Autism spectrum disorder (ASD) is a developmental disorder marked by communication limitations and behavioral features that vary broadly across individuals. The identification of ASD has increased by approximately 30% since 2008. As the identification of ASD continues to increase, similarly so does the number of caregivers of children with ASD, making this an important, and growing population. Since children with ASD may have a unique phenotypic profile of behaviors caregivers of children with ASD often face increased levels of stress, and experience higher levels of stress compared to other populations, including caregivers of children of other developmental disabilities. Chronic stress is a known risk factor for a wide range of chronic diseases, including cardiometabolic and mental health outcomes. Chronic stress may also influence health behaviors such as smoking, alcohol use and physical activity through coping mechanisms. The occurrence of chronic diseases and their risk factors in caregivers of children with ASD has not been well studied. There is a need to further investigate specific child behaviors as correlates of caregiver health and health behaviors. This project included two studies. The first study examined stress in caregivers of children with ASD and focused on specific child behaviors, within a locally-recruited sample of N=116 caregivers of children with ASD aged 3-17 years. Caregivers completed the Autism Behavior Inventory-Short as a measure of child behaviors, and the Parent Stress Scale as a measure of total parenting stress. We used linear regression to determine the association between specific child behaviors and caregiver stress. We hypothesized that caregivers of children with higher levels of behavioral difficulties (social-communication, mental health, repetitive behaviors) will report higher levels of self-reported stress, compared to caregivers of children with fewer behavioral difficulties. More behavioral difficulties in each domain was associated with higher levels of parental stress. For the second study, data on health behaviors and health outcomes from the National Health Interview Survey 2016-2017 cycles were used to compare caregivers of children with ASD to caregivers of typically developing children and children with other disabilities (N=10,162). For the child, information on child's diagnosis was reported by the parent. For the parent, health risk behaviors and health outcomes were self-reported. We used logistic regression to determine effects and hypothesized that caregivers of children with ASD will report more adverse health behaviors (i.e., smoking, alcohol use, less physical activity) compared to caregivers of typically developing children and caregivers of children with other disabilities. We also hypothesized that caregivers of children with ASD will have more cardiometabolic outcomes (i.e., type 2 diabetes, obesity, hypertension, high cholesterol) and more mental health symptoms compared to caregivers of typically developing children and caregivers of children with other disabilities. Compared to typically developing caregivers, caregivers of children with ASD had higher odds of physical inactivity, smoking and tobacco use, and heavy drinking, though these relationships varied when compared to other disability groups. The effect estimates for these relationships also were of low magnitude and were relativity imprecise. Similar patterns of association were shown for health outcomes compared to caregivers of children with other disabilities. Overall, our findings suggest that it is the culmination of the child's phenotype that results in increased caregiver stress, rather than individual, unique behaviors. This may support the idea that is the total experience of all behaviors that is important, including those not required for an ASD diagnosis, but that are commonly shared with other developmental disorders. Furthermore, caregivers of children with ASD had more adverse health behaviors and outcomes compared to caregivers of typically developing children, but not when compared to other disability groups, though these estimates had low magnitude and were relatively imprecise. Caregiver stress should be considered for potential interventions to improve their health. Future studies should seek to better understand why child behaviors influence caregiver stress and how caregiver stress may influence health risk behaviors and health outcomes.

The purpose of this study was to investigate the relationships between children with autism spectrum disorder (ASD) with co-occurring internalizing problems or externalizing behaviors and parents mental and physical health. Furthermore, this study investigated the roles parent stress, family communication and beliefs had on those relationships. Participants included 2091 parents reporting on their child's internalizing problems or externalizing behaviors, their own individual stress and their family communication and beliefs. Results captured significant negative direct effects between child internalizing problems and parents' mental health and child externalizing behaviors and parents' physical health. Furthermore, results captured two significant mediations with parent stress mediating the relationships between child internalizing problems and externalizing behaviors and parent mental health. Results indicated family communication and family beliefs did not moderate the relationships between child internalizing problems and externalizing behaviors and parent stress.

