Experiences of accumulated stress among aging parent caregivers of adults with autism spectrum disorder

With the continuing increased incidence rate of autism spectrum disorder over the decades, there are increasing numbers of adults with autism who require varying levels of lifelong care, typically from parents. It is necessary to understand parents' lived experience of lifelong caregiving, and how their own aging process further impacts life quality. Furthermore, greater understanding of stressors, resources, appraisals, and coping among parent caregivers of children with "high functioning autism" who are transitioning into young adulthood is particularly necessary as services, needs, and experiences for both are nuanced due to functional status, deficits in the service system, and demographic disparities. Given lifespan aspects past research has not addressed, the study focused on development of a measure of parent accumulated stressors, and on interrelations of stressors, perceived social support, future time perspective, burden, satisfaction, and coping on health-related quality of life and meaning in life among 28 parents of young adults with autism. Although proposed quantitative analyses were not completed due to sample size, qualitative analyses on parent experiences and stressors revealed common themes of concern for child's future quality of life, complicated dynamics of providing help to their child overtime, and increased stress related to others' lack of understanding of their child. In total, 10 themes and multiple subthemes were identified in relation to aspects of accumulated stressors. Findings suggest parent stress with this specific population is complex, manifesting in nuanced ways at different life stages. Impacts of the COVID-19 pandemic are also explored, and implications for scientific advancement and clinical services are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Online Availability of a Robot Therapy for Children with Autism

In this paper we will present a case in which a robot therapy for children with autism was transferred from clinic to home conditions. The developed application enables the children to continue with the interventions in home conditions. This proved especially important in the COVID-19 pandemic. The application also allows monitoring of the child's activities, through which the therapist can later analyze the patient's behavior and offer appropriate therapy. The application shows reliable results and gives promise to develop beyond the user case we are considering. © 2023 IEEE.

The challenges of screen time in children with typical development and children with developmental disorders during COVID-19 pandemic.

Background: The significant lifestyle changes that occurred during the lockdown period associated with the COVID-19 pandemic may have had many potential adverse effects on children, in particular, sedentary screen exposure among children, including those with developmental disorders. We conducted a cross-sectional study to investigate and compare the screen time and outdoor activity time of children with typically development (TD) and those with developmental disorders during and before the emergence of COVID-19, and identified the risk factors related to screen time during the COVID-19 pandemic. Methods: A total of 496 children were surveyed via online questionnaires. Parents or/and children filled in the online questionnaire, including basic characteristics, screen time, outdoor activity time, and other related factors. The Statistical Product and Service Solutions software was used to analyze all data. Results: Children spent less time outdoors (t=14.774, P<0.001) and more time on electronic screens (t=-14.069, P<0.001) during the lockdown period of COVID-19, compared to the periods before COVID-19. Age (P=0.037), pre-COVID-19 screen time (P=0.005), screen time used for learning/education (P<0.001), screen time of siblings (P=0.007), and use of screen devices as electronic babysitters (P=0.005) were risk factors for screen time during the COVID-19 pandemic, while restrictive use of electronic devices by parents (P<0.05) was a protective factor. The screen time of children with autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD) was significantly longer than children with TD before COVID-19 pandemic, but there is no statistical difference during the COVID-19 pandemic. Conclusions: During the COVID-19 pandemic, children's screen exposure time increased, and outdoor activities decreased significantly. This represents a significant challenge, and we should focus our efforts on managing children's screen time and promoting healthier lifestyles, including children with typical development, as well as those with developmental disorders.

Neurodegenerative and Neurodevelopmental Diseases and the Gut-Brain Axis: The Potential of Therapeutic Targeting of the Microbiome.

