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

Hsu, Yuu-Hueih; Chen, Chi-Wen; Lin, Yuh-Jyh; Li, Chung‐Yi

doi:10.1007/s10803-022-05453-x

Cited by 10 publications

(6 citation statements)

References 54 publications

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“…Like the trends reported in other countries, Gau et al [31] also noticed that there was a growing awareness of early indicators of ASD in Taiwan. However, children with ASD in Taiwan, on average, receive their diagnoses around the age of 4.5 years, along with a relatively lower prevalence when compared to Western countries [32]. It is believed that these circumstances are mainly caused by the shortage of appropriate ASD-specific screening tools for young children.…”

Section: Discussionmentioning

confidence: 99%

“…The findings of this study revealed that these two screening tools demonstrated similar efficacy in detecting ASD among toddlers from a rural area in Taiwan. However, this study has some limitations: First, given the discrepancies in the prevalence of ASD between urban and rural areas [32,36], it is necessary to further examine the accuracy of the CBS and M-CHAT in detecting ASD in urban areas. Secondly, the ASD screening in this study relied solely on the information gathered from parent-report questionnaires and did not incorporate follow-up interviews, which are beneficial assessment methods.…”

Section: Limitationsmentioning

confidence: 99%

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Comparison between the Clancy Behavior Scale and the Modified Checklist for Autism in Toddlers in Taiwan

Chu,

Su,

Iao

et al. 2024

Children

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(1) Background: Precise diagnosis and early intervention are crucial for toddlers with autism spectrum disorder (ASD) to achieve a better prognosis. This study investigated the efficacy of the Clancy Behavior Scale (CBS) and Modified Checklist for Autism in Toddlers (M-CHAT) in detecting ASD among toddlers under 30 months of age. (2) Methods: A total of 215 toddlers (117 with ASD and 98 with development delays) aged between 18 and 29 months participated in this study. All the primary caregivers of these toddlers were recruited to complete the CBS and M-CHAT. (3) Results: The findings indicated that the accuracy of the CBS and M-CHAT was promising, and the short forms of these two instruments performed better than their full versions. The CBS:9 critical items presented a sensitivity of 0.75 and a specificity of 0.74, while the M-CHAT:14 brief items showed a sensitivity of 0.72 and a specificity of 0.85. (4) Conclusions: The diagnostic accuracy of high-risk ASD toddlers improved via the combination of CBS and M-CHAT, particularly when the information gathered from these two instruments were consistent. The findings may provide implications for enhancing the early detection of ASD.

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Comparison between the Clancy Behavior Scale and the Modified Checklist for Autism in Toddlers in Taiwan

Chu,

Su,

Iao

et al. 2024

Children

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“…The comparability between the invited group and control group 2 was hampered not only by the fact that control group 2 included rural areas and does not have the same access to care as the groups in the capital area, but also because of a difference in educational levels. Several studies have found that the higher the prevalence of ASD, the greater the level of urbanicity [34][35][36][37] , and that a higher educational level of parents is associated with ASD 34 . We did not collect data on parental education.…”

