1. McGill O, Robinson A. “Recalling hidden harms”: autistic experiences of childhood applied behavioural analysis (ABA). Advances in Autism;2021;7(4):269-282.

Purpose This paper aims to investigate the long-term impacts autistic adults experienced from childhood participation in the applied behavioural analysis (ABA). Design/methodology/approach Possible participants were recruited through advertisements on social media and autism and ABA organisations. Possible participants were given the choice between an online or face-to-face interview or an anonymised online questionnaire. Findings Reflections from 10 participants were indicative of a predominantly detrimental impact of ABA. Reflections gave rise to a core theme “recalling hidden harms of childhood experiences of ABA”. Outcomes are discussed in relation to the impact on autistic identity, current research and progressing understanding of the impacts of early intervention from the autistic perspective. Research limitations/implications The practical implications of ABA are discussed alongside recommendations for future practice and research with the involvement of autistic individuals within interventive processes. Originality/value This is the first paper to take an in-depth, qualitative approach to autistic experiences of ABA. The findings themselves are driven to conceptualise and give voice to the core impacts which carried through participants’ exploration and understanding of self.

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2. McNamara S, Bittner M, Healy S. Online training for physical activity practitioners on evidence-based practices for clients with autism. Advances in Autism;2021;7(4):283-293.

Purpose Physical activity professionals often lack the experience and knowledge to implement the pedagogical and behavioral strategies required to successfully work with people with autism spectrum disorder (ASD). To enable individuals with ASD to achieve the benefits of exercise, physical activity professionals must be knowledgeable and skilled in relation to delivering evidence-based practices (EBP). The recent worldwide coronavirus disease pandemic highlights the value and necessity of effective online learning. Recent research has suggested that online settings are a viable setting for professional learning. Therefore, the purpose of this paper is to assess an online course’s impact on physical activity professionals’ frequency of use and self-efficacy toward using EBPs with individuals with ASD. Design/methodology/approach The online program was developed to provide training for a wide-range of professionals interested in working with people with ASD. A survey was administered to participants prior to and after completion of the online course to collect data on sample demographics, and the participants’ perceived frequency and self‐efficacy in using EBPs. Eighty-six physical activity professionals participated in the study. Findings Overall, their self-efficacy toward EBPs and frequency at which participants reported to use EBPs increased significantly from pretest to posttest (p < 0.05). The participants also reported using three of the nine covered EBPs more frequently at post-course completion. In addition, participants’ self-efficacy toward eight of the EBPs was significantly higher post-intervention. Originality/value Findings from this study suggests that a well-structured online intervention has promise for preparing physical activity professionals to work with people with ASD.

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3. Shamsudin ID, Brown T, Yu M-L, Lentin P. Parents of children with autism spectrum disorder’s perception on parent-implemented home-based developmental, individual-difference and relationship (DIR)/Floortime intervention. Advances in Autism;2021;7(4):294-310.

Purpose The developmental, individual-difference and relationship (DIR)/Floortime® approach is a commonly used parent-implemented intervention with children with autism spectrum disorder (ASD). Currently, no evidence is available about the intervention’s implementation and utility in Malaysia. The aim of this paper is to investigate the applicability and impact of implementing the parent-implemented home-based DIR/Floortime® intervention program for children with ASD and their parents in a Malaysian context from parents’ perspectives. Design/methodology/approach A qualitative study using semi-structured interviews with eight mothers and four fathers of children with ASD was conducted. The interviews were analysed using qualitative content analysis. Findings Five themes were developed. Theme 1 described the implementation of DIR/Floortime® intervention; Theme 2 reported challenges parents faced when implementing the intervention; Theme 3 explored parents’ perspective on play; Theme 4 explained the improvements and changes in children with ASD and parents’ abilities and skills; and Theme 5 reported parents’ comments and suggestions about the intervention program. Research limitations/implications Involvement of a limited number of participants and an absence of baseline data limits the interpretation of the impacts of the DIR/Floortime® program’s implementation by parents with their children with ASD. Originality/value Utilization of DIR/Floortime® intervention is practical and appropriate in the Malaysian context. From the parents’ perspective, the DIR/Floortime® approach was beneficial for children with ASD and parents’ skill development and well-being. Further refinement to the program and involvement of participants from various cultural backgrounds are recommended. A greater emphasis for parents on child-led interaction style and play with children are also recommended.

