Search results for: attention deficit/hyperactivity disorder
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 5588

Search results for: attention deficit/hyperactivity disorder

4988 The Influence of Neural Synchrony on Auditory Middle Latency and Late Latency Responses and Its Correlation with Audiological Profile in Individuals with Auditory Neuropathy

Authors: P. Renjitha, P. Hari Prakash

Abstract:

Auditory neuropathy spectrum disorder (ANSD) is an auditory disorder with normal cochlear outer hair cell function and disrupted auditory nerve function. It results in unique clinical characteristic with absent auditory brainstem response (ABR), absent acoustic reflex and the presence of otoacoustic emissions (OAE) and cochlear microphonics. The lesion site could be at cochlear inner hair cells, the synapse between the inner hair cells and type I auditory nerve fibers, and/or the auditory nerve itself. But the literatures on synchrony at higher auditory system are sporadic and are less understood. It might be interesting to see if there is a recovery of neural synchrony at higher auditory centers. Also, does the level at which the auditory system recovers with adequate synchrony to the extent of observable evoke response potentials (ERPs) can predict speech perception? In the current study, eight ANSD participants and healthy controls underwent detailed audiological assessment including ABR, auditory middle latency response (AMLR), and auditory late latency response (ALLR). AMLR was recorded for clicks and ALLR was evoked using 500Hz and 2 kHz tone bursts. Analysis revealed that the participant could be categorized into three groups. Group I (2/8) where ALLR was present only for 2kHz tone burst. Group II (4/8), where AMLR was absent and ALLR was seen for both the stimuli. Group III (2/8) consisted individuals with identifiable AMLR and ALLR for all the stimuli. The highest speech identification sore observed in ANSD group was 30% and hence considered having poor speech perception. Overall test result indicates that the site of neural synchrony recovery could be varying across individuals with ANSD. Some individuals show recovery of neural synchrony at the thalamocortical level while others show the same only at the cortical level. Within ALLR itself there could be variation across stimuli again could be related to neural synchrony. Nevertheless, none of these patterns could possible explain the speech perception ability of the individuals. Hence, it could be concluded that neural synchrony as measured by evoked potentials could not be a good clinical predictor speech perception.

Keywords: auditory late latency response, auditory middle latency response, auditory neuropathy spectrum disorder, correlation with speech identification score

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4987 A Comparative Study of Cognitive Factors Affecting Social Distancing among Vaccinated and Unvaccinated Filipinos

Authors: Emmanuel Carlo Belara, Albert John Dela Merced, Mark Anthony Dominguez, Diomari Erasga, Jerome Ferrer, Bernard Ombrog

Abstract:

Social distancing errors are a common prevalence between vaccinated and unvaccinated in the Filipino community. This study aims to identify and relate the factors on how they affect our daily lives. Observed factors include memory, attention, anxiety, decision-making, and stress. Upon applying the ergonomic tools and statistical treatment such as t-test and multiple linear regression, stress and attention turned out to have the most impact to the errors of social distancing.

Keywords: vaccinated, unvaccinated, socoal distancing, filipinos

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4986 The Use of Phototherapy with Unusual Case Studies in Counselling

Authors: Briar Schulz

Abstract:

The use of phototherapy within the counselling room offers significant advantages in extending far beyond typical "talk therapy" avenues. The benefits of using this approach are numerous and include: efficiency in recalling pertinent information in addition to utilizing a visual lens that often captures opulent detail that can be eluded in traditional dialogue. The goal of this presentation is to provide conference attendees with an opportunity to understand the therapeutic benefits and creative possibilities of incorporating photography into the clinical counselling process. This includes practical strategies for using in specific case studies, where studies of phototherapy have previously been limited. Ethical considerations and limitations to the process will also be addressed. Attendees will observe the benefits of using phototherapy with six longitudinal case studies including: a 30 year old female, with anorexia nervosa; a 22 year old self-harming individual with obsessive compulsive disorder; a 24 year old client with developmental delays, and bipolar disorder; a 14 year old client with Autism; and two clients with rare medical conditions struggling with depression and anxiety, one 21 years old and the other 16 years old. Aspects of each case will be linked to various theoretical modalities to highlight the efficiency and benefits of phototherapy in drawing important clinical conclusions. Furthermore, the use of phototherapy within these clinical areas remains a relatively unexplored area of the literature, and possibilities for future research will be highlighted. Finally, conference attendees will have the opportunity to try various phototherapy strategies within the interactive portion of this presentation. .

Keywords: Atypical, Case studies, Phototherapy, Photovoice

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4985 Development and Validation of the Dimensional Social Anxiety Scale: Assessment for the Offensive Type of Social Anxiety

Authors: Ryotaro Ishikawa

Abstract:

Social Anxiety Disorder (SAD) is marked by the persistent fear of social or performance situations in which embarrassment may occur. In contrast, SA in Japan and in China is understood differently. Taijin Kyofusho (TKS) is a culture-bound subtype of SAD which has been the focus of recent research. TKS refers to a unique form of SAD found in Japanese and East Asian cultures characterized by a fear of offending others, in contrast to prototypical SAD in which the source of fear is typically concerned about one’s own embarrassment, humiliation, or rejection by others. Criteria for TKS partially overlap with but are distinct from SAD; a primary factor distinguishing TKS from SAD appears to be individualistic versus interdependent or collectivistic self-construals. The aim of this study was to develop a scale to assess the typical SAD and offensive type of SAD (TKS). This study aimed to test the internal consistency and validity of the scale (Dimensional Social Anxiety Scale: DSAS) using university students sample. For this, 148 university students were enrolled (male=90, female=58, age=19.77, Standard Deviation=1.04). As a result of confirmatory factor analysis, three-factor models of DSAS were verified (χ2(74) =128.36). These three factors were named ‘general’, ‘perfomance’, and ‘offensive’. DSAS were significantly correlated with the Liebowitz Social Anxiety Scale (r = .538, p < .001). Good internal consistencies were indicated on the three subscales (α = .76 to 89). In conclusion, this study indicated DSAS has adequate internal consistency and validity for assessing of multi-type of SADs.