The human gut microbiome contains the largest number of bacteria in the body and has the potential to greatly influence metabolism, not only locally but also systemically. There is an established link between a healthy, balanced, and diverse microbiome and overall health. When the gut microbiome becomes unbalanced (dysbiosis) through dietary changes, medication use, lifestyle choices, environmental factors, and ageing, this has a profound effect on our health and is linked to many diseases, including lifestyle diseases, metabolic diseases, inflammatory diseases, and neurological diseases. While this link in humans is largely an association of dysbiosis with disease, in animal models, a causative link can be demonstrated. The link between the gut and the brain is particularly important in maintaining brain health, with a strong association between dysbiosis in the gut and neurodegenerative and neurodevelopmental diseases. This link suggests not only that the gut microbiota composition can be used to make an early diagnosis of neurodegenerative and neurodevelopmental diseases but also that modifying the gut microbiome to influence the microbiome-gut-brain axis might present a therapeutic target for diseases that have proved intractable, with the aim of altering the trajectory of neurodegenerative and neurodevelopmental diseases such as Alzheimer's disease, Parkinson's disease, multiple sclerosis, autism spectrum disorder, and attention-deficit hyperactivity disorder, among others. There is also a microbiome-gut-brain link to other potentially reversible neurological diseases, such as migraine, post-operative cognitive dysfunction, and long COVID, which might be considered models of therapy for neurodegenerative disease. The role of traditional methods in altering the microbiome, as well as newer, more novel treatments such as faecal microbiome transplants and photobiomodulation, are discussed.

Remote autism assessments - lessons learned from the Covid-19 pandemic: a service evaluation

PurposeThe COVID-19 pandemic has resulted in health services adapting the delivery of routine assessments, with many operating remotely. This paper aims to explore the lived experiences of individuals undertaking remote autism assessments during the COVID-19 pandemic. Design/methodology/approachA mixed-methods service evaluation was completed in an adult autism and neurodevelopmental service based in the north of England. A total of 24 participants, who had undergone remote autism assessments between March 2020 and July 2020, completed a questionnaire about their experiences. Thematic analysis was performed, and additional quantitative data were analysed descriptively to allow contextual information to be included. FindingsThe evaluation identified three main themes. The first, practical and sensory issues of remote assessment, indicated that internet connectivity problems were common and sometimes impeded a successful assessment. Additionally, participants identified some elements of the videocall impacted their sensory sensitivities. The second theme, emotional responses to remote assessment, demonstrated relief and exhaustion to be common following sessions. The ability to complete assessments from a safe space were favoured by most. The final theme, pros and cons of different assessment methods, highlighted the preference for video assessments above telephone and in person sessions. Originality/valueThis study provides an original contribution to the literature by gathering autistic adults' perspectives on remote autism assessments. The findings suggest that video assessments were the most preferable, over face-to-face and then telephone. Services should offer video and face-to-face assessments while keeping telephone assessments to a minimum.

Limited face-to-face learning on students in inclusive classrooms during the Covid-19 pandemic: Perceptions of elementary school teachers in Indonesia

Implementing limited face-to-face learning (LF2FL) during the COVID-19 pandemic has impacted students in inclusive classrooms. Some of the adjustments teachers and students faced were obstacles and challenges that took time to make. The teacher must comply online learning experience conducted with all its shortcomings during the implementation of LF2FL and its impacts on students, including students with disability. We conducted a study to explore teachers' perceptions of the impact of implementing LF2FL on students in inclusive classrooms in elementary schools. This research used a case study to obtain and examine data in a context that the phenomena will accept in depth. We involved 16 elementary school teachers, conducted semi-structured interviews, and analysed the data using thematic analysis. The results showed two main themes, namely learning outcomes and instructional processes, which emerged for students without disabilities and students with disability. For the learning outcomes, teachers highlighted sub-themes of the cognitive and affective aspects most. The instructional process sub-theme of the interaction was one of the essential aspects of minimising learning loss during online learning from home. Our finding detail in more depth the two types of students, both in terms of similarities and differences of LF2FL on students in inclusive classrooms that contributes to the reconfirmation of knowledge for all students, reduces students' mental stress, and increases student motivation through direct interaction between teachers and students. It is necessary to increase transformational competence in the education system for teachers, especially in the inclusive education system. The government needs to modify the curriculum to be more flexible and adaptive for all students in inclusive elementary schools who can keep up with the changes in education in Indonesia.

