The Experiences of Family Caregivers of Children Living with Autism Spectrum Disorder

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Publisher :
ISBN 13 :
Total Pages : 112 pages
Book Rating : 4.:/5 (128 download)

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Book Synopsis The Experiences of Family Caregivers of Children Living with Autism Spectrum Disorder by : Siluleko Zamokuhle L. Zulu

Download or read book The Experiences of Family Caregivers of Children Living with Autism Spectrum Disorder written by Siluleko Zamokuhle L. Zulu and published by . This book was released on 2019 with total page 112 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Personality Theory in a Cultural Context

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Publisher :
ISBN 13 : 9780757579936
Total Pages : 500 pages
Book Rating : 4.5/5 (799 download)

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Book Synopsis Personality Theory in a Cultural Context by : Mark D. Kelland

Download or read book Personality Theory in a Cultural Context written by Mark D. Kelland and published by . This book was released on 2010-07-19 with total page 500 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Predicting Caregiver and Family Quality of Life for Caregivers of Children with Autism Spectrum Disorder (ASD)

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Publisher :
ISBN 13 :
Total Pages : 179 pages
Book Rating : 4.:/5 (11 download)

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Book Synopsis Predicting Caregiver and Family Quality of Life for Caregivers of Children with Autism Spectrum Disorder (ASD) by : Kerry Ryan Thompson

Download or read book Predicting Caregiver and Family Quality of Life for Caregivers of Children with Autism Spectrum Disorder (ASD) written by Kerry Ryan Thompson and published by . This book was released on 2017 with total page 179 pages. Available in PDF, EPUB and Kindle. Book excerpt: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that is expressed quite differently from person to person due to the spectrum of symptoms an individual may experience. Developmentally, children who have ASD manage issues with communication and restricted or repetitive behaviors that impact their activities of daily living and/or overall functioning (American Psychiatric Association, 2013). The ongoing care and assistance for children with ASD from their caregivers is vital to help them achieve and maintain optimal quality of life. Given the pervasive needs of children with ASD, caregivers have a unique role in providing for their child, as compared to caregivers of children without disabilities. The present study explored the caregiver in a family with a child with ASD. Applying a family systems perspective, Bishop's (2005a, 2005b) Disability Centrality Model constructs (i.e. role impact, relationship satisfaction, mastery) were used to explain caregiver and family quality of life. In addition, family quality of life was measured in such a way to incorporate Bishop's idea of centrality, or the importance an individual places on certain areas of life. A three-step statistical analysis was completed in order to better measure this conceptualization. This study included 204 caregivers who met the criteria for the study (i.e., caregiver of a child with ASD under the age of 18; self-reported reading level of 6th grade or above). Hayes' regression based path-analytic framework, PROCESS v2.16 was used to determine the explained variance of caregiver and family quality of life. In addition, correlational and moderation analyses were tested. Results suggested that the caregiver's perceived quality of life is positively correlated with the caregiver's perceived family quality of life. In addition, results indicated that the proposed path analyses explained 52.3% of the variance in caregiver quality of life, 44.4% variance for the weighted family quality of life model, and between 23.1-45.2% variance in the five-individual family quality of life-satisfaction domains (i.e, family interaction, parenting, emotional well-being, physical/material well-being, disability-related support). Finally, to better understand the impact of importance on quality of life, a three-step statistical analysis found that importance was significant when used as a weighted measurement of family quality of life that took the importance and satisfaction in consideration in their relation to one another; however, importance was not significant as a moderator between the relationship of caregiver relationship satisfaction and family quality of life. The findings in this study expand the current literature on caregivers of children with ASD, caregiver quality of life, and family quality of life. In addition, this study demonstrated the viability of strengths-based models of caregiver and family quality of life using Disability Centrality Model constructs through a family systems perspective for a sample of caregivers of children with ASD. Future implications for rehabilitation research and practice are discussed.