Children with autism spectrum disorder (ASD) are uniquely vulnerable to any adverse effects of the coronavirus (COVID-19) pandemic due to greater healthcare needs, dependency on resources and services, and difficulty in adapting to environmental changes. Caregivers of children with autism also experience substantial stress, even under ideal conditions, and have simultaneously been negatively impacted by the pandemic based on disruptions in routines and social infrastructures that typically bolster against mental health problems. Comprising data from two studies, this dissertation reports changes throughout the pandemic regarding the adaptive and developmental health of children with autism; access and barriers to telehealth; and the emotional wellbeing of their parents, with an additional aim to determine whether clinical or sociodemographic characteristics affect outcomes. Study 1 was a secondary analysis of 3,941 parents of children with autism between the ages of 3- and 10-years-old, shared from the Simons Foundation Powering Autism Research for Knowledge (SPARK) national autism project. Study 2 consisted of primary data collected from 85 parents of children with ASD within this same age range, recruited throughout the United States. Both studies obtained direct responses from caregivers to comprehensively explore challenges presented by the COVID-19 pandemic and characterize the outcomes of children with ASD and their families. Participants were given an online battery of standardized and novel measures, administered across Baseline and Follow-Up timeframes (spanning 1–6 months in Study 1, and 3 months for Study 2). Tests of group and mean differences and regression analyses assessed relations among behavioral characteristics of the children, general experiences and concerns regarding current service delivery, and the impact of the COVID-19 outbreak on parental wellbeing, while quotes and free-response comments were reviewed descriptively for common themes. Results showed children with ASD mostly demonstrated increases in adaptive and self-care behaviors between evaluation points, yet still performed below chronological age-level. Most families faced disruption in autism services due to COVID-19, but transitioning to online/remote delivery has been possible and successful in some instances. Finally, all children and parents experienced negative mental health effects during this time, though the extent of this impact varied based on risk and/or protective factors inherent to each individual family. Results also uncovered demographic disparities in COVID-19-related stressors and outcomes, particularly for parents from a lower educational background, families who are economically disadvantaged, and those residing in smaller geographic areas. Thematic analyses revealed parent concerns surrounding finances, fear of sickness, and the overarching impacts on child development, given the shift in education, therapies, and social interaction opportunities. Positive changes frequently included increased time for family togetherness, reduced academic and social worry in children, and benefits provided by technology. These findings outline the impact of the coronavirus pandemic on the autism population and can guide efforts to maintain and promote health and development while in crisis and inform strategies to limit potential harm in future emergencies. The value of this dissertation is its qualitative and quantitative consideration of both child and caregiver, and emphasis on the importance of ASD services during this critical age of development, recommending both parent and provider training programs as the best method to ensure continuity of care.

The aim of the book is to serve for clinical, practical, basic and scholarly practices. In twentyfive chapters it covers the most important topics related to Autism Spectrum Disorders in the efficient way and aims to be useful for health professionals in training or clinicians seeking an update. Different people with autism can have very different symptoms. Autism is considered to be a "spectrum" disorder, a group of disorders with similar features. Some people may experience merely mild disturbances, while the others have very serious symptoms. This book is aimed to be used as a textbook for child and adolescent psychiatry fellowship training and will serve as a reference for practicing psychologists, child and adolescent psychiatrists, general psychiatrists, pediatricians, child neurologists, nurses, social workers and family physicians. A free access to the full-text electronic version of the book via Intech reading platform at http://www.intechweb.org is a great bonus.