Keywords: social anxiety, cognitive theory, assessment, anxiety disorder

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4984 Cross-sectional Developmental Trajectories of Executive Function and Relations to Theory of Mind in Autism Spectrum Disorder

Authors: Evangelia-Chrysanthi Kouklari, Evdokia Tagkouli, Vassiliki Ntre, Artemios Pehlivanidis, Stella Tsermentseli, Gerasimos Kolaitis, Katerina Papanikolaou

Abstract:

Executive Function (EF) is a set of goal-directed cognitive skills essentially needed in problem-solving and social behavior. Developmental EF research has indicated that EF emerges early in life and marks dramatic changes before the age of 5. Research evidence has suggested that it may continue to develop up to adolescence as well, following the development of the prefrontal cortex. Over the last decade, research evidence has suggested distinguished domains of cool and hot EF, but traditionally the development of EF in Autism Spectrum Disorder (ASD) has been examined mainly with tasks that address the “cool” cognitive aspects of EF. Thus, very little is known about the development of “hot” affective EF processes and whether the cross-sectional developmental pathways of cool and hot EF present similarities in ASD. Cool EF has also been proven to have a strong correlation with Theory of Mind (ToM) in young and middle childhood in typical development and in ASD, but information about the relationship of hot EF to ToM skills is minimal. The present study’s objective was to explore the age-related changes of cool and hot EF in ASD participants from middle childhood to adolescence, as well as their relationship to ToM. This study employed an approach of cross-sectional developmental trajectories to investigate patterns of cool and hot EF relative to chronological age within ASD. Eighty-two participants between 7 and 16 years of age were recruited to undertake measures that assessed cool EF (working memory, cognitive flexibility, planning & inhibition), hot EF (affective decision making & delay discounting) and ToM (false belief and mental state/emotion recognition). Results demonstrated that trajectories of all cool EF presented age-related changes in ASD (improvements with age). With regards to hot EF, affective decision-making presented age-related changes, but for delay discounting, there were no statistically significant changes found across younger and older ASD participants. ToM was correlated only to cool EF. Theoretical implications are discussed as the investigation of the cross-sectional developmental trajectories of the broader EF (cool and hot domains) may contribute to better defining cognitive phenotypes in ASD. These findings highlight the need to examine developmental trajectories of both hot and cool EF in research and clinical practice as they may aid in enhancing diagnosis or better-informed intervention programs.

Keywords: autism spectrum disorder, developmental trajectories, executive function, theory of mind

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4983 Shifted Window Based Self-Attention via Swin Transformer for Zero-Shot Learning

Authors: Yasaswi Palagummi, Sareh Rowlands

Abstract:

Generalised Zero-Shot Learning, often known as GZSL, is an advanced variant of zero-shot learning in which the samples in the unseen category may be either seen or unseen. GZSL methods typically have a bias towards the seen classes because they learn a model to perform recognition for both the seen and unseen classes using data samples from the seen classes. This frequently leads to the misclassification of data from the unseen classes into the seen classes, making the task of GZSL more challenging. In this work of ours, to solve the GZSL problem, we propose an approach leveraging the Shifted Window based Self-Attention in the Swin Transformer (Swin-GZSL) to work in the inductive GSZL problem setting. We run experiments on three popular benchmark datasets: CUB, SUN, and AWA2, which are specifically used for ZSL and its other variants. The results show that our model based on Swin Transformer has achieved state-of-the-art harmonic mean for two datasets -AWA2 and SUN and near-state-of-the-art for the other dataset - CUB. More importantly, this technique has a linear computational complexity, which reduces training time significantly. We have also observed less bias than most of the existing GZSL models.

Keywords: generalised, zero-shot learning, inductive learning, shifted-window attention, Swin transformer, vision transformer

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4982 Peer Bullying and Mentalization from the Perspective of Pupils

Authors: Anna Siegler

Abstract:

Bullying among peers is not uncommon; however, adults can notice only a fragment of the cases of harassment during everyday life. The systemic approaches of bullying investigation put the whole school community in the focus of attention and propose that the solution should emerge from the culture of the school. Bystanders are essential in the prevention and intervention processes as an active agent rather than passive. For combating exclusion, stigmatization and harassment, it is important that the bystanders have to realize they have the power to take action. To prevent the escalation of violence, victims must believe that students and teachers will help them and their environment is able to provide safety. The study based on scientific narrative psychological approach, and focuses on the examination of the different perspectives of students, how peers are mentalizing with each other in case of bullying. The data collection contained responses of students (N = 138) from three schools in Hungary, and from three different area of the country (Budapest, Martfű and Barcs). The test battery include Bullying Prevalence Questionnaire, Interpersonal Reactivity Index and an instruction to get narratives about bullying, which effectiveness was tested during a pilot test. The obtained results are in line with the findings of previous bullying research: the victims are mentalizing less with their peers and experience greater personal distress when they are in identity threatening situations, thus focusing on their own difficulties rather than social signals. This isolation is an adaptive response in short-term although it seems to lead to a deficit in social skills later in life and makes it difficult for students to become socially integrated to society. In addition the results also show that students use more mental state attribution when they report verbal bullying than in case of physical abuse. Those who witness physical harassment also witness concrete answers to the problem from teachers, in contrast verbal abuse often stays without consequences. According to the results students mentalizing more in these stories because they have less normative explanation to what happened. To expanding bullying literature, this research helps to find ways to reduce school violence through community development.

Keywords: bullying, mentalization, narrative, school culture

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4981 Changes in EEG and Emotion Regulation in the Course of Inward-Attention Meditation Training

Authors: Yuchien Lin

Abstract:

This study attempted to investigate the changes in electroencephalography (EEG) and emotion regulation following eight-week inward-attention meditation training program. The subjects were 24 adults without meditation experiences divided into meditation and control groups. The quantitatively analyzed changes in psychophysiological parameters during inward-attention meditation, and evaluated the emotion scores assessed by the State-Trait Anxiety Inventory (STAI), the Positive and Negative Affect Schedule (PANAS), and the Emotion Regulation Scale (ERS). The results were found: (1) During meditation, significant EEG increased for theta-band activity in the frontal and the bilateral temporal areas, for alpha-band activity in the left and central frontal areas, and for gamma-band activity in the left frontal and the left temporal areas. (2) The meditation group had significantly higher positive affect in posttest than in pretest. (3) There was no significant difference in the changes of EEG spectral characteristics and emotion scores in posttest and pretest for the control group. In the present study, a unique meditative concentration task with a constant level of moderate mental effort focusing on the center of brain was used, so as to enhance frontal midline theta, alpha, and gamma-band activity. These results suggest that this mental training allows individual reach a specific mental state of relaxed but focused awareness. The gamma-band activity, in particular, enhanced over left frontoparietal area may suggest that inward-attention meditation training involves temporal integrative mechanisms and may induce short-term and long-term emotion regulation abilities.