A Comparison of Telehealth-Based Instruction with or without Instructive Feedback.

Language delays are commonly displayed by children on the autism spectrum. To help facilitate the development of verbal behavior, practitioners often implement intensive one-on-one, face-to-face instruction. However, the COVID-19 pandemic hindered typical face-to-face service delivery and caused practitioners to assess alternative approaches to facilitate clients' continued progress. Instructive feedback (IF) is one teaching strategy to enhance instruction or make it more efficient. During this teaching procedure, instructors provide formal teaching of target responses and embed demonstrations of secondary target responses within sequences of instruction. In the current study, we investigated the efficacy of IF provided within telehealth instruction. Four participants on the autism spectrum participated in the study. Participants received two forms of telehealth instruction that targeted speaker-responding. The first form consisted of discrete trial instruction (DTI), and the second form combined DTI with IF. These results indicate that both forms of instruction improved speaker-responding of primary targets for all participants. Additionally, a secondary analysis of secondary targets indicated that two of the four participants acquired some secondary targets. These results suggest that including IF within DTI might be beneficial for some participants receiving DTI via telehealth.

Investigating the effects of COVID-19 lockdown on Italian children and adolescents with and without neurodevelopmental disorders: a cross-sectional study.

We conducted a cross-sectional study to compare the impact of social distancing and lifestyle changes that occurred during Corona Virus Disease 2019 (COVID-19) lockdown on children and adolescents with and without Neurodevelopmental Disorders (NDDs). An online questionnaire was administered in order to investigate the effects of NDD condition, socio-demographic status, familiar/home environment and COVID-19 exposure on their lives during a two months period of social isolation. We used logistic regression, focusing on five endpoints (remote learning, lifestyle, stress/anxiety, sociality, scolding) to define the extent of these effects. Most questions were paired up to parents and children, to verify the occurrence of agreement. 8305 questionnaires were analyzed, 1362 of which completed by NDDs and 6943 by controls. Results showed that the presence of a NDD, compared to controls, had a significant impact on: Remote Learning (i.e. subjects with NDDs experienced more difficulties in attending online classes and studying), Sociality (i.e. subjects with NDDs missed their schoolmates less), Scolding (i.e. subjects with NDDs were scolded more often) and Anxiety (i.e. subjects with NDDs were perceived by their parents as more anxious). Substantial agreement between parents and children arose from questions concerning Remote learning, Lifestyle and Scolding. The current study actually points out that having a NDD gives account for a stronger influence on school performance and on behavioral and psychological aspects, during a two months lockdown. Such results may provide useful information to governments and school authorities on how carrying through supportive strategies for youth affected by NDDs. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12144-021-02321-2.

Children with Autism Spectrum Disorder in Times of COVID-19: Examining Emotional and Behavioral Problems, Parental Well-Being, and Resilience.

This longitudinal study assessed the impact of the COVID-19 pandemic on children with autism spectrum disorder (ASD; n = 62; Mage = 13 years) by measuring emotional and behavioral problems before and during the pandemic, and by comparing this change to a matched sample of children without ASD (n = 213; Mage = 16 years). Moreover, we examined whether indicators of parental well-being promoted resilience of children with ASD. Results showed that the mean change in problems did not differ between children with and without ASD. Importantly, some children showed an increase in problems, while others showed resilience. Parental well-being indicators were not related to resilience among children with ASD. The interindividual variability in responses, particularly among children with ASD, highlights the need for personalized support.

