Implementing a Mental Health Care Program and Home-Based Training for Mothers of Children With Autism Spectrum Disorder in an Urban Population in Bangladesh: Protocol for a Feasibility Assessment Study

Abstract

BackgroundMothers of children with autism spectrum disorder (ASD) have reported a higher level of depression than mothers of children with other neurodevelopmental disorders in both developed and developing countries. Mothers are the lifetime caregivers of children with ASD, and a high burden of depression can negatively impact their ability to provide care. However, access to mental health services in primary care is limited, given the scarcity of qualified providers in Bangladesh.ObjectiveWe aim to pilot the feasibility of integrating mental health services for the mothers of children with ASD attending schools offering ASD care and improve skills of mothers for child care through a home-based training program.MethodsThe study will be conducted in two selected schools in Dhaka in Bangladesh that have been offering services for ASD for more than 10 years. A female psychologist will be deployed at the schools to offer nonpharmacological services for all mothers having a depressive episode. Referral for pharmacological treatment will be made at the discretion of supervising psychiatrists. An ASD special educator will provide training to the mothers for enhancing their child care skills at home on a monthly basis. The proposed intervention package will be implemented over a period of 4-6 months, and the feasibility of the intervention will be assessed through a pre- and postintervention evaluation by obtaining the perspectives of various stakeholders involved in the implementation of mental health services and maternal training. The primary outcome will include assessment of acceptability, adaptability, demand, practicality, implementation, and integration of the package intervention in the school settings. The secondary outcomes will include assessment of: 1) the prevalence of maternal depression; 2) children’s behavioral, social, and communication skills; and 3) the intervention participation costs incurred by institutions and families.ResultsBetween February and March 2017, 188 mothers of children with ASD were screened for depression following a written informed consent. Based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), the Structured Clinical Interview for the DSM-IV (SCID-1) was administered to 66 mothers. In-depth interviews were conducted with 10 mothers and 8 various stakeholders. Between January-June 2017, the team finalized a draft psychosocial counseling module and a maternal training module. Between April-May 2017, mental health services were provided by psychologists to 41 mothers who attended the counseling centers at each school. Three special educators have been trained in June 2017 to initiate training of the participating mothers.ConclusionsThis is the first study of a mental health intervention for mothers of children with ASD to reduce their burden of depression and improve the outcomes of their children. The findings will inform the provision of services for children with ASD and their mothers in Bangladesh and similar settings.

Burden of major depressive disorder and quality of life among mothers of children with autism spectrum disorder in urban bangladesh

“…The national survey of ASD in Bangladesh conducted in 2013 reported the prevalence of ASD to be 15.5 per 10,000 children, with a higher prevalence of ASD in urban (300 per 10,000 children) than rural areas (6.8 per 10,000 children) [NCDC, RCHCIB, BMRC, 2013]. Recently, one study conducted in a rural subdistrict in Bangladesh reported that the prevalence of ASD was 7.5 per 10,000 children, indicating the prevalence of ASD may be increasing in Bangladesh than previously reported [Akhter et al, 2018].…”

“…The awareness of ASD is not widespread and the contemporary conceptions of ASD as practiced among few providers in urban areas are severely restricted. The prevalence of recognized and treated ASD is therefore likely to remain low with poor levels of awareness, diagnosis, and services [NCDC, RCHCIB, BMRC, 2013].…”

“…The current programs for children with ASD in Bangladesh are highly childcare-centric. There are no services supporting and enabling the mental and physical health of mothers [-Bangladesh, 2014;Naheed et al, 2017]. Developing a feasible program for the mothers of children with ASD to support their mental and physical health needs has a great potential to optimize family functioning [Feinberg, Silverstein, & Ferreira-Cesar, 2013;Wongkittirungrueang, 2016].…”

An mCARE study on patterns of risk and resilience for children with ASD in Bangladesh

“…Though several works 45 , 46 in this relevant area to determine the mental health of the children with ASD in Bangladesh, in this study, we specifically identify the behavioral changes of the children with ASD in Bangladesh during the COVID-19 lockdown period. Compared to other studies, in this work, we have deployed our developed mCARE: APP and mCARE: SMS tools among our cohort.…”

Feasibility of a school-based mental health program implementation to improve the status of depression and quality of life of mothers of children with autism spectrum disorders in urban Bangladesh: MENTHOL study

“…For the neurodevelopmental group overall, the global burden of depression is highest among mothers of children with autism spectrum disorders (ASD) (Weitlauf et al, 2014). A recent study from Bangladesh demonstrated that about 50% of mothers of children with ASD experienced major depressive disorder (MDD), and half of the mothers with MDD presented with a concurrent major depressive episode (MDE) (Naheed et al, 2020).…”