Keywords: meditation, EEG, emotion regulation, gamma activity

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4980 Nitrogen Fixation of Soybean Approaches for Enhancing under Saline and Water Stress Conditions

Authors: Ayman El Sabagh, AbdElhamid Omar, Dekoum Assaha, Khair Mohammad Youldash, Akihiro Ueda, Celaleddin Barutçular, Hirofumi Saneoka

Abstract:

Drought and salinity stress are a worldwide problem, constraining global crop production seriously. Hence, soybean is susceptible to yield loss from water deficit and salinity stress. Therefore, different approaches have been suggested to solve these issues. Osmoprotectants play an important role in protection the plants from various environmental stresses. Moreover, organic fertilization has several beneficial effects on agricultural fields. Presently, efforts to maximize nitrogen fixation in soybean are critical because of widespread increase in soil degradation in Egypt. Therefore, a greenhouse research was conducted at plant nutritional physiology laboratory, Hiroshima University, Japan for assessing the impact of exogenous osmoregulators and compost application in alleviating the adverse effects of salinity and water stress on soybean. Treatments was included (i) water stress treatments (different soil moisture levels consisting of (100%, 75%, and 50% of field water holding capacity), (ii) salinity concentrations (0 and 15 mM) were applied in fully developed trifoliolate leaf node (V1), (iii) compost treatments (0 and 24 t ha-1) and (iv) the exogenous, proline and glycine betaine concentrations (0 mM and 25 mM) for each, was applied at two growth stages (V1 and R1). The seeds of soybean cultivar Giza 111, was sown into basin from wood (length10 meter, width 50cm, height 50cm and depth 350cm) containing a soil mixture of granite regosol soil and perlite (2:1 v/v). The nitrogen-fixing activity was estimated by using gas chromatography and all measurements were made in three replicates. The results showed that water deficit and salinity stress reduced biological nitrogen fixation and specific nodule activity than normal irrigation conditions. Exogenous osmoprotectants were improved biological nitrogen fixation and specific nodule activity as well as, applying of compost led to improving many of biological nitrogen fixation and specific nodule activity with superiority than stress conditions. The combined application compost fertilizer and exogenous osmoprotectants were more effective in alleviating the adverse effect of stress to improve biological nitrogen fixation and specific nodule activity of Soybean.

Keywords: a biotic stress, biological nitrogen fixation, compost, osmoprotectants, specific nodule activity, soybean

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4979 The Relevance of Family Involvement in the Journey of Dementia Patients

Authors: Akankunda Veronicah Karuhanga

Abstract:

Dementia is an age mental disorder that makes victims lose normal functionality that needs delicate attention. It has been technically defined as a clinical syndrome that presents a number of difficulties in speech and other cognitive functions that change someone’s behaviors and can also cause impairments in activities of daily living, not forgetting a range of neurological disorders that bring memory loss and cognitive impairment. Family members are the primary healthcare givers and therefore, the way how they handle the situation in its early stages determines future deterioration syndromes like total memory loss. Unfortunately, most family members are ignorant about this condition and in most cases, the patients are brought to our facilities when their condition was already mismanaged by family members and we thus cannot do much. For example, incontinence can be managed at early stages through potty training or toilet scheduling before resorting to 24/7 diapers which are also not good. Professional Elderly care should be understood and practiced as an extension of homes, not a dumping place for people considered “abnormal” on account of ignorance. Immediate relatives should therefore be sensitized concerning the normalcy of dementia in the context of old age so that they can be understanding and supportive of dementia patients rather than discriminating against them as present-day lepers. There is a need to skill home-based caregivers on how to handle dementia in its early stages. Unless this is done, many of our elderly homes shall be filled with patients who should have been treated and supported from their homes. This skilling of home-based caregivers is a vital intervention because until elderly care is appreciated as a human moral obligation, many transactional rehabilitation centers will crop up and this shall be one of the worst moral decadences of our times.

Keywords: dementia, family, Alzheimers, relevancy

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4978 Zebrafish Larvae Model: A High Throughput Screening Tool to Study Autism

Authors: Shubham Dwivedi, Raghavender Medishetti, Rita Rani, Aarti Sevilimedu, Pushkar Kulkarni, Yogeeswari Perumal

Abstract:

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder of early onset, characterized by impaired sociability, cognitive function and stereotypies. There is a significant urge to develop and establish new animal models with ASD-like characteristics for better understanding of underlying mechanisms. The aim of the present study was to develop a cost and time effective zebrafish model with quantifiable parameters to facilitate mechanistic studies as well as high-throughput screening of new molecules for autism. Zebrafish embryos were treated with valproic acid and a battery of behavioral tests (anxiety, inattentive behavior, irritability and social impairment) was performed on larvae at 7th day post fertilization, followed by study of molecular markers of autism. This model shows a significant behavioural impairment in valproic acid treated larvae in comparison to control which was again supported by alteration in few marker genes and proteins of autism. The model also shows a rescue of behavioural despair with positive control drugs. The model shows robust parameters to study behavior, molecular mechanism and drug screening approach in a single frame. Thus we postulate that our 7 days zebrafish larval model for autism can help in high throughput screening of new molecules on autism.

Keywords: autism, zebrafish, valproic acid, neurodevelopment, behavioral assay

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4977 Aspect-Level Sentiment Analysis with Multi-Channel and Graph Convolutional Networks

Authors: Jiajun Wang, Xiaoge Li

Abstract:

The purpose of the aspect-level sentiment analysis task is to identify the sentiment polarity of aspects in a sentence. Currently, most methods mainly focus on using neural networks and attention mechanisms to model the relationship between aspects and context, but they ignore the dependence of words in different ranges in the sentence, resulting in deviation when assigning relationship weight to other words other than aspect words. To solve these problems, we propose a new aspect-level sentiment analysis model that combines a multi-channel convolutional network and graph convolutional network (GCN). Firstly, the context and the degree of association between words are characterized by Long Short-Term Memory (LSTM) and self-attention mechanism. Besides, a multi-channel convolutional network is used to extract the features of words in different ranges. Finally, a convolutional graph network is used to associate the node information of the dependency tree structure. We conduct experiments on four benchmark datasets. The experimental results are compared with those of other models, which shows that our model is better and more effective.