Serving Individuals With Autism Spectrum Disorder in the Age of COVID-19: Special Considerations for Rural Families

This position paper explores the needs of rural families of children, adolescents, and adults with autism spectrum disorder (ASD) during the age of COVID-19. Prior to COVID-19, literature portrays elevated stress in families of individuals with ASD and health and socioeconomic disparities for rural and underserved populations. These disparities were exacerbated due to COVID-19 and subsequent lockdowns and economic turmoil. Academic and adaptive skills training were particularly impacted due to school closures, with parents tasked with taking some responsibility for training these skills. Our goals for this article focus on special considerations for rural families regarding (a) neurobiological and developmental impacts of stressful experiences like COVID-19, (b) delineation of the impacts on individuals with ASD and other comorbid and related conditions, and (c) education and intervention needs during these times. Finally, we offer suggestions for future care during pandemic events, including recommendations for improving service delivery under such conditions. [ FROM AUTHOR] Copyright of Rural Special Education Quarterly is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

The spectrum of the journey: Narrating identities during professional learning in pivotal response treatment for novice elementary teachers of students with autism spectrum disorder

In Ontario, Policy/Program Memoranda No. 140 (PPM 140) authorizes educators to utilize Applied Behavioural Analysis methods to support students with Autism Spectrum Disorder (ASD) in the classroom. Although typically favoured, inclusive policies are difficult to translate into practice without training (Lindsay et al., 2013). Novice educators (i.e., first five years of their career) are at the cusp of developing a teacher identity as they are shifting roles from that of a teacher candidate to what it means to be a professional teacher.Symbolic interactionism (SI) is one theory deemed useful for narrating and investigating identity. According to Blumer (1986), SI is a theory which investigates how individuals develop subjective meanings and how those meanings are reformed during an interpretive process producing different behavioural responses. Within the teaching profession, physical objects refer to space or material. Social objects refer to the interactions with individuals. objects are beliefs about professional development (PD) and identity (Blumer, 1986).Current studies do not address how teachers with larger classes may implement evidence-based practices, such as Pivotal Response Treatment (PRT). Even when general education teachers do receive training in PRT, an investigation into identity is missing. This doctoral dissertation investigates how a professional learning in PRT in Ontario may influence novice (i.e., first five years of their career) elementary educators' (i.e., JK-Grade three) identity as a teacher from a qualitative (i.e., narrative inquiry) design. Results from interviews, journals, and focus groups revealed themes. Physical objects included (1) accessibility to tangible resources and in-class trainings, (2) motivation/accountability, (3) barrier of time, (4) barrier of COVID-19, (5) barrier of staffing, and (6) barrier of size/needs of a classroom. Analyzing social objects revealed (7) student relationship building, (8) classroom staff communication, (9) low parental communication, and (10) distance support from administrators. Conversations around identity detailed how (11) early educational experiences and (12) previous characteristics associated with a teacher impacted a present (13) definition of teacher identity as the philosophy of teaching. This exposed themes such as (14) advocating for accommodations, (15) life-long learner, (16) self-reflective, (17) connection between personal/social self, and (18) a generalist role. (19) Micro-level solutions such as obtaining more strategies for themselves, and (20) macro-level solutions such as dedicating more time within teacher education programs and in-person training were also discoursed.Physical and social objects had a direct impact on objects. The first premise of symbolic interactionism, meaning, delved deep into how novice educators acted towards objects based on the meanings assigned to them throughout the study. Through social interactions (i.e., premise two - language) with myself as the researcher, the research study, the other participants, and stakeholders in their school climate, an investigation into the interpretation process (i.e., premise three - thought) revealed the above themes. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Parent Coaching in Early Intervention for Autism Spectrum Disorder: A Brief Report

Coaching caregivers of young children on the autism spectrum is a critical component of parent-mediated interventions. Little information is available about how providers implement parent coaching for children on the autism spectrum in publicly funded early intervention systems. This study evaluated providers' use of parent coaching in an early intervention system. Twenty-five early intervention sessions were coded for fidelity to established caregiver coaching techniques. We found low use of coaching techniques overall, with significant variability in use of coaching across providers. When providers did coach caregivers, they used only a few coaching strategies (e.g., collaboration and in vivo feedback). Results indicate that targeted training and implementation strategies focused on individual coaching components, instead of coaching more broadly, may be needed to improve the use of individual coaching strategies. A focus on strengthening the use of collaboration and in vivo feedback may be key to improving coaching fidelity overall.