People with autism spectrum disorder may have unique development challenges, but they face a range of health issues like all people, and many of these may be compounded by an ASD. This book provides the tools and information so the health care professional can think differently about caring for this patient and see through his or her eyes. The presentations of 28 contributors share the importance of early, continuous, coordinated, and individualized care that is integrated into the existing health care system. Examples of models and policies that have improved the access, experience, and outcomes for patients with ASD are shared. In addition, the importance of continuous quality improvement through data collection and monitoring of outcomes is emphasized. This information is essential for addressing the capacity crisis now in providing routine, specialized, and emergency care for individuals with ASD. Some of the major topics discussed include: the epidemiology of autism spectrum disorder; facilitating the role of parents in management and advocacy; the impact of the sensory environment on care; medications for the treatment of psychiatric comorbidities; frameworks to guide practice and research with patients; building a home for acute care needs; assisting parents in adapting and making decisions regarding treatment options; integrating genetic testing into health care; educating nurses with faculty and curricular issues; emergency medicine and improving service; physical therapy to promote health, function, and community participation; using big data to direct quality improvement; and monitoring patient outcomes in research and policy outcomes. This significant volume brings together a wealth of expertise with information and strategies across the lifespan for individuals with autism spectrum disorder.

In this issue of Pediatric Clinics of North America, guest editors Drs. Xiaoming Li and Sayward Harrison bring their considerable expertise to the topic of Progress in Behavioral Health Interventions for Children and Adolescents. Nearly three-quarters of adult mental health disorders have their onset during childhood, where treatment becomes more difficult and has greater social, educational, and economic consequences over time. This issue provides the information and resources needed to identify and treat mental health and clinical issues in children, with the goal of improving outcomes. Contains 16 relevant, practice-oriented topics including leveraging technology in novel interventions for autism spectrum disorder; childhood obesity prevention and treatment; parental rules, parental routines, and children’s (0-12 years) sleep and screen time; family-based preventions and interventions for child emotional and behavioral functioning in families facing stress/trauma; integrating behavioral health in primary care; and more. Provides in-depth clinical reviews on behavioral health interventions for children and adolescents, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

Background: Caregivers of children with Autism Spectrum Disorder (ASD) have been found to have poor mental health outcomes and higher stress compared to the general population, parents of typically developing children, and parents of children with other chronic health care conditions. Emotional support for caregivers has been shown to buffer the stress and negative effects that some caregivers experience. Caregivers living in rural areas may face additional barriers to obtaining support for themselves due to the lack of local support resources. Purpose: The purpose of this dissertation study is to examine geographic (urban, suburban, and rural setting) disparities in overall mental health and stress for caregivers and the amount of emotional support sources received by caregivers of children with ASD. In addition, the impact emotional support has on caregiver overall mental health and stress for caregivers of children with ASD is explored. Method: A cross-sectional secondary analysis of the 2016-2019 National Survey of Children’s Health (NSCH) data was used to conduct this dissertation study. Complex survey data analyses techniques with bivariable and multivariable linear regression models were employed for the statistical analyses. Results: No geographic disparities were found in caregiver overall mental health, caregiver stress, or emotional support received when controlling for possible confounding variables. Informal emotional support was found to significantly decrease caregiver stress for caregivers of children with ASD when controlling for covariates. In addition, formal emotional support was found to increase stress for caregivers, but this relationship was no longer significant when controlling for covariates. Overall, near or over a quarter of the subpopulation sample in each geographic area reported having no informal support sources and over half reported having no formal support sources. Conclusion: Despite hypotheses based on previous research, geographic location of residence did not predict outcome variables in parents of children with ASD. However, a concerning percentage of the sample in this study reported having no informal or formal emotional support. This is troubling as informal emotional support appears to be beneficial in decreasing caregiver stress for caregivers of children with ASD. Recommendation: Future research is needed to explore the characteristics and types of emotional support found beneficial to caregivers of children with ASD in varying geographic areas. Barriers to receiving emotional support need to be identified and intervention studies are needed to target the lack of emotional support accessed by caregivers of children with ASD. When providing formal emotional support to caregivers of children with ASD, health care providers need to be aware of the possibility of adding stress to caregivers.