Keywords: aspect-level sentiment analysis, attention, multi-channel convolution network, graph convolution network, dependency tree

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4976 A Robotic “Puppet Master” Application to ASD Therapeutic Support

Authors: Sophie Sakka, Rénald Gaboriau

Abstract:

This paper describes a preliminary work aimed at setting a therapeutic support for autistic teenagers using three humanoid robots NAO shared by ASD (Autism Spectrum Disorder) subjects. The studied population had attended successfully a first year program, and were observed with a second year program using the robots. This paper focuses on the content and the effects of the second year program. The approach is based on a master puppet concept: the subjects program the robots, and use them as an extension for communication. Twenty sessions were organized, alternating ten preparatory sessions and ten robotics programming sessions. During the preparatory sessions, the subjects write a story to be played by the robots. During the robot programming sessions, the subjects program the motions to be realized to make the robot tell the story. The program was concluded by a public performance. The experiment involves five ASD teenagers aged 12-15, who had all attended the first year robotics training. As a result, a progress in voluntary and organized communication skills of the five subjects was observed, leading to improvements in social organization, focus, voluntary communication, programming, reading and writing abilities. The changes observed in the subjects general behavior took place in a short time, and could be observed from one robotics session to the next one. The approach allowed the subjects to draw the limits of their body with respect to the environment, and therefore helped them confronting the world with less anxiety.

Keywords: autism spectrum disorder, robot, therapeutic support, rob'autism

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4975 Light, Restorativeness and Performance in the Workplace: A Pilot Study

Authors: D. Scarpanti, M. Brondino, M. Pasini

Abstract:

Background: the present study explores the role of light and restorativeness on work. According with the Attention Restoration Theory (ART) and a Model of Work Environment, the main idea is that some features of environment, i.e., lighting, influences the direct attention, and so, the performance. Restorativeness refers to the presence/absence level of all the characteristics of physical environment that help to regenerate direct attention. Specifically, lighting can affect level of fascination and attention in one hand; and in other hand promotes several biological functions via pineal gland. Different reviews on this topic show controversial results. In order to bring light on this topic, the hypotheses of this study are that lighting can affect the construct of restorativeness and, in the second time, the restorativeness can affect the performance. Method: the participants are 30 workers of a mechatronic company in the North Italy. Every subject answered to a questionnaire valuing their subjective perceptions of environment in a different way: some objective features of environment, like lighting, temperature and air quality; some subjective perceptions of this environment; finally, the participants answered about their perceived performance. The main attention is on the features of light and his components: visual comfort, general preferences and pleasantness; and the dimensions of the construct of restorativeness; fascination, coherence and being away. The construct of performance per se is conceptualized in three level: individual, team membership and organizational membership; and in three different components: proficiency, adaptability, and proactivity, for a total of 9 subcomponents. Findings: path analysis showed that some characteristics of lighting respectively affected the dimension of fascination; and, as expected, the dimension of fascination affected work performance. Conclusions: The present study is a first pilot step of a wide research. These first results can be summarized with the statement that lighting and restorativeness contribute to explain work performance variability: in details perceptions of visual comfort, satisfaction and pleasantness, and fascination respectively. Results related to fascination are particularly interesting because fascination is conceptualized as the opposite of the construct of direct attention. The main idea is, in order to regenerate attentional capacity, it’s necessary to provide a lacking of attention (fascination). The sample size did not permit to test simultaneously the role of the perceived characteristics of light to see how they differently contribute to predict fascination of the work environment. However, the results highlighted the important role that light could have in predicting restorativeness dimensions and probably with a larger sample we could find larger effects also on work performance. Furthermore, longitudinal data will contribute to better analyze the causal model along time. Applicative implications: the present pilot study highlights the relevant role of lighting and perceived restorativeness in the work environment and the importance to focus attention on light features and the restorative characteristics in the design of work environments.

Keywords: lighting, performance, restorativeness, workplace

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4974 Relevance Of Cognitive Rehabilitation Amongst Children Having Chronic Illnesses – A Theoretical Analysis

Authors: Pulari C. Milu Maria Anto

Abstract:

Background: Cognitive Rehabilitation/Retraining has been variously used in the research literature to represent non-pharmacological interventions that target the cognitive impairments with the goal of ameliorating cognitive function and functional behaviors to optimize the quality of life. Along with adult’s cognitive impairments, the need to address acquired cognitive impairments (due to any chronic illnesses like CHD - congenital heart diseases or ALL - Acute Lymphoblastic Leukemia) among child populations is inevitable. Also, it has to be emphasized as same we consider the cognitive impairments seen in the children having neurodevelopmental disorders. Methods: All published brain image studies (Hermann, B. et al,2002, Khalil, A. et al., 2004, Follin, C. et al, 2016, etc.) and studies emphasizing cognitive impairments in attention, memory, and/or executive function and behavioral aspects (Henkin, Y. et al,2007, Bellinger, D. C., & Newburger, J. W. (2010), Cheung, Y. T., et al,2016, that could be identified were reviewed. Based on a systematic review of the literature from (2000 -2021) different brain imaging studies, increased risk of neuropsychological and psychosocial impairments are briefly described. Clinical and research gap in the area is discussed. Results:30 papers, both Indian studies and foreign publications (Sage journals, Delhi psychiatry journal, Wiley Online Library, APA PsyNet, Springer, Elsevier, Developmental medicine, and child neurology), were identified. Conclusions: In India, a very limited number of brain imaging studies and neuropsychological studies have done by indicating the cognitive deficits of a child having or undergone chronic illness. None of the studies have emphasized the relevance nor the need of implementingCR among such children, even though its high time to address but still not established yet. The review of the current evidence is to bring out an insight among rehabilitation professionals in establishing a child specific CR and to publish new findings regarding the implementation of CR among such children. Also, this study will be an awareness on considering cognitive aspects of a child having acquired cognitive deficit (due to chronic illness), especially during their critical developmental period.