Making Homes That Work

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Publisher :
ISBN 13 : 9781927771006
Total Pages : 96 pages
Book Rating : 4.7/5 (71 download)

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Book Synopsis Making Homes That Work by : George Braddock

Download or read book Making Homes That Work written by George Braddock and published by . This book was released on 2013 with total page 96 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Essentials of Adaptive Behavior Assessment of Neurodevelopmental Disorders

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Publisher : John Wiley & Sons
ISBN 13 : 1119075459
Total Pages : 208 pages
Book Rating : 4.1/5 (19 download)

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Book Synopsis Essentials of Adaptive Behavior Assessment of Neurodevelopmental Disorders by : Celine A. Saulnier

Download or read book Essentials of Adaptive Behavior Assessment of Neurodevelopmental Disorders written by Celine A. Saulnier and published by John Wiley & Sons. This book was released on 2018-05-01 with total page 208 pages. Available in PDF, EPUB and Kindle. Book excerpt: A practical guide to adaptive behaviors across a range of neurodevelopmental disorders Adaptive behavior assessment measures independent living skills, including communication, social skills, personal care, and practical work skills. For individuals with intellectual disabilities, evaluation of these skills is a critical tool for measuring eligibility and can identify specific skills that must be learned before effective educational interventions can be implemented. Essentials of Adaptive Behavior Assessment of Neurodevelopmental Disorders describes the role of adaptive behavior in assessment and treatment, and provides clear guidance for measurement. Case samples provide real-world illustration of behaviors and assessment, and systematic comparison of various measures are presented and explained to better inform planning. Individual chapters outline specific adaptive behaviors across a range of neurodevelopmental disorders, giving clinicians, practitioners, students, and researchers a better understanding of diagnostic differentials and how to place independent skill programming in treatment and intervention. Plan intervention and treatment based on accessible measurement guidelines across a range of disorders Gain a deeper understanding of adaptive functioning specific to ADHD, autism spectrum disorders, disruptive behavior disorders, and genetic disorders Compare and contrast current measures to evaluate their strengths, weaknesses, and areas of overlap Quickly locate essential information with Rapid Reference and Caution boxes For individuals with neurodevelopmental disorders, adaptive behaviors are the keys to independence; without them, these individuals will perpetually struggle with achieving optimum independence without the basic skills needed to function at home, in school, and in the community. Assessment allows these skills to be factored in to treatment and intervention planning, and can help improve the outcomes of other intervention methods. Essentials of Adaptive Behavior Assessment of Neurodevelopmental Disorders clarifies the assessment of these important behaviors, helping clinicians make more informed decisions around diagnosis, education, and treatment planning.

Autism Spectrum Disorders in Adults

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Publisher : Springer
ISBN 13 : 331942713X
Total Pages : 278 pages
Book Rating : 4.3/5 (194 download)

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Book Synopsis Autism Spectrum Disorders in Adults by : Bernardo Barahona Corrêa

Download or read book Autism Spectrum Disorders in Adults written by Bernardo Barahona Corrêa and published by Springer. This book was released on 2017-04-13 with total page 278 pages. Available in PDF, EPUB and Kindle. Book excerpt: In this book a group of international experts guide the reader through the clinical features of adults with autism spectrum disorders, describe the care needs of patients and their families, explain the evolution of the disorders into old age, and highlight what can be done to help. Detailed attention is paid to the medical and psychiatric problems of adults with these disorders and the approach to their education and professional integration. In addition, expert neuroscientists summarize current views on the neurobiology of autism. Autism spectrum disorders are devastating neurodevelopmental disorders. Although diagnosis and therapeutic interventions usually take place in infancy, they are chronic lifelong conditions. Surprisingly, the literature on autism spectrum disorders in adults is scarce. Moreover, most mental health professionals working with adults have little training in autism, and adult mental health services around the world are rarely prepared to address the needs of these patients, which tend to increase with age. This book therefore fills a crucial gap in the literature and will prove useful for all who care for and deal with adults in the Autistic Spectrum.