A Catholic Christian understanding of autism spectrum disorder and grief within the funeral setting

Attending the funeral of a loved one offers bereaved individuals the opportunity to say goodbye to the deceased, providing closure to the grieving loved one and concretizing the deceased's death. Within the Catholic-Christian tradition, the funeral rite is seen as an act of worship, a part of the more powerful story of salvation. Within this belief system, the funeral rite represents the deceased loved one's soul returning to God in the afterlife. It is a way to thank God for the endless mercy He has shown His children on Earth. Under the helpful guidance and expertise of funeral directors, funeral proceedings allow family and friends to grieve the loss of their loved one, surrounded by a community of prayer and support, which can provide a step toward healing. However, certain groups of individuals are commonly deprived of the opportunity to participate in or attend the funeral of a loved one. People in the autism community can fall into this category, as their grief is often disenfranchised. Their experience of disenfranchised grief can be problematic, as excluding these individuals from the funeral service may impact their grief and mourning process. Because grief reactions within people with autism are understudied, little is known as how to adequately address the needs of these individuals at the funeral of a loved one. Also, many funeral directors do not receive formal training on how to work with people with autism. Thus, they may not be aware of the extra support that individuals with autism may need when attending a funeral service.Therefore, through the lens of Catholic-Christian integration, this dissertation seeks to examine how grief manifests within people with autism more fully. Specifically, this dissertation examines the role that funeral attendance may play in their grief processes. Moreover, using archival data from a pilot study, a training program for funeral directors will be examined for its effectiveness. Furthermore, interview data from professionals in the field of autism and grief will be analyzed and discussed. Combining a thorough literature review of the topic with data from professionals in the field, this dissertation aims to better understand how grief manifests within this population, specifically as it relates to funeral attendance. Throughout the dissertation, the need for grief studies and interventions within the autism community will be highlighted, especially during this time of increased death and subsequent grief and mourning due to the COVID-19 pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Leisure, Employment, Community Participation, and Quality of Life in Primary Caregivers of Autistic Children: A Qualitative Study.

PURPOSE: In prioritising the needs of their autistic children, parents often modify their own participation across leisure, social, and workforce activities. Few studies have examined the impact these modifications have on caregiver quality of life (QoL). The aim in the current study was to examine how parenting their autistic child/ren impacts parent's participation and QoL. METHODS: Twenty primary caregivers (29-48 years, all female) of autistic children (7-11 years) were interviewed online about their participation in leisure, community, and employment activities including the impact of COVID-19. RESULTS: Five themes with underlying subthemes were identified using reflexive thematic analysis. The themes were: (1) Reflecting on the important things in life, (2) Getting access to everything needed, (3) Barriers to participation in meaningful activities, (4) Facilitators of participation in meaningful activities, and (5) Participation through the COVID-19 pandemic. CONCLUSION: The findings highlight the importance of regular participation in meaningful activities for parents of autistic children and the support needed by them, particularly single parents, to achieve balance between meeting caring responsibilities and their own participation needs.

Vaccine refusal risk factors among parents of children with autism spectrum disorders.