Keywords: cognitive rehabilitation, neuropsychological impairments, congenital heart diseases, acute lymphoblastic leukemia, epilepsy, and neuroplasticity

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4973 Postpartum Depression and Its Association with Food Insecurity and Social Support among Women in Post-Conflict Northern Uganda

Authors: Kimton Opiyo, Elliot M. Berry, Patil Karamchand, Barnabas K. Natamba

Abstract:

Background: Postpartum depression (PPD) is a major psychiatric disorder that affects women soon after birth and in some cases, is a continuation of antenatal depression. Food insecurity (FI) and social support (SS) are known to be associated with major depressive disorder, and vice versa. This study was conducted to examine the interrelationships among FI, SS, and PPD among postpartum women in Gulu, a post-conflict region in Uganda. Methods: Cross-sectional data from postpartum women on depression symptoms, FI and SS were, respectively, obtained using the Center for Epidemiologic Studies-Depression (CES-D) scale, Individually Focused FI Access scale (IFIAS) and Duke-UNC functional social support scale. Standard regression methods were used to assess associations among FI, SS, and PPD. Results: A total of 239 women were studied, and 40% were found to have any PPD, i.e., with depressive symptom scores of ≥ 17. The mean ± standard deviation (SD) for FI score and SS scores were 6.47 ± 5.02 and 19.11 ± 4.23 respectively. In adjusted analyses, PPD symptoms were found to be positively associated with FI (unstandardized beta and standardized beta of 0.703 and 0.432 respectively, standard errors =0.093 and p-value < 0.0001) and negatively associated with SS (unstandardized beta and standardized beta of -0.263 and -0.135 respectively, standard errors = 0.111 and p-value = 0.019). Conclusions: Many women in this post-conflict region reported experiencing PPD. In addition, this data suggest that food security and psychosocial support interventions may help mitigate women’s experience of PPD or its severity.

Keywords: postpartum depression, food insecurity, social support, post-conflict region

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4972 Quality of Life among Mothers of Children with Autism Spectrum Disorder in Saudi Arabia

Authors: Asma Alsaleh, Kara Makara

Abstract:

Autistic spectrum disorder (ASD) is a neurodevelopmental condition characterized by difficulties with communication and interaction. Besides presenting challenges for the ASD individual, the condition can entail negative outcomes for those who care for them, most often mothers. While this issue has been studied substantially in Western society, less is known about how mothers in the Arab world are affected by raising an ASD child. This study sought to gain insights into this area by assessing quality of life and stress in mothers with (n = 25) and without (n = 25) ASD children in Riyadh (Saudi Arabia) by using, respectively, the World Health Organization Quality of Life Assessment-BREF (WHOQOL-BREF) and the Parenting Stress Index-Short Form (PSI-SF). Data pertaining to income and education were also attained to investigate how socioeconomic factors interact with the above-mentioned variables. The analysis revealed that total stress scores and scores on the individual subscales of the PSI-SF were significantly higher for the mothers with an ASD child compared to those without an ASD child, though the opposite was true of quality of life scores. Moreover, increased income was associated with increased quality of life and decreased stress. While there were not main effects of education, there were interactions between education, whether children were ASD or non-ASD, and the outcome variables. These results suggest that mothers of ASD children in an Arab culture are at increased risk of negative outcomes relative to mothers of typically developing children, and, therefore, this study may act as a foundation for the delivery of interventions to assist mothers in this position.

Keywords: autism, education, income, mothers, quality of life, stress

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4971 Fiscal Stability Indicators and Public Debt Trajectory in Croatia

Authors: Hrvoje Simovic

Abstract:

Paper analyses the key problems of fiscal sustainability in Croatia. To point out key challenges of fiscal sustainability, the public debt sustainability is analyzed using standard indicators of fiscal stability, accompanied with the identification of regime changes approach in the public debt trajectory using switching regression approach. The analysis is conducted for the period from 2001 to 2016. Results show huge vulnerability in recession period (2009-14), so key challenges in current fiscal policy and public debt management are recognized in maturity prolongation, interest rates trends, and credit rating expectations.

Keywords: fiscal sustainability, public debt, Croatia, budget deficit

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4970 Memory Based Reinforcement Learning with Transformers for Long Horizon Timescales and Continuous Action Spaces

Authors: Shweta Singh, Sudaman Katti

Abstract:

The most well-known sequence models make use of complex recurrent neural networks in an encoder-decoder configuration. The model used in this research makes use of a transformer, which is based purely on a self-attention mechanism, without relying on recurrence at all. More specifically, encoders and decoders which make use of self-attention and operate based on a memory, are used. In this research work, results for various 3D visual and non-visual reinforcement learning tasks designed in Unity software were obtained. Convolutional neural networks, more specifically, nature CNN architecture, are used for input processing in visual tasks, and comparison with standard long short-term memory (LSTM) architecture is performed for both visual tasks based on CNNs and non-visual tasks based on coordinate inputs. This research work combines the transformer architecture with the proximal policy optimization technique used popularly in reinforcement learning for stability and better policy updates while training, especially for continuous action spaces, which are used in this research work. Certain tasks in this paper are long horizon tasks that carry on for a longer duration and require extensive use of memory-based functionalities like storage of experiences and choosing appropriate actions based on recall. The transformer, which makes use of memory and self-attention mechanism in an encoder-decoder configuration proved to have better performance when compared to LSTM in terms of exploration and rewards achieved. Such memory based architectures can be used extensively in the field of cognitive robotics and reinforcement learning.

Keywords: convolutional neural networks, reinforcement learning, self-attention, transformers, unity

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4969 Anti-Fibrillation Propensity of a Flavonoid Baicalein against the Fibrils of Hen Egg White Lysozyme: Potential Therapeutics for Lysozyme Amyloidosis

Authors: Naveed Ahmad Fazili

Abstract:

More than 20 human diseases involve the fibrillation of a specific protein/peptide which forms pathological deposits at various sites. Hereditary lysozyme amyloidosis is a systemic disorder which mostly affects liver, spleen and kidney. This conformational disorder is featured by lysozyme fibril formation. In vivo lysozyme fibrillation was simulated under in vitro conditions using a strong denaturant GdHCl at 3M concentration. Sharp decline in the ANS fluorescence intensity compared to the partially unfolded states, almost 20 fold increase in ThT fluorescence intensity, increase in absorbance at 450 nm suggesting turbidity, negative ellipticity peak in the far-UVCD at 217 nm, red shift of 50 nm compared to the native state in congo red assay and appearance of a network of long rope like fibrils in TEM analysis suggested HEWL fibrillation. Anti-fibrillation potency of baicalein against the preformed fibrils of HEWL was investigated following ThT assay in which there was a dose dependent decrease in ThT fluorescence intensity compared to the fibrillar state of HEWL with the maximum effect observed at 150 μM baicalein concentration, loss of negative ellipticity peak in the far-UVCD region, dip in the Rayleigh scattering intensity and absorbance at 350 nm and 450 nm respectively together with a reduction in the density of fibrillar structure in TEM imaging. Thus, it could be suggested that baicalein could prove to be a positive therapeutics for hereditary human lysozyme amyloidosis.