Autism and Asperger Syndrome

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Publisher : Oxford University Press
ISBN 13 : 019850490X
Total Pages : 170 pages
Book Rating : 4.1/5 (985 download)

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Book Synopsis Autism and Asperger Syndrome by : Simon Baron-Cohen

Download or read book Autism and Asperger Syndrome written by Simon Baron-Cohen and published by Oxford University Press. This book was released on 2008-05-29 with total page 170 pages. Available in PDF, EPUB and Kindle. Book excerpt: "In this book Simon Baron-Cohen summarizes the current understanding of autism and Asperger Syndrome. He explains the process of diagnosis, as well as the options for education and intervention for those with these conditions. Taking a lifespan approach, Professor Baron-Cohen considers how the conditions affect very young children through to adulthood. He also outlines his new Empathizing-Systemizing (ES) theory, which aims to explain all of the psychological features of autistic-spectrum conditions." "This book is designed firstly for people with these conditions and their families. It will be useful to clinicians, teachers, and other professionals involved in the care and support of people on the autistic-spectrum. The book will also provide an introduction to the topic for students in the social and biological sciences."--BOOK JACKET.

Adolescents and Adults with Autism Spectrum Disorders

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Publisher : Springer Science & Business
ISBN 13 : 1493905066
Total Pages : 346 pages
Book Rating : 4.4/5 (939 download)

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Book Synopsis Adolescents and Adults with Autism Spectrum Disorders by : Fred R. Volkmar

Download or read book Adolescents and Adults with Autism Spectrum Disorders written by Fred R. Volkmar and published by Springer Science & Business. This book was released on 2014-04-18 with total page 346 pages. Available in PDF, EPUB and Kindle. Book excerpt: The research on children with autism spectrum disorders (ASD) is extensive and growing. Although these conditions are recognized as affecting the entire lifespan, the literature on ASD after childhood is limited and has not been brought together in a single volume in over a decade. Adolescents and Adults with Autism Spectrum Disorders fills this knowledge gap by focusing on needs and difficulties unique to these stages of development. Expert contributors offer cogent reviews of complex issues, from education to employment, leisure activities to illegal behaviors, mental health issues to medical health concerns. The latest findings in key areas, such as psychosocial and residential treatments, social skills programs, epidemiology, the impact of ASD on families, are examined in detail. Throughout the volume, coverage focuses on areas requiring improved models of assessment, updated data, new interventions and increased support services. Featured topics include: Transition from high school to adulthood for adolescents and young adults with ASD. Innovative programming to support college students with ASD. Romantic relationships, sexuality and ASD. Treatment of mental health comorbidities. Assessment and treatment planning in adults with ASD. The range of outcomes and challenges in middle and later life. Adolescents and Adults with Autism Spectrum Disorders is a must-have reference for a wide range of clinicians and practitioners – as well as researchers and graduate students – in clinical child, school and developmental psychology; child and adolescent psychiatry; social work; rehabilitation medicine/therapy; education and general practice/family medicine. It will also serve as an important resource for parents and caregivers with its focus on translating the current state of knowledge relevant to understanding adolescents and adults with ASD into practical and relevant recommendations on how best to support them.

Determinants of Quality of Life in Caregivers of Children with Autism and Autism Concerns

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Publisher :
ISBN 13 :
Total Pages : 76 pages
Book Rating : 4.:/5 (18 download)

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Book Synopsis Determinants of Quality of Life in Caregivers of Children with Autism and Autism Concerns by : Colleen M. Harker