BACKGROUND: Vaccine refusal is a global trend and was announced as one of the top ten health threats in recent years. The rate of vaccine refusal (VR) among children with autism spectrum disorders (ASD) has also increased in parallel with the global trend but their vaccination behavior may differ from that of the normal population. This study aims to determine the VR rates among parents of children with ASD, to define the risk factors for developing VR, and to evaluate the parental concerns for childhood vaccinations in this susceptible population. METHODS: We conducted a 4-part survey questionnaire among parents of children with ASD, evaluating the vaccination status for both the child with ASD and their younger sibling. The vaccination uptake of the first child was accepted as the `baseline` behavior, while the following sibling`s uptake was suggested as the `current` behavior. The risk factors of VR were determined with logistic regression analysis. RESULTS: The study group included 110 parents of children with ASD (M/F:76/34) and their younger siblings (M/F:57/53). The rate of `baseline VR` was 12.7 % whereas the `current VR` was 40% (p=0.001). High socioeconomic status (relative risk [RR]: 4.4; 95% confidence interval [CI]: 1.01-16.6; p=0.04), using social media as the main source of information (RR: 7; 95% CI: 1.5-32; p= 0.01) and lack of regular well-child visits of the sibling (RR: 25; 95% CI 4.1-166; p=0.001) were determined as risk factors for VR. CONCLUSIONS: The vaccination behavior of parents changed after having a child with ASD, and thus, the younger siblings may constitute a risk group for VR. In clinical practice, pediatricians should be aware of this risk and evaluate the vaccination uptake of the younger siblings of children with ASD more carefully. Regular well-child visits and improving media literacy may be the key points to prevent VR in this susceptible population.

Long-term Behavioral Consequences of the COVID-19 Pandemic for Autistic Individuals and Their Mothers.

Long-term effects of the COVID-19 pandemic on autistic individuals and their families are recently emerging. This study investigated these effects in 40 mother-child dyads by measuring the behavioral problems of autistic individuals (via Aberrant Behavior Checklist) and their mothers' anxiety levels (via Beck Anxiety Inventory) during the pre-pandemic period, one month after, and one year after its onset. One year into the pandemic, aberrant behaviors of autistic individuals worsened only for those whose mothers had high anxiety levels. The continued negative impact of the COVID-19 pandemic on the behavior of autistic individuals is related to their mother's anxiety level, highlighting the need to support maternal mental health in families with individuals with autism.

Case report: Treatment-resistant depression, multiple trauma exposure and suicidality in an adolescent female with previously undiagnosed Autism Spectrum Disorder.

High rates of co-occurring depression are commonly reported in youth with Autism Spectrum Disorder (ASD), especially in individuals without intellectual disability (ID). Depression in ASD undermines adaptive behavior and is associated with a higher risk of suicidality. Females with ASD may be particularly vulnerable due to their greater use of camouflaging strategies. Indeed, in comparison to males, ASD is underdiagnosed in females, despite higher rates of internalizing symptoms and suicidality. Trauma exposure may also play a role in the development of depressive symptoms in this population. Moreover, evidence for effective treatments of depression in autistic youth are lacking, with ASD individuals frequently experiencing low efficacy and side effects. We present the case of an adolescent female with previously undiagnosed ASD without ID, admitted for active suicidal plans and a treatment-resistant depression (TRD), occurred after a COVID-19 lockdown in the context of cumulative exposure to stressful life events. Comprehensive clinical assessments performed at intake confirmed severe depression with suicidality. Intensive psychotherapy and different changes in medications were carried out (SSRI, SNRI, SNRI + NaSSA, SNRI + aripiprazole), all of which were ineffective, with persistent suicidal thoughts, often requiring intensive individual monitoring. The patient was finally successfully treated with lithium augmentation of fluoxetine, with no side effects. During hospitalization she was also evaluated by an ASD specialized center, where a diagnosis of ASD was made according to the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R) scores, as well as to clinical judgment of a senior psychiatrist. The present case report shows that clinicians should not overlook undiagnosed autism as a possible cause of TRD, especially in females without ID, where higher rates of under diagnosis may be in part related to their greater use of camouflage. It also suggests that ASD underdiagnosis and resulting unmet needs may be involved in vulnerability to stressful experiences, depression, and suicidality. Furthermore, it shows the complexity of providing care to TRD in youth with autism, suggesting that an augmentation therapy with lithium, a commonly recommended therapeutic strategy for refractory depression in typically developing samples, may also be effective in this population.