Keywords: amyloid fibrils, baicalein, congo red, negative ellipticity, therapeutics

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4968 Pattern of Substance Use: Study in a De-Addiction Clinic

Authors: Mohammad Muntasir Maruf, Muhammad Zillur Rahman Khan, Nasim Jahan, Md. Waziul Alam Chowdhury, Satparkash, Md. Nozrul Islam

Abstract:

Background: Substance use disorders have become a major public health problem in Bangladesh. Objectives: The present study was designed to assess the pattern of substance use and factors related to it among the hospitalized patients. Methods: This was a cross-sectional study. All the patients who were admitted in a private drug de-addiction clinic in the capital city (Dhaka) of Bangladesh during 1 July-31 December, 2013 and diagnosed as a case of substance use disorder by applying Structured Clinical Interview for DSM- Clinician Version were enrolled in the study. Data were collected through face to face interview by a semi-structured questionnaire and the information was complemented by the case-notes. Study subjects were 105 in number. Data analysis was performed using Statistical Package for Social Sciences (SPSS). Results: Most (90.5%) of the respondents were male. The mean age of the respondents was 28.8 (± 8.0) years. Majority (91.4%) were poly-substance users. Most (27.6%) respondents used 3 types of substances. Smoking or inhalation was the route used by most (90.5%) respondents. More than three-fourth (81%) of the respondents used nicotine. Among the other substances, majority (79%) used opiates group, followed by cannabinoids group (55.2%) and alcohol (41%). Curiosity, peer pressure and to have enjoyment or fun were identified as the common reasons for initiating substance use. Conclusions: A high proportion of poly-substance use was found. The study findings would help in management and prevention strategy of substance use in Bangladesh.

Keywords: Bangladesh, de-addiction clinic, poly-substance users, substance use disorder

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4967 Identification of Workplace Hazards of Underground Coal Mines

Authors: Madiha Ijaz, Muhammad Akram, Sima Mir

Abstract:

Underground mining of coal is carried out manually in Pakistan. Exposure to ergonomic hazards (musculoskeletal disorders) are very common among the coal cutters of these mines. Cutting coal in narrow spaces poses a great threat to both upper and lower limbs of these workers. To observe the prevalence of such hazards, a thorough study was conducted on 600 workers from 30 mines (20 workers from 1 mine), located in two districts of province Punjab, Pakistan. Rapid Upper Limb Assessment sheet and Rapid Entire Body Assessment sheet were used for the study along with a standard Nordic Musculoskeleton disorder questionnaire. SPSS, 25, software was used for data analysis on upper and lower limb disorders, and regression analysis models were run for upper and lower back pain. According to the results obtained, it was found that work stages (drilling & blasting, coal cutting, timbering & supporting, etc.), wok experience and number of repetitions performed/minute were significant (with p-value 0.00,0.004 and 0.009, respectively) for discomfort in upper and lower limb. Age got p vale 0.00 for upper limb and 0.012 for lower limb disorder. The task of coal cutting was strongly associated with the pain in upper back (with odd ratios13.21, 95% confidence interval (CI)14.0-21.64)) and lower back pain (3.7, 95% confidence interval 1.3-4.2). scored on RULA and REBA sheets, every work-stage was ranked at 7-highest level of risk involved. Workers were young (mean value of age= 28.7 years) with mean BMI 28.1 kg/m2

Keywords: workplace hazards, ergonomic disorders, limb disorders, MSDs.

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4966 Analysis of the Development of Communicative Skills After Participating in the Equine-Assisted-Therapy Program Step-By-Step in Communication

Authors: Leticia Souza Guirra, Márcia Eduarda Vieira Ramos, Edlaine Souza Pereira, Leticia Correa Celeste

Abstract:

Introduction: Studies indicate that equine-assisted therapy enables improvements in several areas of functioning that are impaired in children with autism spectrum disorder (ASD), such as social interaction and communication. Objective: The study proposes to analyze the development of dialogic skills of a verbal child with ASD after participating in the equine-assisted therapy Step By Step in Communication. Method: This is quantitative and qualitative research through a case study. It refers to a 6 years old child diagnosed with ASD belonging to a group of practitioners of the Brazilian National Equine-Assited-Therapy Association. The Behavioral Observation Protocol (PROC) was used to evaluate communicative skills before and after the intervention, which consisted of 24 sessions once a week. Results: All conversational skills increased their frequency, with participation in dialogue and initiation of interaction. The child also increases the habit of waiting for his turn and answering the interlocutor. The emission of topics not related to conversation and echolalia showed a significant decrease after the intervention. Conclusion: The studied child showed improvement in communicative skills after participating in the equine-assisted therapy Step By Step in Communication. Contributions: This study contributes to a greater understanding of the impact of equine-assisted therapy on the communicative abilities of children with ASD.

Keywords: equine-assisted-therapy, autism spectrum disorder, language, communication, language and hearing sciences

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4965 Quasiperiodic Magnetic Chains as Spin Filters

Authors: Arunava Chakrabarti

Abstract:

A one-dimensional chain of magnetic atoms, representative of a quantum gas in an artificial quasi-periodic potential and modeled by the well-known Aubry-Andre function and its variants are studied in respect of its capability of working as a spin filter for arbitrary spins. The basic formulation is explained in terms of a perfectly periodic chain first, where it is shown that a definite correlation between the spin S of the incoming particles and the magnetic moment h of the substrate atoms can open up a gap in the energy spectrum. This is crucial for a spin filtering action. The simple one-dimensional chain is shown to be equivalent to a 2S+1 strand ladder network. This equivalence is exploited to work out the condition for the opening of gaps. The formulation is then applied for a one-dimensional chain with quasi-periodic variation in the site potentials, the magnetic moments and their orientations following an Aubry-Andre modulation and its variants. In addition, we show that a certain correlation between the system parameters can generate absolutely continuous bands in such systems populated by Bloch like extended wave functions only, signaling the possibility of a metal-insulator transition. This is a case of correlated disorder (a deterministic one), and the results provide a non-trivial variation to the famous Anderson localization problem. We have worked within a tight binding formalism and have presented explicit results for the spin half, spin one, three halves and spin five half particles incident on the magnetic chain to explain our scheme and the central results.