Download or read book Determinants of Quality of Life in Caregivers of Children with Autism and Autism Concerns written by Colleen M. Harker and published by . This book was released on 2018 with total page 76 pages. Available in PDF, EPUB and Kindle. Book excerpt: Given the unique demands of raising a child with autism spectrum disorder (ASD), it is necessary to understand the impact on the quality of life (QoL) of their caregivers. Though QoL is considered an important outcome in health services research (Moons et al., 2006; Oliveira, Carvalho, & Esteves 2016), there is a lack of knowledge about QoL in caregivers of children with ASD or caregivers of children for whom there are ASD concerns, but no formal diagnosis. The objectives of the current study were to (1) Examine how having a young child with ASD or ASD concerns affects caregiver QoL, relative to children with other developmental concerns and typical development; (2) Examine profiles across QoL domains within each caregiver group to determine which QoL domains were most impacted relative to other domains; (3) Examine to what extent three levels of determinants contribute to caregiver QoL: family demographic (child age, family income, caregiver employment status, number of children in the home), psychological (parenting stress), and health care (family-centered care); and 4) (Exploratory) Examine the extent to which family centered care moderates the relation between parenting stress and QoL. The sample was drawn from a larger NIH study examining screening and referral practices for children with ASD in primary care provider (PCP) practices and early intervention (EI) agencies in Washington State. The sample was comprised of three groups: caregivers of children with ASD or ASD concerns (ASD/ASD Concerns; n = 42), caregivers of children with other developmental concerns (Other Concerns; n = 34), and caregivers of children with typical development (No Concerns; n = 112). Caregivers completed a measure of family demographics, parenting stress, family-centered care, and QoL at their time of entry in the study. Results indicated that caregivers in the ASD/ASD Concerns group reported significantly lower Psychological and Social QoL than caregivers in the Other Concerns group and the No Concerns group, and significantly lower Environmental QoL and Physical QoL than caregivers in the No Concerns group (Objective 1). For caregivers in the ASD/ASD Concerns group, Social QoL was significantly lower than Environmental and Physical QoL and Psychological QoL was significantly lower than Environmental QoL (Objective 2). Income, parenting stress, and family-centered care were significant predictors for all four QoL domains, while the number of children residing in the home was a significant predictor for Physical QoL only. There was also a significant group by stress interaction for Environmental QoL, such that there was a stronger negative relationship between parenting stress and Environmental QoL for caregivers in the ASD/ASD Concerns group compared to caregivers in the No Concerns group (Objective 3). Family-centered care did not moderate the relationship between parenting stress and QoL as predicted (Objective 4). Overall, these findings suggest that future research is needed to determine how to provide additional support to all caregivers, particularly low-income families and caregivers who are experiencing high levels of parenting stress and low levels of family-centered care.

Applied Regression Analysis and Generalized Linear Models

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Publisher : SAGE Publications
ISBN 13 : 1483321312
Total Pages : 612 pages
Book Rating : 4.4/5 (833 download)

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Book Synopsis Applied Regression Analysis and Generalized Linear Models by : John Fox

Download or read book Applied Regression Analysis and Generalized Linear Models written by John Fox and published by SAGE Publications. This book was released on 2015-03-18 with total page 612 pages. Available in PDF, EPUB and Kindle. Book excerpt: Combining a modern, data-analytic perspective with a focus on applications in the social sciences, the Third Edition of Applied Regression Analysis and Generalized Linear Models provides in-depth coverage of regression analysis, generalized linear models, and closely related methods, such as bootstrapping and missing data. Updated throughout, this Third Edition includes new chapters on mixed-effects models for hierarchical and longitudinal data. Although the text is largely accessible to readers with a modest background in statistics and mathematics, author John Fox also presents more advanced material in optional sections and chapters throughout the book. Accompanying website resources containing all answers to the end-of-chapter exercises. Answers to odd-numbered questions, as well as datasets and other student resources are available on the author′s website. NEW! Bonus chapter on Bayesian Estimation of Regression Models also available at the author′s website.

Stress and Coping in Autism

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Publisher : Oxford University Press, USA
ISBN 13 : 9780195182262
Total Pages : 484 pages
Book Rating : 4.1/5 (822 download)

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Book Synopsis Stress and Coping in Autism by : M. Grace Baron

Download or read book Stress and Coping in Autism written by M. Grace Baron and published by Oxford University Press, USA. This book was released on 2006 with total page 484 pages. Available in PDF, EPUB and Kindle. Book excerpt: Publisher description

The Division of Family Work Among Fathers and Mothers of Children with an Autism Spectrum Disorder

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Publisher :
ISBN 13 :
Total Pages : 189 pages
Book Rating : 4.:/5 (88 download)

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Book Synopsis The Division of Family Work Among Fathers and Mothers of Children with an Autism Spectrum Disorder by : Paula L. Ogston-Nobile

