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    Support needs of ASD families in the Manawatu DHB catchment area : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Manawatū, New Zealand
    (Massey University, 2018) West, David Hyrum James
    Autistic Spectrum Disorder (ASD) is becoming increasingly understood as being both widely heterogeneous and complex for the individual on the spectrum. Similarly, families are also highly variable and complex; they are arguably the most important support unit a child with ASD has, with their own resources, constraints, values and beliefs. Service individualisation, which accounts for such variances within the individual, and the collective, is broadly seen as critical for service delivery success. To date, little research has gauged the extent of ASD service individualisation abroad, and an understanding of how this is done in Aotearoa New Zealand is absent. The intent of this research was to investigate whether or not existing services and supports target the uniqueness of both the individual with ASD, and their families to enable them to participate in society. In particular, a key focus was if services are appropriate, accessible and sufficient. To accomplish the intent of the research a concurrent triangulation mixed-methods design was utilised. Both quantitative and qualitative data was gathered from caregivers of autistic children – firstly, through an online survey featuring several lifespan themes, and subsequently, qualitative data was collected through caregiver interviews carried out with participants recruited from the MidCentral and Nelson Marlborough District Health Board (DHB) areas. Analyses of the prioritised qualitative data indicated that a variety of service delivery factors prevented families with autistic children from optimal functioning, and participating in society. Furthermore, systemic issues were theorised to be the underlying causes of several of the difficulties faced by autistic children, and their families. The importance of individualised care packages that meet the needs of the families spoken to was emphasised, and the 'wicked problem' (Stace, 2011) of services that are appropriate, accessible and adequate remains ongoing. Recommendations for meeting the needs of individuals with ASD and their families are discussed.
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    Enhancing augmentative and alternative communication use through collaborative planning and peer modelling : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Educational Psychology, Massey University, Albany, New Zealand
    (Massey University, 2017) Young, Amy
    Communication difficulties are a core feature of autism spectrum disorder (ASD). It is estimated that 30-50% of children and adults with ASD do not develop sufficient spoken language to meet their daily communication needs. As well as difficulties with producing spoken language, children with ASD exhibit challenges with social-communication, for example, they may use a limited range of communicative functions and/or have difficulty initiating and responding to social interactions. For children who have difficulty producing spoken language, augmentative and alternative communication (AAC) systems can provide an accessible and functional means of communication. In order for children who are learning to use AAC to become competent communicators, they must have frequent exposure to high quality language interactions with skilled communication partners. While there is an evidence base showing that behavioural, requesting focussed interventions can be effective in some circumstances for children with ASD, concerns about generalisability, and the lack of socio-communicative focus have led to calls for more naturalistic, social communication interventions. This study focused on investigating ways of supporting a child’s social communication using AAC within an interactional activity in the natural environment of his classroom. A descriptive case-study design was used to document the implementation of a four-phase, peer-mediated AAC intervention in an inclusive classroom. The focus was on social communication, and the intervention was developed and enacted in a collaborative partnership with the classroom teacher. In conducting this study, multiple sources of data, including interviews, observations, and data from an AAC system, were collated and analysed. From this analysis, three key themes emerged: a) enhanced participation, b) creation of a communicably accessible environment, and c) increased teacher agency. These themes suggest positive outcomes for a naturalistic, social-communication intervention, adding to the calls for further research development in this area.
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    Raising a child with an Autism Spectrum Disorder : the experience of stigma by association, its impact on caregiver wellbeing, the influence of signature strengths, and the experience of growth : a thesis presented in partial fulfillment of the requirements for the degree of Doctorate of Clinical Psychology at Massey University, Manawatu, New Zealand
    (Massey University, 2017) Weastell, Katie
    The life of a child with an Autism Spectrum Disorder (ASD) is known to include many difficulties, not only due to social, behavioural and communication difficulties, but also as the child does not fit society’s specifications of ‘normal.’ Stressors encountered by caregivers raising a child with an ASD are well documented; however one often overlooked stressor for caregivers is stigma by association. Research to date has begun to explore the impact of stigma by association on the wellbeing of caregivers raising children with an ASD. However research is scarce, and has not yet addressed how some caregivers who experience stigma by association manage to resist this negative influence. Through two studies this thesis explored the experience of caregivers of children with ASDs New Zealand, looking in particular at stigma by association and whether personal signature strengths (particularly hope, gratitude and curiosity) may decrease its impact on caregiver wellbeing. It also examined whether, in spite of documented negative outcomes for caregivers, there is in fact room for a caregiver to experience growth as a byproduct of raising a child with an ASD. Participants took part in interviews (Study One, six participants), or completed an online questionnaire (Study Two, 100 participants). All caregivers spoke of difficulties associated with raising their child which on the whole reflected previous research. Difficulties included practical restrictions, personal costs and social stigma. Every caregiver was found to have experienced stigma by association. Study Two participants had all encountered both enacted and internalised stigma by association in the previous six months, and stigma by association had a significant negative relationship with caregiver wellbeing. Positively, if a caregiver possessed higher levels of hope or gratitude, mediation analysis found the presence of these strengths decreased the influence of stigma by association on wellbeing. Promisingly, all caregivers were also able to identify many ways in which they had grown as a byproduct of the experience of raising their child, whether it was through increased positive emotions, experiences, or personal development. Findings suggest that in spite of caregiver’s challenges they may not only survive, but thrive.