Keywords: Aubry-Andre model, correlated disorder, localization, spin filter

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4964 Cytogenetic Investigation of Patients with Disorder of Sexual Development Using G-Banding Karyotype and Fluorescence In situ Hybridization

Authors: Riksa Parikrama, Bremmy Laksono, Dadang S. H. Effendi

Abstract:

Disorder of sexual development (DSD) covers various conditions with a specific term such as Klinefelter syndrome, Turner syndrome, androgen insensitivity syndrome, and many more. The techniques to accurately diagnose those conditions has developed extensively. However, conventional karyotype and fluorescence in situ hybridization (FISH) are still widely used in many genetic laboratories as the basic method to determine chromosomal condition of DSD patients. Cytogenetic study was conducted on 36 DSD patients in Cell Culture and Cytogenetics Laboratory, Faculty of Medicine Universitas Padjadjaran, Indonesia. Most of the patients referred to the laboratory diagnosed with primary amenorrhea, hypospadias, micropenis, genitalia ambiguity, or congenital adrenal hyperplasia. The study used G-banding technique to acquire complete karyotype and followed by FISH as either confirmation or comparison method. Among 36 patients, G-banding karyotype and FISH results showed that two were diagnosed with 45, X (Turner syndrome); three with 47, XXY (Klinefelter syndrome); five with 46, XX DSD; 22 with 46, XY DSD; and four with 46,XY complete androgen insensitivity syndrome. G-banding karyotype analysis were paired with FISH using X and Y chromosome probe produced similar results. The present analysis showed that FISH is a reliable method to attain a rapid and accurate chromosome analysis result of DSD patients. Nevertheless, conventional karyotype technique is still vital if other condition appeared in DSD patients in order to get more detailed karyotype result which FISH method cannot achieve.

Keywords: chromosome, DSD, FISH, karyotype

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4963 In Search of Commonalities in the Determinants of Child Sex Ratios in India and People's of Republic of China

Authors: Suddhasil Siddhanta, Debasish Nandy

Abstract:

Child sex ratios pattern in the Asian Population is highly masculine mainly due to birth masculinity and gender bias in child mortality. The vast and the growing literature of female deficit in world population points out the diffusion of child sex ratio pattern in many Asian as well as neighboring European countries. However, little attention has been given to understand the common factors in different demographics in explaining child sex ratio pattern. Such a scholarship is extremely important as level of gender inequity is different in different country set up. Our paper tries to explain the major structural commonalities in the child masculinity pattern in two demographic billionaires - India and China. The analysis reveals that apart from geographical diffusion of sex selection technology, patrilocal social structure, as proxied by households with more than one generation in China and proportion of population aged 65 years and above in India, can explain significant variation of missing girl child in these two countries. Even after controlling for individual capacity building factors like educational attainment, or work force participation, the measure of social stratification is coming out to be the major determinant of child sex ratio variation. Other socio economic factors that perform much well are the agency building factors of the females, like changing pattern of marriage customs which is proxied by divorce and remarriage ratio for china and percentage of female marrying at or after the age of 20 years in India and the female workforce participation. Proportion of minorities in socio-religious composition of the population and gender bias in scholastic attainment in both these counties are also found to be significant in modeling child sex ratio variations. All these significant common factors associated with child sex ratio point toward the one single most important factor: the historical evolution of patriarchy and its contemporary perpetuation in both the countries. It seems that prohibition of sex selection might not be sufficient to combat the peculiar skewness of excessive maleness in child population in both these countries. Demand sided policies is therefore utmost important to root out the gender bias in child sex ratios.

Keywords: child sex ratios, gender bias, structural factors, prosperity, patrilocality

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4962 The Importance of Mental Health Literacy: Interventions in a Psychiatry Service of Hospital José Joaquim Fernandes, Portugal

Authors: Mariana Mangas, Yaroslava Martins, Ana Charraz, Ana Matos Pires

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Introduction: Health literacy empowers people of knowledge, motivation and skills to access, understand, evaluate and mobilize information relating to health. Although the benefits of public knowledge of physical disease are widely accepted, knowledge about mental disorder has been compatibly neglected. Nowadays there is considerably evidence that literacy is of great importance for the promotion of health and prevention of mental illness. Objective: Disclosure the concept and importance of mental health literacy and introduce the literacy program of Psychiatry Service of Hospital José Joaquim Fernandes. Methodology: A search was conducted on PubMed, using keywords “literacy” and “mental health”. A description of mental health literacy interventions implemented on Psychiatry Service of Hospital José Joaquim Fernandes was performed, namely, psychoeducation programs for depression and bipolar disorder. Results and discussion: Health literacy enables patient to be able to actively participate in his treatment. The improving of mental health literacy can promote early identification of mental disorders, improve treatment results, increase the use of health services and allow the community to take action to achieve better mental health. Psychoeducation is very useful in improving the course of disease and in reducing the number of episodes and hospitalizations. Bipolar patients who received psychoeducation and pharmacotherapy have no relapses during the program and last year. Conclusion: Mental health literacy is not simply a matter of having knowledge, rather, it is knowledge linked to action which can benefit mental health.

Keywords: mental health, literacy, psychoeducation, knowledge, empowerment

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4961 Previously Undescribed Cardiac Abnormalities in Two Unrelated Autistic Males with Causative Variants in CHD8

Authors: Mariia A. Parfenenko, Ilya S. Dantsev, Sergei V. Bochenkov, Natalia V. Vinogradova, Olga S. Groznova, Victoria Yu. Voinova

Abstract:

