Lower inhibitory control was associated with higher autism traits on observational (rs=-.269, p=.011) and parent-report measures (rs=-.273, p=.007), at two-, but not three-years. Three-year-olds with high parent-reported autistic traits showed lower working memory table-top task performance (rs=-.337, p=.003). Similar associations were observed between parent-reported autistic traits and touchscreen measures of working memory (rs=-.230, p=.052) and cognitive flexibility (rs=-.299, p=.033), but did not survive correction for multiple comparisons.
Conclusions: Autistic traits are linked to variation in EF performance from as early as two years. EF difficulties appear first for inhibitory control but are more evident for working memory by age three.
Bridging The Communication Gap: Lexical Alignment in Online Interaction for Autistic Children Aged Six- to Eight-Years Old
Adriana Chee Jing Chieng
1, Tze Peng Wong1, Camille Wynn2, Tyson Barett3, & Stephanie Borrie3
1University of Nottingham Malaysia, Malaysia
2University of Houston, USA
3Utah State University, USA
Background: Autistic children often struggle with social communication, which can affect their language, social and emotional development. Lexical alignment, a communication phenomenon in which conversation partners become more similar in their word choices, promotes a shared understanding and conversational success. However, the occurrence of lexical alignment among autistic children aged six to eight years in naturalistic conversations is not well understood.
Aim: This ongoing study examined lexical alignment in autistic children during an online adult-child interaction. It explores predictive factors (i.e., language proficiency and familiarity with conversational partners) that may moderate the degree of alignment and the association between alignment and conversational success.
Methodology: A total of 26 autistic children interacted with both a familiar (child’s mother) and an unfamiliar conversational partner (university student) across two separate online sessions to complete a ten-minute pretend play activity. Overall, 52 conversations were recorded and transcribed. Lexical alignment scores (i.e., repeated lemmas between adjacent conversational turns) were generated using ALIGN software.
Analysis: A preliminary analysis of twelve children using Bayesian multilevel Zero-Inflated Beta regression models suggested that autistic children aligned lexically with their conversational partners within an online naturalistic conversation. However, their alignment did not appear to be moderated by the factors studied. Ongoing analysis will validate the association between lexical alignment and conversational success.
Conclusion: While these initial findings suggest that autistic children align lexically with their conversational partners, the relationship between their alignment and conversation success is yet to be addressed. This has important implications for developing interventions aimed at bridging the communication gap in autistic children.
Family History of ADHD Associates With Stronger Problem-Solving Skills Amongst Two- to Three-Year-Olds
Alexandra Hendry
1, Emily Jones2, Mark H. Johnson3, Tony Charman4, & the BASIS STAARS team
1University of Oxford, UK
2Birkbeck University of London, UK
3University of Cambridge, UK
4Institute of Psychiatry, Psychology & Neuroscience, King’s College London, UK
Background: Difficulties with inhibitory control and other executive functions (higher-order skills critical for analytic problem-solving) are common amongst individuals with autism or ADHD, and their first-degree relatives. However, adolescents/adults with ADHD show advantages in insight-based problem-solving. In a general-population sample of one-and-a-half- to four-year-olds, low inhibitory control associates with stronger problem-solving performance.
Aims: We investigate whether toddlers with a family history (FH) of ADHD or autism show differences in problem-solving.
Methods: 129 children (FH-autism-only, n=67; FH-ADHD-only, n=22; FH-Autism-&-ADHD, n=16; No-FH-autism/ADHD, n=24) completed an open-ended problem-solving task (Problem-Solving Box) at ages two and three years. Videos were coded for Success (cumulative time to retrieve three rewards, inverted), Generativity (count of goal-directed strategies attempted), Persistence (proportion of time spent on goal-directed manipulation) and Perseveration (time spent on the dominant strategy as a proportion of goal-directed manipulation). Differences in performance by FH-Autism/ADHD were tested using ANOVAs.
Results: FH-ADHD two-year-olds had higher Success scores (M=307.66, SD=235.84) and greater Generativity (M=6.12, SD=2.85) compared with No-FH-ADHD two-year-olds (M=159.49, SD=170.00; M=4.50, SD=3.09) (F(1,106)=13.813, p<.001, η2p=.115; F(1,103)=6.849, p=.010, η2p=.062). FH-ADHD three-year-olds had higher Success scores (M=453.05, SD=291.15) and lower Perseveration (M=0.40, SD=0.14) compared with No-FH-ADHD three-year-olds (M=345.53, SD=226.27; M=0.48, SD=0.17) F(1,109)=6.231,p=.010, η2p=.054; F(1,93)=6.393, p=.013, η2p=.064). No significant FH-autism or FH-ADHD/FH-autism interaction effects were found.
