Young Children with Autism in a Multiethnic Immigrant Population. Prevalence, Feeding Disorders, Early Detection, and Intervention
Abstract
Background: Autism is a neurodevelopmental condition characterized by a pattern of major
impairments in social communication and behavioural/sensory problems, with high rates of coexisting
neurodevelopmental and medical conditions. Over the past decade, there has been a documented rise in
the registered prevalence of autism worldwide. Children born to immigrant parents may face an
increased risk of autism. Several studies tend to suggest that they are often diagnosed with autism
relativity late, potentially depriving them of important early interventions.
Aims: The studies in this thesis were performed in a multiethnic immigrant area in Gothenburg, Sweden,
and had the following primary objectives (1) examine autism prevalence and risk factors, (2) describe
clinical characteristics of autism, including feeding problems, (3) explore psychometric properties of
the instrument Joint Attention Observation Schedule Preschool (JA-OBS preschool) in children with
suspected autism, and (4) describe an intervention program based on the Early Start Denver Model
(ESDM) for young children with autism in a preschool setting and capture the experiences and
perspectives of the preschool staff involved in the implementation of this program.
Methods: Data were collected from a prospective longitudinal study of 46 preschool-aged children
diagnosed with DSM-5 autism living in a multiethnic immigrant population area. Within this
community, a local multidisciplinary team was established, focusing on diagnosis and treatment of early
neurodevelopmental problems in children. All 46 children underwent thorough assessments and
interventions from this team. Medical records from the Child Health Centre and comprehensive
neuropsychiatric assessments were used. Data encompassed the period from pre- and perinatal stages
up to the child’s sixth year of age. Semi-structured interviews were conducted with 15 preschool staff
members working within the area.
Results: The registered prevalence for autism in the area was 3.7%. Notably, a range of risk factors,
including both genetic and non-genetic factors, were identified. A significant proportion of the children
with autism experienced feeding problems (76.1%), with Avoidant/Restrictive Food Intake Disorder
(ARFID) noted in 28.3% of cases. Early onset age and heterogeneity of feeding problems were
highlighted. The internal consistency reliability of the JA-OBS Preschool was estimated at 0.8
(Cronbach’s alpha) and percent agreement across raters ranged from 76.9% to 100%. Central
components of the intervention program, grounded in the ESDM framework, were emphasised by the
preschool staff. These encompassed contextual prerequisites, such as the preschool staff’s participation
in intervention program fostered by the local environment and features linked to the ESDM
methodology. The preschool staff’s experiences indicated that the implementation of ESDM
significantly enriched the learning experiences of children with autism, their parents, fellow peers within
the preschool, as well as the staff members themselves.
Conclusions: A high prevalence of autism among children within this immigrant population was found.
Multiple associated factors for autism were documented, along with substantial individual needs of both
the children and their families. This encompassed very high rates of early feeding problems and ARFID.
The results underscore the imperative to develop multidisciplinary models in healthcare that increase
accessibility to services for children with autism in immigrant communities. In that effort, the
multidisciplinary team exemplifies how multi-faceted approaches can address immigrant families’ many
needs and support health equity. Preschools may hold significant potential for the early identification of
autism indicators. The intervention program based on the ESDM presents a promising model for young
children with autism in the multiethnic immigrant setting.
Parts of work
1. Linnsand P, Gillberg C, Nilses Å, Hagberg B, Nygren G. A High Prevalence of Autism Spectrum Disorder in Preschool Children in an Immigrant, Multiethnic Population in Sweden: Challenges for Health Care Journal of Autism and Developmental Disorders. 2020; 51:538-549 http://doi.org/10.1007/s10803-020-04563-8 2. Nygren G, Linnsand P, Hermansson J, Dinkler L, Johansson M, Gillberg C. Feeding Problems Including Avoidant Restrictive Food Intake Disorder in Young Children with Autism Spectrum Disorder in a Multiethnic Population Frontiers in Pediatrics. 2021; 9:780680 http://doi.org/10.3389/fped.2021.780680 3.Linnsand P, Hermansson J, Gillberg, C, Nygren G. A Feasibility Study of a New Instrument for Detection of Autism Signs in Preschool Settings. Psychometric Properties of the Joint Attention Observation Schedule Preschool (JA-OBS preschool) Frontiers in Child and Adolescent Psychiatry. 2022; 1:1061451 http://doi.org/10.3389/frcha.2022.1061451 4. Linnsand P, Nygren G, Hermansson J, Gillberg C, Carlsson E. Integrating an Early Start Denver Model Program into Swedish Preschools for Young Children with Autism in a Multiethnic Immigrant Setting. In manuscript
Degree
Doctor of Philosophy (Medicine)
University
University of Gothenburg. Sahlgrenska Academy
Institution
Institute of Neuroscience and Physiology. Department of Psychiatry and Neurochemistry
Disputation
Fredagen den 8 december, kl 13.00, Hörsal K Isaksson, Medicinaregatan 16, Göteborg
https://gu-se.zoom.us/j/67827858536?pwd=ZVJGdDl3cm5jOTJ6MjZ2ZU9iRUhpUT09
Date of defence
2023-12-08
petra.linnsand@gu.se
Date
2023-11-14Author
Linnsand, Petra
Keywords
Autism
Young children
Immigrant Population
Prevalence
Feeding Disorders
ARFID
Early Detection and Intervention
Early Start Denver Model
Publication type
Doctoral thesis
ISBN
978-91-8069-507-7 (PRINT)
978-91-8069-508-4 (PDF)
Language
eng