Download or read book The Division of Family Work Among Fathers and Mothers of Children with an Autism Spectrum Disorder written by Paula L. Ogston-Nobile and published by . This book was released on 2014 with total page 189 pages. Available in PDF, EPUB and Kindle. Book excerpt: [A]n often ignored aspect of parenting and family work is the responsibility-related caregiving (i.e. the monitoring, arranging, and planning) that is done to ensure that a child is cared for. Among fathers and mothers who have a child with an autism spectrum disorder (ASD), the intensity of meeting these needs is greater than for a typically developing child (e.g. additional coordination of schooling, interventions, healthcare, recreation, respite, and after-school services). As is the case for all parents, they must also attend to the demands of household labor (e.g. car maintenance, groceries, laundry, yard care), nurture their relationships (e.g. partner, friends, other family members) and find time to pursue interests outside of the home. The aim of this study was to examine parents' management of and satisfaction with the division of responsibility-related caregiving and household labor, parenting stress, the couple's relationship quality, and family functioning among parents of children with an ASD. Fathers (n = 66) and mothers (n = 104) of school-age children with an ASD responded to an online questionnaire. Most parents (mean 41.4 y.) were white (95%) and well-educated (98% had at least some college). All lived in the United States with the child and the child' s other parent. Parents provided information about their child (82% boys, mean 8.8 y.), including level of functioning. Fathers managed less responsibility-related caregiving than mothers, but they did not differ in their management of household labor. Parents were most satisfied with how the family work was shared when they managed less of it; however, when one parent always managed the work, satisfaction with the couple' s relationship was lowest and parenting stress was highest. Satisfaction with how the family work was shared was positively associated with overall family functioning. In general, parents, couples, and families fare better when the management of family work is shared between parents. Findings will further our understanding of the experience of fathers and mothers who have a child with an ASD, and may aid in our efforts to best support families affected by the autism spectrum disorders.

A Comprehensive Book on Autism Spectrum Disorders

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Author :
Publisher : BoD – Books on Demand
ISBN 13 : 9533074949
Total Pages : 491 pages
Book Rating : 4.5/5 (33 download)

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Book Synopsis A Comprehensive Book on Autism Spectrum Disorders by : Mohammad-Reza Mohammadi

Download or read book A Comprehensive Book on Autism Spectrum Disorders written by Mohammad-Reza Mohammadi and published by BoD – Books on Demand. This book was released on 2011-09-15 with total page 491 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.

Children with Hearing Loss

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Publisher :
ISBN 13 : 9780966182651
Total Pages : 0 pages
Book Rating : 4.1/5 (826 download)

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Book Synopsis Children with Hearing Loss by : David Luterman

Download or read book Children with Hearing Loss written by David Luterman and published by . This book was released on 2006 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Written for parents, siblings and extended family members who want a better understanding of the impact hearing loss can have in their young loved one. Hearing loss in children can have more devastating effects than in adults because it can impair the ability to learn vocabulary, grammar, word order, idiomatic expressions and other aspects of verbal communication. This is a guide on how to address the most important educational issues and processes through the school years, including legal rights and legislation. It also addresses the profound emotional impact hearing loss can have on a child and how it can affect the entire family dynamic. Readers can even prevent some of the pitfalls common among families new to a child with hearing loss. This book also covers the latest technology available to these children, especially in the classroom, including assistive listening devices, hearing aids and cochlear implants and dispels myths associated with wearing amplified.

Sleep and Quality of Life Among Family Caregivers with Children who Have Autism Spectrum Disorders

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Publisher :
ISBN 13 :
Total Pages : 162 pages
Book Rating : 4.:/5 (94 download)

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Book Synopsis Sleep and Quality of Life Among Family Caregivers with Children who Have Autism Spectrum Disorders by : Maureen Russell