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4. Davidson CJ, Lodge K, Kam A. The impact of the COVID-19 pandemic on autistic adults – a survey. Advances in Autism;2021;7(4):311-321.

Purpose To date there has been limited research on the impact of the COVID-19 pandemic on autistic people. This study aims to present the results of a survey of autistic people (n = 51) conducted by a UK specialist autism team. Design/methodology/approach A cross-sectional online survey. Findings A total of 72% respondents reported either some or significant deterioration in mental health during the pandemic. The issues that caused most negative impact were uncertainty over what will happen next and disruption of normal routine. Respondents reported a variety of coping strategies to help them through the pandemic. Originality/value To date there has been little research looking specifically at the impact of the COVID-19 pandemic on autistic people. This paper adds weight to the evidence that the pandemic has had a particularly severe impact on autistic adults and includes useful information on potential coping strategies for this population.

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5. McConkey R, Cassin M-T, McNaughton R, Armstrong E. Enhancing the social networks of adults with ASD: a low level community intervention. Advances in Autism;2021;7(4):322-334.

Purpose This paper aims to design and evaluate an innovative community-based service for adults with autism in a rural region of Northern Ireland. The goal was to reduce their social isolation through gaining social skills and building social networks. Design/methodology/approach Over three years, 54 persons with a median age of 21 years received 12 months of one-to-one, personalised support and opportunities to participate in peer groups and social activities which are detailed in the paper. Quantitative and qualitative information about the impact of the service was obtained from its users, their relatives, as well as service personnel. Findings Service users rated themselves to have changed in more ways than did their relatives and staff although there was a consensus that the changes were most marked in terms of spending more time out of the house, engaging in more community activities, being more independent and increased confidence. The main benefits they perceived from participation in the project were socialising, new experiences and learning new things. Research limitations/implications As with many service projects, a longer term follow-up of service users was not possible due to resource constraints. Practical implications The service could be replicated with suitable staff although current constraints on social care budgets have limited its expansion to more users and extension to other areas in Northern Ireland. Social implications Reducing the social isolation of adult persons with autism spectrum disorders needs to be personalised to the person, their living circumstances and the community in which they live. Family carers also stand to gain from community support services. Originality/value This low level, low cost service was implemented in a predominantly rural area with a majority of users from socially deprived areas.

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6. El-Monshed AH, Amr M. Perceived stress among mothers of children with autism spectrum disorder in Egypt. Advances in Autism;2021;7(4):335-344.

Purpose Children diagnosed with autism spectrum disorder (ASD) and their families especially their mothers face numerous and pervasive challenges. Difficulties to access quality care, financial burden, issues of adulthood and their child’s behaviors may produce significant stressors to mothers. This study aims to assess perceived stress among mothers of children with ASD in Egypt. Design/methodology/approach A cross-sectional study was conducted in Mansoura University Hospital, Egypt on 94 mothers of children with ASD using a structured questionnaire of the socio-demographic and clinical features of the studied mothers and their children and the perceived stress scale (PSS). Findings The mean total PSS score of mothers was 31.97 ± 12.39 and the level of autism had a statistically significant relation with stress perceived by the studied mothers. Research limitations/implications The findings in this study were based on caregivers’ self-reporting. As such, inaccurate reporting might have biased the findings. The main limitations of this study include non-participation and dropout. During data collection, some mothers declined to participate in the study. Also, the current study was conducted in one hospital. This represents a loss of valuable information and may weaken the generalizability of the current study findings. Another limitation is the use of a convenience sample in the study. With the use of convenience sampling, there is an increased risk of bias, as study participants may not accurately reflect the characteristics of the total population. Practical implications Caregivers’ education programs through media and press should be developed for mothers of children with ASD to help those who experience levels of stress by presenting knowledge about ASD and treatment and training on adaptive coping methods and teaching communication and problem-solving. Recognizing levels of stress and parent counseling may be a useful strategy. Regular periodic meetings should be conducted between mothers and hospital personnel to promote proper communication. One key policy implication, this paper can derive from this study is the need for cooperation between the Ministry of Health, social welfare and other relevant governmental and non-governmental organizations to provide support for families of individuals with ASD such as financial aids. It is also recommended that future study would benefit a larger sample to enhance external validity. As well, future qualitative research is recommended to more fully understand the lived experience of mothers of children with ASD. Originality/value This study provides evidence that mothers of children with ASD experienced high perceived stress. Caregivers’ education programs through media and press should be developed in Egypt for mothers of children with ASD.

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