COVID-19 Vaccination Clinic for Individuals With Autism Spectrum Disorder and Related Disorders: Feasibility and Acceptability.

INTRODUCTION: Autistic individuals often have comorbid medical conditions, which can increase the likelihood of being severely affected by COVID-19. The best prevention for this is vaccination. However, some autistic individuals engage in behaviors that might create a barrier to successful vaccination. AIMS: We describe the development and acceptability of a clinic specializing in the administration of COVID-19 vaccines for individuals diagnosed with autism spectrum disorder (ASD) who exhibit challenging behavior. METHOD: The clinic utilized behavioral antecedent strategies and contingencies to increase compliance with the vaccine and decrease distress associated with the procedure. RESULTS: We achieved a 100% success rate with vaccine administration and caregivers reported high satisfaction with the clinic. CONCLUSIONS: The present vaccine clinic is adaptable to various settings and patients and was well-received overall by caregivers. Replication in different geographic regions may be beneficial when resources allow for this type of clinic.

Fitting in an Unfit Society With Autism Spectrum Disorder: Case Report.

Evaluating behavioral mimicking is important in healthcare providers' everyday functioning with an increased presentation of Tourette syndrome-like cases during the COVID-19 pandemic, seen due to the popular video creators on social media (e.g., TikTok) exhibiting these behaviors. Individuals with autism spectrum disorder (ASD) face difficulties with connection and assimilation, and they adapt by camouflaging their behaviors to fit with those of the neurotypical majority. Our team evaluated the behaviors of one individual with ASD to establish whether camouflaging was playing a role in her psychiatric stabilization in our inpatient psychiatric unit. We present a case of a 30-year-old female with ASD, admitted to our long-term inpatient psychiatric facility for significant mood dysregulation that persisted despite numerous treatment approaches (mediations, groups, etc.). While her initial behaviors included head banging and self-induced falls, her behaviors seemed to change based on those of her peers, in an apparent attempt to camouflage into the social environment within the unit. She also appeared to learn new self-harm behaviors, such as skin picking, from peers around her. The team was able to establish a temporal link between some instances of peers exhibiting specific behaviors and our patient engaging in similar behavior. Although inpatient units effectively manage long-term stabilization in other psychiatric disorders, these environments are not designed for individuals with ASD. Treatment teams should recognize the malleability of behaviors in patients with ASD and must identify and manage behavioral mimicking early during inpatient psychiatric treatment; otherwise, it may lead to significant harm.

Benefits and challenges of tele-dance movement psychotherapy with children with autism and their parents.

Dance movement psychotherapy can be physically and psychologically beneficial for children with autism spectrum disorder. The coronavirus disease 2019 pandemic required therapy to take place online. However, tele-dance movement psychotherapy with children with autism spectrum disorder has yet to be studied. This mixed methods study involving qualitative research and movement analyses entailed providing tele-dance movement psychotherapy to children with autism spectrum disorder and their parents, during the coronavirus disease 2019 pandemic, and exploring its potential benefits and challenges. The parents who completed the programme reported positive outcomes including the child's social development, enjoyment, improved understanding of their child, insight and ideas, as well as relationship-building. Movement analyses using the Parent Child Movement Scale (PCMS) lent greater insight into these developments. All of the parents reported challenges in participating in tele-dance movement psychotherapy. These were related to screen-to-screen interactions, home, and physical distance. There was a relatively high attrition rate. These findings highlight the challenges of tele-dance movement psychotherapy with children with autism spectrum disorder and the unique benefits of meeting in person whilst the positive outcomes may indicate that tele-dance movement psychotherapy can be beneficial, perhaps particularly as an interim or adjunct form of therapy. Specific measures can be taken to enhance engagement.