Download or read book Sleep and Quality of Life Among Family Caregivers with Children who Have Autism Spectrum Disorders written by Maureen Russell and published by . This book was released on 2014 with total page 162 pages. Available in PDF, EPUB and Kindle. Book excerpt: Autism spectrum disorder (ASD) holds potential for significantly impacting the primary caregiver and family, as well as the child with ASD. In particular, sleep problems occur frequently among children with ASD, and their poor sleep may negatively affect that of their caregivers. Health-related quality of life (HRQoL) and Family Quality of Life (FQoL) are salient indices of caregiver and family well-being. This pilot study explored associations between family caregiver sleep problems and caregiver sense of coherence (SOC) or coping on HRQoL and FQoL. Additionally, this study examined relationships between child sleep and behavior problems on caregiver sleep and well-being. Sixty-two family caregivers of children with ASD (M =7.61, range: 6-11 years old) participated in this survey study. Participants provided demographic information and completed measures of HRQoL, FQoL, caregiver sleep, SOC, parental stress, child sleep, and child behavior. Caregivers with longer sleep duration reported better mental health and better FQol. Caregivers who reported insomnia symptoms, non-restorative sleep, and insufficient sleep were more likely to report poorer mental health than caregivers who did not report these sleep disorder symptoms. A stronger caregiver SOC was associated with lower caregiver stress, better mental health, and better FQoL. Significant relationships were found between shorter caregiver sleep duration or sleep disorder symptoms (i.e., difficulty staying asleep, early morning awakening, insufficient sleep) and greater child sleep problems. Moreover, short sleep duration or insufficient sleep among caregivers was significantly associated with greater parenting stress. Notably, biological parents with Restless Legs Syndrome (RLS) had children with more restless sleep and higher rates of some behavior problems. There are a number of potential connections between sleep problems of children with ASD and sleep problems of their caregivers that are likely rooted in genetic, environmental, socio-economic, and behavioral factors. Interventions for sleep problems must address the context of the family and consider that sleep problems may be common to the caregiver and the child. The results of this study support findings from many prior studies and point to salient variables for future research and interventions to promote healthy caregiver sleep.

Comprehensive Guide to Autism

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Publisher : Springer
ISBN 13 : 9781461447870
Total Pages : 0 pages
Book Rating : 4.4/5 (478 download)

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Book Synopsis Comprehensive Guide to Autism by : Vinood B. Patel

Download or read book Comprehensive Guide to Autism written by Vinood B. Patel and published by Springer. This book was released on 2013-10-15 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Autism is a complex multifaceted disorder affecting neurodevelopment during the early years of life and, for many, throughout the life span. Inherent features include difficulties or deficits in communication, social interaction, cognition, and interpersonal behavioral coordination, to name just a few. Autism profoundly impacts the affected individual, the family, and, in many cases, the localized communities. The increased prevalence of childhood autism has resulted in rapid developments in a wide range of disciplines in recent years. Nevertheless, despite intensive research, the cause(s) remain unresolved and no single treatment strategy is employed. To address these issues, Comprehensive Guide to Autism is an all-embracing reference that offers analyses and discussions of contemporary issues in the field of autism. The work brings together scientific material from leading experts in the field relating to a wide range of important current topics, such as the early identification and treatment of children with autism, pertinent social and behavioral studies, recent developments in genetics and immunology, the influence of diet, models of autism, and future treatment prospects. Comprehensive Guide to Autism contains essential readings for behavioral science researchers, psychologists, physicians, social workers, parents, and caregivers.

My Andrew

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Publisher : AAPC Publishing
ISBN 13 : 9781931282307
Total Pages : 180 pages
Book Rating : 4.2/5 (823 download)

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Book Synopsis My Andrew by : Wallis A. Simpson

Download or read book My Andrew written by Wallis A. Simpson and published by AAPC Publishing. This book was released on 2007 with total page 180 pages. Available in PDF, EPUB and Kindle. Book excerpt: Discovering that your child has a permanent pervasive developmental disorder is a shock to any parent. At first, it is hard to believe that the diagnosis is true. But quickly, you begin to immerse yourself in information to learn as much as you can, as quickly as you can. When the author's son was diagnosed with ASD at the age of four, she began collecting files of paperwork from doctors and therapists, test results, IEPs, and her own journal writings. She later combined it in chronological order and used it as a resource to explain her son to teachers, grandparents, caregivers, therapists, and other parents. The result is My Andrew, a heartfelt look into the first eight years of a family's journey to raise their son with autism. Presented in a journal format, this book presents what ASD means to a family's everyday life ? it highlights the ups and downs, the victories and the setbacks.