Conclusions: Toddlers with FH-ADHD are more-efficient problem-solvers, generating more unique strategies (aged 2) and perseverating on a single strategy for less time (aged 3) than peers with no FH of ADHD. Identifying positive attributes of heritable cognitive profiles associated with autism and ADHD will allow clinicians and researchers to better understand and support children at elevated likelihood of neurodivergence.
Conceptualizing Resilience: Narratives of Families of Individuals With Autism Spectrum Disorders in the Philippines
Karen Sacdalan
1,2
1De La Salle University Manila, PHILIPPINES
2Barcase Psychological Services and THOUGHTFULL WORLD, INC., Philippines
Background: This study is about families with a family member with Autism Spectrum Disorder (ASD), and it specifically examined the conceptualization of resilience found in the narratives of parents of individuals with ASD.
Aims: The primary focus of this research is to advance the understanding of the types of capacities these families have in the face of the difficulties of raising a family member with ASD. The crux of the narratives is the tensions, turning points, and areas of vulnerabilities felt by families during varied life stages.
Methods: Research data were gathered from ten families of various demographic background and experiences. Data were taken from narratives of parents, siblings, and children with ASD. Narrative method of inquiry was employed to obtain information, which revealed a new concept of resilience based on the contexts of the participants on disability management.
Results: It has been found that resilience is a sequential progression of the following: (1) acceptance, (2) adjustment, and (3) advocacy. This lifespan model of resilience comes in varying degrees and intermittently present throughout the developmental lifespan of the child. Six components of resilience were found: (1) faith in God, (2) ASD knowledge, (3) family solidarity, (4) self-efficacy, (5) appropriate interventions, and (6) community support. The sequence of real-life problems, painful memories, and blissful recollections are the focal points that ushered in life lessons for families of children with ASD.
Conclusions: This study underscores the impact of disability that, over time, has created a unique family perspective on parenting, lifestyles, social relationships, death, and other future life aspirations. In retrospect, the lived experiences of parents contained in the life stories revealed ways of seeing the parenting role and the child with ASD.
Development of a Social Skills Training Module for High Functioning Autism Spectrum Disorder (HFASD) Youth Using Video Modelling and Spherical Video-Based Virtual Reality (SVVR)
Mohd Akif Farhan Ahmad Basri
, Wan Salwina Wan Ismail, Norazlin Kamal Nor, Noorlaili Mohd Tohit, Farah Deena Abd Samad, Mohammad Nazir Ahmad, & Nur Saadah Mohamad Aun
Universiti Kebangsaan Malaysia, MALAYSIA
Background: Autism Spectrum Disorder (ASD) is a developmental disorder characterized by impairment in social communications skills and restricted, repetitive behavior. It is a wide spectrum of disorders ranging from low functioning individuals with low IQ and low verbal capacity, to high functioning individuals with average or high IQ. Social skill is the main deficit in HFASD, imposing specific challenges in their daily life and affecting quality of life (QoL). Since ASD has no cure, intervention in particular teaching of social skills is of paramount importance. Interventions assisted with technology such as video modelling and virtual reality in social skills training has been found to be motivating, engaging and enjoyable.
Aims: To describe the development of a social skills training module for high functioning autism spectrum disorder (HFASD) youth using video modelling and spherical video-based virtual reality (SVVR).
Methods: This study consists of two phases. In the first phase, a qualitative approach was used to analyse the needs of the module. In-depth interviews were conducted with 13 HFASD youth, seven parents and six healthcare experts on the social skills difficulties and cognitive behavior strategies that helps in socializing. This data was then analyzed using thematic analysis and triangulated with literature review. In the second phase, a focus group discussion was conducted with five experts in video development and virtual reality to explore the best practice and cost-effective technology to develop the content that was established in the previous phase.
Results: In the first phase, the themes that were prominent in social skills difficulties were non-verbal responses, initiating, and maintaining conversations and emotional difficulties. Cognitive behavioral strategies that were prominent were relaxation techniques, psychoeducation, modelling, and perspective-taking questions. In the second phase, findings suggest that the combination of video modelling and spherical video-based virtual reality (SVVR) was most suitable and cost-effective to develop the content of the module.
Conclusions: A social skills module using video modelling and SVVR is a potential tool for training social skills among HFASD youth. Future research is suggested to evaluate the feasibility, relevance, and user experience of the technology-assisted module.