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    Associations between sensory issues, mealtime behaviours, and food and nutrient intakes in children with Autism Spectrum Disorder : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Human Nutrition and Dietetics at Massey University, Albany, New Zealand
    (Massey University, 2016) Taylor, Nicole
    Background: Sensory issues are defined as dysfunction within the integration of the seven senses within the brain. Dysfunction can lead to issues within higher-level integrative functions such as social participation and planning and praxis, and lead to atypical responses to one’s environment. Sensory issues are highly prevalent in children with Autism Spectrum Disorder (ASD) and have been associated with difficult mealtime behaviours. It is not known if sensory issues are associated with food or nutrient intake in ASD children living in New Zealand (NZ). Nutritional deficits during development could have compounding effects on cognition and behaviour in ASD. Methods: Analysis of baseline data from an ongoing randomised-controlled trial was undertaken. Using a cross-sectional observational study design we investigated associations of sensory issue severity with frequency of difficult mealtime behaviour and food and nutrient intakes of children aged 2.5–8 years with ASD in NZ. The Sensory Processing Measure (SPM), Behavioural Paediatric Feeding Assessment Scale, Dietary Intake for Child’s Eating (DICE), and four-day food diaries were used to measure sensory issues, difficult mealtime behaviours, food intake, and nutrient intake, respectively. Results: Of 113 participants, 90.2% of children had sensory issues, and 41.5% of children had clinical difficult mealtime behaviours. An increase in sensory issue severity corresponded to an increase in frequency of difficult mealtime behaviours (r=.265, p=.007). Social participation issue severity was inversely associated with the total DICE score (r=-.305, p=.003). More than 50% of the children did not meet Ministry of Health recommendations for servings of fruit, vegetables, breads and cereals, milk and milk products, or nutrient intakes for calcium. Neither sensory issue severity nor frequency of difficult mealtime behaviours appeared to be associated with food and nutrient intakes. Conclusion: Sensory issues are highly prevalent in ASD children and sensory issue severity is positively associated with frequency of difficult mealtime behaviours. Intervention is required in a number of children with ASD to ensure food and nutrient intake recommendations are met.
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    Developing reading comprehension for children with Autism Spectrum Disorder through concrete representations : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Educational Psychology at Massey University, Albany, New Zealand
    (Massey University, 2016) Serci, Amanda
    The ability to comprehend written text is an essential skill for all students, leading to their increased engagement at school, and the development of communication and cognitive skills. Recent research has found that a significant number of students with autism spectrum disorder (ASD) may have fluent word reading skills, but often experience difficulties with reading comprehension. Research is limited on this topic, and there are few studies that have identified strategies that enhance comprehension for learners with ASD. In the present study, the researcher investigated whether it was possible for students with ASD to improve their reading comprehension through a multimodal, researcher developed intervention, “Show Me’. Concrete figures and objects representing text features were manipulated by the students in accordance with the text they read, as a scaffold to assist their understanding. A single subject multiple baseline design was utilised to assess the effect of the intervention on the reading comprehension ability of three participants (aged 7-10 years old) with ASD. The results established a functional relationship between the independent variable, the ‘Show Me’ intervention, and participants’ ability to respond to comprehension questions during and after a reading session. A smaller relationship was established between the intervention and the verbal output of the students. Staff responses to the intervention were positive and indicated high social validity. The findings suggest that the manipulation of concrete representations may support students with ASD develop their reading comprehension abilities.
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    Teachers' perceptions about their preparedness to teach and include children with Autism Spectrum Disorder in the regular classroom : a thesis presented in partial fulfilment of the requirements for the degree of Master of Educational Psychology at Massey University, Palmerston North, New Zealand
    (Massey University, 2016) Apers, Cherie
    This research explored five primary school teachers’ perceptions about their preparedness to teach and include students with Autism Spectrum Disorder in a regular classroom. Taking a qualitative approach, these teachers were interviewed individually using semi-structured interviews, whereby the research methodology followed an appreciative inquiry framework. The use of this framework allowed for the positive aspects of their practices to be revealed. The research discovered that through a combination of prior knowledge and teaching experience, these teachers were able to develop and practice an inclusive pedagogy with strategies that could be utilised, not just for those with a disability, but for all children in their classrooms. While there were some areas where the teachers felt they could do with more support, these were taken on as challenges. The teachers involved demonstrated that inclusion of students with ASD in the regular classroom is possible and that this can be a positive experience that benefits the student with ASD, other students, the teachers themselves, the school, and the wider community.