Section: Discussionmentioning

confidence: 99%

Evaluating screening for autism spectrum disorder using cluster randomization

Jonsdottir,

Saemundsen,

Thorarinsdottir

et al. 2024

Sci Rep

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We evaluated the rate of autism spectrum disorder (ASD) in a group invited to a screening program compared to the rates in two groups who received usual care. The population eligible for screening was all children in Iceland registered for their 30-month well-child visits at primary healthcare centers (PHCs) from March 1, 2016, to October 31, 2017 (N = 7173). The PHCs in the capital area of Reykjavik were the units of cluster randomization. Nine PHCs were selected for intervention (invited group), while eight PHCs received usual care (control group 1). PHCs outside the capital area were without randomization (control group 2). An interdisciplinary team, including a pediatrician contributing with physical and neurological examination, a psychologist evaluating autism symptoms using a diagnostic instrument, and a social worker interviewing the parents, reached a consensus on the clinical diagnosis of ASD according to the ICD-10 diagnostic system. Children in the population were followed up for at least two years and 119 cases were identified. The overall cumulative incidence of ASD was 1.66 (95% confidence interval (CI): 1.37, 1.99). In the invited group the incidence rate was 2.13 (95% CI: 1.60, 2.78); in control group 1, the rate was 1.83 (95% CI: 1.31, 2.50); and in control group 2, the rate was 1.02 (95% CI: 0.66, 1.50). Although the rate of ASD was higher in the invited group than in the control groups, the wide confidence intervals prevented us from concluding definitively that the screening detected ASD more readily than usual care.

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“…Caregivers were recruited via special schools or centers and parent associations, which means that we did not reach caregivers without access to these settings. Since the chances of getting a diagnosis are much lower in rural than in urban areas ( Hsu et al, 2022 ; Lauritsen et al, 2014 ), the reported unmet needs are likely to be an underestimation. The actual percentage of autistic children not enrolled in school may be higher than in the present sample.…”

Section: Discussionmentioning

confidence: 99%

Urban and rural differences in needs, service use and satisfaction among caregivers of autistic children in Morocco

Jonge

Boutjdir

Korchi

et al. 2023

Autism

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Understanding caregivers’ needs is crucial for service planning and empowering caregivers around the world. Although research on autism from Arab countries is emerging, many countries are still unrepresented. Moreover, within-country disparities are understudied. This study investigated differences in needs, service use, and satisfaction between urban or rural living caregivers of autistic children in Morocco. The “Andersen Behavioral Model of Health Services Use” served as a conceptual framework to investigate factors associated with receiving intervention and service satisfaction. Results from a survey among 131 Moroccan caregivers of autistic children revealed similarities and differences in urban and rural living caregivers’ challenges and needs. Children from urban communities had 12 times higher odds of receiving intervention despite similar age and verbal ability. Significantly, fewer children from rural communities attended school as compared with urban communities. Limited autonomy skills in children were more challenging to rural caregivers, while limited social-communicational skills were more challenging to urban caregivers. These differences may inform healthcare policy-makers and program developers. Adaptive interventions are important to reflect regional needs, resources, and practices. Addressing enabling factors such as costs, information barriers, or stigma may help reduce both global and within-country disparities in autism care. Lay Abstract It is very important to understand the needs of caregivers to be able to empower caregivers and to develop or improve services around the world. Therefore, research in different regions is needed to understand differences in caregivers needs between countries, but also between areas within countries. This study investigated differences in needs and service use between caregivers of autistic children in Morocco, living in urban and rural areas. A total of 131 Moroccan caregivers of autistic children took part in the study and responded to an interview survey. The results showed both similarities and differences between urban and rural living caregivers’ challenges and needs. Autistic children from urban communities were much more likely to receive intervention and attend school than children from rural communities, even though age and verbal skills of the two groups of children were comparable. Caregivers expressed similar needs for improved care and education, but different challenges in caring. Limited autonomy skills in children were more challenging to rural caregivers, while limited social-communicational skills were more challenging to urban caregivers. These differences may inform healthcare policy-makers and program developers. Adaptive interventions are important to respond to regional needs, resources, and practices. In addition, the results showed the importance of addressing challenges as experienced by caregivers such as costs related to care, barriers in access to information, or stigma. Addressing these issues may help reduce both global and within-country differences in autism care.

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

Cited by 10 publications

References 54 publications

Comparison between the Clancy Behavior Scale and the Modified Checklist for Autism in Toddlers in Taiwan

Comparison between the Clancy Behavior Scale and the Modified Checklist for Autism in Toddlers in Taiwan

Evaluating screening for autism spectrum disorder using cluster randomization

Urban and rural differences in needs, service use and satisfaction among caregivers of autistic children in Morocco

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