Formative Evaluation of a Social Skills Training Module for High Functioning Autism Spectrum Disorder (HFASD) Youth Using Video Modelling and Spherical Video-Based Virtual Reality (SVVR)
Wan Salwina Wan Ismail
, Norazlin Kamal Nor, Noorlaili Mohd Tohit, Mohd Akif Farhan Ahmad Basri, Farah Deena Abd Samad, Mohammad Nazir Ahmad, & Nur Saadah Mohamad Aun
Universiti Kebangsaan Malaysia, MALAYSIA
Background: The use of video modelling and virtual reality in social skills training for high functioning autism spectrum disorder (HFASD) youth has been found to be motivating, engaging and enjoyable. However, the high cost and complexity in developing a digitally modeled VR environment and characters becomes a barrier for utilization. An area of resurgence in recent literature to overcome this barrier is the spherical video-based virtual reality (SVVR), which places users in a spherical video environment in which they interact with the content via head movements. The videos are created using 360-degree video to render the representation of the virtual environment, which is more cost-effective and less complex in development.
Aims: To describe the formative evaluation of a newly developed social skills training module using video modelling and spherical video-based virtual reality.
Methods: Semi-structured interviews were conducted with five experts to conduct a formative evaluation of the feasibility, relevance, and user experience.
Results: The content of the module was feasible, relevant, and easy to use. Feedbacks for improvisation includes the method of instantiating the cognitive and behavior techniques used in the content, use of autism-friendly language and highlights of key words on screen.
Conclusions: The newly developed social skills training module using video modelling and SVVR is feasible to use. For further improvement, future research is suggested to evaluate the feasibility from the perspectives of neurotypical youth and youth with HFASD.
Following the Autistic Child’s Lead: Adult-Child Word Coordination in Online Conversations
Tze Peng Wong
1, Adriana Chieng1 , Camille Wynn2, Tyson Barrett3, & Stephanie Borrie3
1University of Nottingham Malaysia, MALAYSIA
2University of Houston, USA
3Utah State University, USA
Background: Adults’ capacity to follow their child’s lead by coordinating their words with the children’s words, is integral to language and social-communication interventions. Past studies mainly focused on the facilitative effects of word coordination on language and emotional development, but not how adults’ word coordination sustain online conversations with autistic children.
Aims: This study investigates adults’ capacity to coordinate their words with autistic children’s words in online conversations using the notion of lexical alignment. Lexical alignment refers to episodes in which conversational partners converge their word use by becoming similar in their word choice.
Methods: The participants were two groups of 26 Malaysian adults who acted as the familiar conversational partner (mothers of the autistic children), and unfamiliar conversational partner (undergraduate students). Each mother and student interacted with a six-to-eight-year-old autistic child in an online semi-structured play using Malaysian English. Altogether, 52 conversations were transcribed. The ALIGN software was used to analyse the adults’ lexical alignment scores, measured as lemmas that the adults re-used from the children’s preceding turn.
Results: Preliminary Bayesian multilevel zero-inflated beta regression analyses of twelve mothers, and twelve university students, suggest the presence of lexical alignment among the adults. The adults’ degree of lexical alignment increased with the children’s language ability. Ongoing analyses involve lexical alignment predictors such as familiarity with the children, and a comparison with typically developing children.
Conclusions: The results will provide insights towards the role of lexical alignment as a word coordination scaffolding mechanism to support autistic children’s online conversations.
Synergy – A Novel Programme for Changing Perspectives in Understanding and Responding to Behaviors of Concern
Richard Mills
1 & George Bagakis2
1AT-Autism London, UK
2University of the Peloponnese, Greece
Background: In 2013, AT-Autism and the Laskaridis Foundation Piraeus Greece began a new programme of work to understand and respond to behaviors of concern in Greek schools. The outcome was Synergy, a school-based, mentor-supported training programme focusing not on child behavior but on teacher mindsets, stress, and wellbeing. The principles are rooted in applied psychology, applied sociology, learning theory, and physiology, within a clear ethical framework. This was launched in Greece in 2014 and has extended to other countries including the UK.
Aims: (1) To reduce teacher stress and school exclusions. (2) To increase in teacher efficacy and wellbeing. (3) To reduce school exclusions and improved wellbeing for students.
Methods: Teacher survey and semi- structured interviews with thematic analysis, of teachers and mentors in participant schools in the Attica region of Greece.
Results: Following participation in the programme, teachers report reduced stress, improved efficacy, and higher satisfaction. This was associated with reduction in exclusions of at-risk children. These children included those with a diagnosis of autism, refugees, and children with a range of other conditions and conduct disorders, and mental health diagnoses.
Conclusions: The two-day training Synergy programme allied to ongoing mentor support was effective in achieving the aims in respect of stated outcomes. This model is applicable to other settings and groups where behaviors of concern are a feature.