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    Iron status in young children with Autism Spectrum Disorder : a thesis submitted in partial fulfilment of the requirements for the degree of Masters in Science in Nutrition and Dietetics at Massey University, Albany, New Zealand
    (Massey University, 2015) Makker, Micaela Grace
    Background: Autism Spectrum Disorder (ASD) is diagnosed when a child shows unusual social behaviour, difficulty communicating both verbally and non-verbally, and performing repetitive tasks. Children with ASD often present with unusual feeding patterns and behaviours, and overseas research shows children with ASD are at greater risk of iron deficiency and iron deficiency anaemia. Maintaining adequate iron levels is very important, as during periods of growth and development iron has a role to play in both brain structure and function. Therefore it is important for children to eat foods rich in iron or foods that optimise iron bioavailability. In New Zealand, the prevalence of iron deficiency in children is relatively low, being 1.6%. However, there is no published data on iron status or dietary factors associated with iron status in New Zealand children with ASD. Objective: To investigate factors influencing iron status in a cohort of children with Autism Spectrum Disorder living in New Zealand. Methods: Sixty nine children with ASD between the ages of 2.5-8 years took part in this cross-sectional study. Participants were required to complete an estimated four-day food diary, a dietary questionnaire, and a Behavioural Paediatrics Feeding Assessment Scale (BPFAS) questionnaire. Serum ferritin, serum iron, total iron binding capacity, transferrin saturation and haemoglobin were measured to determine iron status. Statistical analysis was performed using independent t-tests, Mann-Whitney, Chi-square and Fishers’ exact test. Results: Iron depletion was present in 32.9% of the sample population (serum ferritin ≤ 20 μg/L), and iron deficiency was present in an additional 4.3% (serum ferritin ≤ 12 μg/L). No participants had iron deficiency anaemia (serum ferritin SF ≤ 12 μg/L plus Hb ≤ 110 g/L in 1-5 years; or Hb ≤ 115 g/L in 5-8 years). Participants in the iron replete group had significantly higher dietary protein intake (P = 0.003) and vitamin A intake (P = 0.036) compared to iron insufficient participants. The iron insufficient group had a significantly higher BPFAS frequency score than the iron replete group (P = 0.022), and significantly more participants in the iron insufficient group had a BPFAS score ≥84 (P = 0.020), indicating more feeding issues. No differences in patterns or factors affecting dietary intake were seen when comparing iron insufficient and iron replete groups. Conclusion: Children with ASD in New Zealand appear to be at an increased risk of iron depletion and iron deficiency compared to neuro typical developing children. While no differences in dietary iron intake were seen between the iron replete and iron insufficient groups, iron replete participants had significantly higher intake of protein and vitamin A. More feeding behavioural problems were identified in the iron insufficient group compared to the iron replete group. Further studies with a larger sample size should be undertaken to investigate other factors (dietary and non-dietary) to establish determinants of iron status in this population.
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    Dietary intakes, use of exclusion diets and supplements in children aged 2 1/2 - 8 years with Autism Spectrum Disorder in New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics at Massey University, Albany, New Zealand
    (Massey University, 2015) Waring, Aimee Jayne
    Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that affects 1 in 68 children. Children with ASD are thought to be a nutritionally vulnerable population due to a tendency to exhibit eating behaviours such as selective or picky eating. Gaining popularity among parents of children with ASD is the use of complementary and alternative medical (CAM) therapies such as exclusion diets and supplements. Little is known about the dietary intakes of this population and whether they are meeting nutrition guidelines. The aim of this study was to investigate the dietary intakes and use of exclusion diets/supplements in children with ASD in New Zealand. Methods: Fifty children aged 2.5-8 years old with a medical diagnosis of ASD according to the DSM-V were recruited through Waitakere District Health Board (WDHB) and autism support groups. Parents were supplied with a 4-day food diary and dietary questionnaire which was used to collect information on dietary intakes, types of exclusion diets and supplements being used, reasons for use, perceived improvements, and where parents received information from. Dietary data from the 4-day food diaries was also used to conduct a food group analysis. The number of servings from each of the food groups was compared to the Ministry of Health Food and Nutrition Guidelines for Healthy Children and Young People (aged 2-18 years) recommended daily serves. Results: Children in this study were found to have carbohydrate, protein and fat intakes within the acceptable range. Dietary fibre was found to be a nutrient of concern as 40% of children were not meeting the recommendation. There were a large proportion of children not meeting the Estimated Average Requirement (EAR) for calcium (26% of children). Children were not meeting the recommended number of daily serves of fruit, vegetables or dairy. Significant differences were found when looking at dietary intakes based on exclusion diet status, where children in the exclusion diet group have significantly lower calcium intakes than children in the non-exclusion diet group (p=0.03). This study also found that 31% of children were using exclusion diets and 55% were using supplements. Conclusion: Results of this study suggest that children with ASD are not meeting the daily recommended servings of various food groups including fruits, vegetables and dairy. Although energy intakes were not impaired, certain nutrients in the diets of children with ASD in this study were below recommended daily intakes, specifically calcium, vitamin D and dietary fibre. Children with ASD may not receive a dietetic referral unless their growth is faltering and therefore nutritional deficiencies may go unnoticed. More research is needed to determine the impact of exclusion diet and supplement use on the nutritional intakes of children with ASD.