Introduction: Autism is the most common neurodevelopmental disorder. Autism is characterized by difficulties in social interaction and adherence to stereotypic behavioral patterns and frequently co-occurs with epilepsy, intellectual disabilities, connective tissue disorders, and other conditions. CHD8 codes for chromodomain-helicase-DNA-binding protein 8 - a chromatin remodeler that regulates cellular proliferation and neurodevelopment in embryogenesis. CHD8 is one of the genes most frequently involved in autism. Patients and methods: 2 unrelated male patients, P3 and P12, aged 3 and 12 years old, underwent whole genome sequencing, which determined that they both had different likely pathogenic variants, both previously undescribed in literature. Sanger sequencing later determined that P12 inherited the variant from his affected mother. Results: P3 and P12 presented with autism, a developmental delay, ataxia, sleep disorders, overgrowth, and macrocephaly, as well as other clinical features typically present in patients with causative variants in CHD8. The mother of P12 also has autistic traits, as well as ataxia, hypotonia, sleep disorders, and other symptoms. However, P3 and P12 also have different cardiac abnormalities. P3 had signs of a repolarization disorder: a flattened T wave in the III and aVF derivations and a negative T wave in the V1-V2 derivations. He also had structural valve anomalies with associated regurgitation, local contractility impairment of the left ventricular, and diastolic dysfunction of the right ventricle. Meanwhile, P12 had Wolff-Parkinson-White syndrome and underwent radiofrequency ablation at the age of 2 years. At the time of observation, P12 had mild sinus arrhythmia and an incomplete right bundle branch block, as well as arterial hypertension. Discussion: Cardiac abnormalities were not previously reported in patients with causative variants in CHD8. The underlying mechanism for the formation of those abnormalities is currently unknown. However, the two hypotheses are either a disordered interaction with CHD7 – another chromodomain remodeler known to be directly involved in the cardiophenotype of CHARGE syndrome – a rare condition characterized by coloboma, heart defects and growth abnormalities, or the disrupted functioning of CHD8 as an A-Kinase Anchoring Protein, which are known to modulate cardiac function. Conclusion: We observed 2 unrelated autistic males with likely pathogenic variants in CHD8 that presented with typical symptoms of CHD8-related neurodevelopmental disorder, as well as cardiac abnormalities. Cardiac abnormalities have, until now, been considered uncharacteristic for patients with causative variants in CHD8. Further accumulation of data, including experimental evidence of the involvement of CHD8 in heart formation, will elucidate the mechanism underlying the cardiophenotype of those patients. Acknowledgements: Molecular genetic testing of the patients was made possible by the Charity Fund for medical and social genetic aid projects «Life Genome.»

Keywords: autism spectrum disorders, chromodomain-helicase-DNA-binding protein 8, neurodevelopmental disorder, cardio phenotype

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4960 Approaches to Inducing Obsessional Stress in Obsessive-Compulsive Disorder (OCD): An Empirical Study with Patients Undergoing Transcranial Magnetic Stimulation (TMS) Therapy

Authors: Lucia Liu, Matthew Koziol

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Obsessive-compulsive disorder (OCD), a long-lasting anxiety disorder involving recurrent, intrusive thoughts, affects over 2 million adults in the United States. Transcranial magnetic stimulation (TMS) stands out as a noninvasive, cutting-edge therapy that has been shown to reduce symptoms in patients with treatment-resistant OCD. The Food and Drug Administration (FDA) approved protocol pairs TMS sessions with individualized symptom provocation, aiming to improve the susceptibility of brain circuits to stimulation. However, limited standardization or guidance exists on how to conduct symptom provocation and which methods are most effective. This study aims to compare the effect of internal versus external techniques to induce obsessional stress in a clinical setting during TMS therapy. Two symptom provocation methods, (i) Asking patients thought-provoking questions about their obsessions (internal) and (ii) Requesting patients to perform obsession-related tasks (external), were employed in a crossover design with repeated measurement. Thirty-six treatments of NeuroStar TMS were administered to each of two patients over 8 weeks in an outpatient clinic. Patient One received 18 sessions of internal provocation followed by 18 sessions of external provocation, while Patient Two received 18 sessions of external provocation followed by 18 sessions of internal provocation. The primary outcome was the level of self-reported obsessional stress on a visual analog scale from 1 to 10. The secondary outcome was self-reported OCD severity, collected biweekly in a four-level Likert-scale (1 to 4) of bad, fair, good and excellent. Outcomes were compared and tested between provocation arms through repeated measures ANOVA, accounting for intra-patient correlations. Ages were 42 for Patient One (male, White) and 57 for Patient Two (male, White). Both patients had similar moderate symptoms at baseline, as determined through the Yale-Brown Obsessive Compulsive Scale (YBOCS). When comparing obsessional stress induced across the two arms of internal and external provocation methods, the mean (SD) was 6.03 (1.18) for internal and 4.01 (1.28) for external strategies (P=0.0019); ranges were 3 to 8 for internal and 2 to 8 for external strategies. Internal provocation yielded 5 (31.25%) bad, 6 (33.33%) fair, 3 (18.75%) good, and 2 (12.5%) excellent responses for OCD status, while external provocation yielded 5 (31.25%) bad, 9 (56.25%) fair, 1 (6.25%) good, and 1 (6.25%) excellent responses (P=0.58). Internal symptom provocation tactics had a significantly stronger impact on inducing obsessional stress and led to better OCD status (non-significant). This could be attributed to the fact that answering questions may prompt patients to reflect more on their lived experiences and struggles with OCD. In the future, clinical trials with larger sample sizes are warranted to validate this finding. Results support the increased integration of internal methods into structured provocation protocols, potentially reducing the time required for provocation and achieving greater treatment response to TMS.

Keywords: obsessive-compulsive disorder, transcranial magnetic stimulation, mental health, symptom provocation

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4959 Mothers' Satisfaction with Emergency Care When Their Child Has an Autism Spectrum Disorder

Authors: Merav Ben Natan, Heba Igbarin, Arwa Watted

Abstract:

Introduction: The rising prevalence of autism spectrum disorders (ASD) has heightened the need to understand the challenges faced by children with ASD and their families in emergency departments (EDs). Children with ASD often experience additional health issues and heightened anxiety in the chaotic ED environment, which can impact their care and parental satisfaction. Purpose: This study aimed to examine factors identified by mothers as affecting their satisfaction with the care provided to their children in the ED, among mothers of children with ASD in comparison to mothers of children without ASD. Design and methods: In this correlational quantitative study, 128 Israeli mothers – 59 (46%) mothers of children with ASD and 69 (54%) of children without ASD - completed an online survey based on a Ministry of Health national survey of patient experience. Results: Mothers of children with ASD expressed lower satisfaction with the care provided. The difference was particularly evident concerning waiting times for examination of the child by nurses and physicians in the ED, whether the nurses were attentive and responsive to the mother's questions and concerns, whether the ED staff demonstrated coordination and cooperation with regard to medical care of the child, and whether work in the ED was conducted in an orderly and organized manner. The presence of communication difficulties in children predicted mothers' satisfaction with care. Conclusions: These findings suggest that certain needs of mothers and/or their children with ASD do not receive an appropriate response in the ED. Practice implications: It is important to raise the awareness of healthcare providers in EDs regarding the needs of children with ASD and their parents, especially children with communication difficulties. Strategies should be implemented to improve the experience of children with ASD and their parents in the ED.

Keywords: autism spectrum disorder, emergency department, parental satisfaction, healthcare challenges

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