Eating Skills in Children With Autism Via Video Modeling: An Evaluation of Face and Content Validity
Nurul Khairani Ismail
1, Hasrul Hosshan1,2, Nurbieta Abd Aziz1, Abdul Halim Masnan1,2, Mohd Muslim Md Zali1, & Norsayyidatina Che Rozubi1
1Sultan Idris Education University, Tanjong Malim, Malaysia
2National Child Development Research Centre, Tanjong Malim, Malaysia
Background: Children with Autism Spectrum Disorder (ASD) may develop eating issues due to behavioral, cognitive, and environmental variables. Behavioral characteristics may influence eating habits, leading to monotony and rigidity. This observation is based on Bandura’s social learning theory, which asserts that observational learning through modelling profoundly affects children’s skill development.
Aims: This study examined the face and content validity of video modelling together with social story on eating skills in Children with ASD.
Methods: The semi-structured interview was used to assess face validity of video modelling with the social story. In contrast, the content validity index (relevancy, clarity, simplicity, and ambiguity) was employed based on input from practitioners and experts in special education, early childhood education, and educational technology.
Results: Face validity resulted in feedback on the suitability of videos for eating activities, video quality and clarity, video instructions suitability, task analysis arrangement, and “other” recommendations. On the other hand, content validity from the reading for S-CVI/Ave, relevance, clarity, simplicity, and ambiguity scores for Video 1: eating with a spoon are all 0.93. For Video 2: eating with a fork, the S-CVI/Ave scores are also 0.93 for all task analyses, whereas in Video 3: eating with hands, the relevance, simplicity, and ambiguity for S-CVI/Ave scores are 0.93, but only 0.91 for clarity.
Conclusions: To conclude, using video modelling with the social story can maximise the strengths of children with ASD, particularly when teaching eating skills but requires examining the face and content validity and refining the developed module as needed to ensure it is reasonable and practical.
Exploring Social Skills Difficulties of Youth With HFASD in Malaysia: Comparison of Perspectives From Youth, Parents, and Professionals
Farah Deena Abd Samad
, Wan Salwina Wan Ismail, Noorlaili Mohd Tohit, Mohd Tauhid, Norazlin Kamal Nor, Mohd Akif Farhan Ahmad Basri, Chong Siew Koon, & Shalisah Sharip
Universiti Kebangsaan Malaysia, Malaysia
Background: High Functioning Autism Spectrum Disorder (HFASD) refers to individuals on the other end of the spectrum who do not have intellectual disability but exhibit deficits in communication and social interaction. Understanding their perspectives of the specific social challenges is particularly important to facilitate intervention.
Aims: Using a qualitative approach, this study explored specific elements of social skills difficulties from the perspectives of HFASD individuals, parents and healthcare experts with experience in managing youth with HFASD.
Methods: We conducted in-depth interviews with 26 participants involving thirteen youths diagnosed with HFASD, seven parents with children diagnosed with HFASD and six healthcare experts in Kuala Lumpur, Malaysia. The perspective of HFASD individuals, parents and healthcare professionals were compared.
Results: HFASD youth emphasized more on difficulties in understanding non-verbal cues, language barriers and initiating conversations. Their levels of motivation varied from low to high across individuals. Parents focused more on the rigidity of their topics of interest in communication, insecurities and lack of self-awareness. Healthcare experts emphasized on the deficiencies in perspective-taking and understanding pragmatics. All HFASD, parents and healthcare experts highlighted that high social anxiety was a significant barrier in socializing.
Conclusions: Understanding social skills challenges of youth with HFASD from their own perspectives, the views of parents and healthcare experts, may facilitate social skills intervention among youth with HFASD.
The Use of Category Cluster Recall Technique and its Effect on Eyewitness Accuracy and Confidence in Children With ADHD
Loheswary Arumugam
& Shamsul Haque
Monash University, MALAYSIA
Background: Children with Attention Deficit Hyperactivity Disorder (ADHD) were known to have short attention spans which may impact their functioning.
Aims: The objective of this research was to investigate the accuracy of eyewitness testimony in children with Attention Deficit Hyperactivity Disorder (ADHD).
Methods: Participants aged between nine and 17 years old were recruited from school around Klang Valley and via online. Three experiments were carried out where the children were shown a video clip on an Asian man (the perpetrator) walking and snatching handbag of a lady who is walking on the street. Viewer had a view of the perpetrator. The video lasted for 22 seconds, after which their memories for the incident presented in the clip was tested.
Results: Twenty-six children showed a relationship between the interviewing techniques used on participants and participants’ recall accuracy, indicating that the Category Cluster Recall technique used on children with ADHD was more likely to have better recall accuracy than Free Recall technique when identifying suspects. No interaction effects both the interviewing techniques used and the presence of target on the confidence level of participants when identifying suspects.
Conclusions: This result contributes to our legal system on how children with ADHD can be reliable eyewitnesses and how we can improve the interrogation technique during an investigation.
