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Although most children with autism and other neurodevelopmental disorders live in low- and middle-income countries, assessment tools are lacking in these settings. This study aims to culturally adapt and validate two questionnaires for use in Ethiopia: the Autism Treatment Evaluation Checklist and the Pediatric Quality of Life Inventory™ Family Impact Module. Both questionnaires were adapted to be suitable for administration in low-literate caregivers and translated using the backward translation procedure. The factor structure, reliability and validity were investigated using caregiver-reports on 300 children with neurodevelopmental disorders or physical health conditions. Confirmatory factor analysis of the Pediatric Quality of Life Inventory™ Family Impact Module data indicated an acceptable fit of the hypothesised eight-factor structure. Internal consistency was high for both measures. Test--retest reliability was excellent for the Autism Treatment Evaluation Checklist and moderate to excellent for the Pediatric Quality of Life Inventory™ Family Impact Module. Both questionnaires demonstrated adequate known-group validity, with moderate to very large effect size group differences between case and control groups. The questionnaires correlated moderately with each other. In conclusion, the Ethiopian adaptations of the Autism Treatment Evaluation Checklist and the Pediatric Quality of Life Inventory™ Family Impact Module are valid and reliable tools for use in parents of children with neurodevelopmental disorders including autism. These adapted measures may also be valuable for use in other low-income settings.

Introduction: Attention Deficit Hyperactivity Disorder (ADHD), a prevalent neurodevelopmental disorder affecting a significant portion of the population, is commonly managed with stimulant medications. These medications, while effective, have been associated with thermoregulatory dysfunction and an increased risk of heat-related adverse events. The current study sought to compare the incidence of such events in ADHD patients receiving stimulant medications with those not on these treatments. Methods: A retrospective cohort study was conducted utilizing de-identified electronic medical records from a Global Research Network. The study population comprised ADHD patients on stimulant medication aged 6-24 years, with a comparison group of ADHD patients not receiving stimulant medications. Patients were followed from the date of first cohort inclusion (index event) for one year to track heat-related illnesses, including dehydration, hyperthermia, heat stroke, and other heat-related conditions. Propensity score matching was employed to balance baseline characteristics (age, gender) between cohorts. Risk ratios, odds ratios, and hazard ratios were calculated to assess the incidence of heat-related illnesses between groups. Statistical analysis was performed on the TriNetX platform, with survival analysis conducted via Kaplan-Meier estimates. Results: Analysis revealed a decreased risk of heat-related illnesses in the stimulant medication group, with a risk ratio of 0.559(95% CI: 0.485, 0.644). The mean number of events was also lower in the stimulants medication group (p=0.028). Additionally, Kaplan-Meier survival analysis indicated a higher probability of remaining free from heat-related illnesses in the stimulant group over a one-year period, with a statistically significant difference (log-rank test, χ² = 93.035, p < 0.0001). Discussion: These results suggest that stimulant medications may be associated with a reduced risk of heat-related illnesses in ADHD patients, potentially contributing to better overall outcomes in this population. Further research is warranted to explore the underlying mechanisms and to confirm these findings across larger and more varied patient populations. [ABSTRACT FROM AUTHOR]

The World Health Organization's Caregiver Skills Training programme for children with developmental disorders or delays teaches caregivers strategies to help them support their child's development. Ethiopia has a severe lack of services for children with developmental disorders or delays. This study explored the perspectives of Ethiopian caregivers, professionals and other stakeholders to inform adaptation and implementation of the World Health Organization's Caregiver Skills Training in Ethiopia. Data collection included (1) a consultation and review, comprising stakeholder meetings, review of draft Caregiver Skills Training materials and feedback from Ethiopian Master Trainees and (2) a pre-pilot including quantitative feasibility and acceptability measures and qualitative interviews with caregivers (n = 9) and programme facilitators/observers (n = 5). The consultation participants indicated that the Caregiver Skills Training addresses an urgent need and is relevant to the Ethiopian context. Several adaptations were proposed, including more emphasis on psycho-education, stigma, parental feelings of guilt and expectations of a cure. The adapted Caregiver Skills Training was pre-piloted with excellent participation (100%) and retention (90%) rates. Four themes were developed from the qualitative data: (1) Programme acceptability and relevance, (2) Perceived programme benefits, (3) Challenges and barriers and (4) Suggestions for improvement. The World Health Organization's Caregiver Skills Training addresses a local need and, with careful adaptations, is feasible and acceptable to be implemented in Ethiopia. These findings may have relevance to low-resource settings worldwide. [The World Health Organization (WHO) Caregiver Skills Training (CST) Team co-authored this article.]

A large gap in provision of services for children with developmental disabilities (DD) has been identified in Ethiopia, especially in the education system. Including children with disabilities in mainstream schools is encouraged by policies, but progress in this direction has been limited. This study aimed to explore stakeholders' perspectives on contextual factors relevant for inclusive education for children with DD in mainstream schools in Ethiopia, with a focus on Adis Ababa. Data were collected through semi-structured interviews with 39 local stakeholders, comprising caregivers of children with DD, school teachers and principals/managers, non-governmental organisation representatives, government officials, clinicians and academics/consultants. We used template analysis to code the data and map them onto domains of the Context and Setting dimensions of the Context and Implementation of Complex Interventions framework. Stakeholders discussed frameworks in the Legal and Ethical context endorsing the right of all children to education. However, they reported multiple reasons why children with DD in Ethiopia have limited access to education, either in special or mainstream schools. First, individual features, such as gender and support needs, discussed in the Epidemiological context, may affect the likelihood of a child with DD to be accepted in school. Transportation challenges are a key barrier in the Geographical context. Socio-economic and Socio-cultural contexts present barriers at the levels of the nation, school and family, mostly related to limited services and material and financial resources and limited awareness of DD. Stakeholders believe the currently limited but growing commitment in the Political context can support progress towards the removal of these barriers. Our findings can form the basis for development of an implementation plan that addresses such barriers and capitalises on existing facilitators. [ABSTRACT FROM AUTHOR]

Autism and other developmental disabilities are common in low- and middle-income countries. The World Health Organization developed the caregiver skills training programme to address the needs of families having children with developmental disabilities globally. This study explored the acceptability and feasibility of the caregiver skills training programme facilitated by non-specialists in rural Ethiopia, where contextual factors such as poverty, stigma and low literacy may affect training delivery. In-depth interviews were conducted with caregivers (n = 19) and four focus groups with non-specialist facilitators (n = 8) in two rural pilot tests of the caregiver skills training programme. Results suggested that participants experienced the caregiver skills training programme as acceptable and relevant for their context but suggested some modifications to improve the programme. Caregivers' accounts showed that facilitation by non-specialists was acceptable; facilitators emphasised the importance of supervision throughout the programme. Participants indicated that the home visit and group training modalities were acceptable and feasible. Facilitators indicated that some caregiver skills training programme topics were difficult to explain to caregivers; the concept of formalised play between caregiver and child was particularly foreign to caregivers. Lack of available toys made it difficult to practise some of the caregiver skills programme training exercises. These findings may have relevance to non-specialist delivery of the caregiver skills programme training and other parent-mediated interventions in low-resource contexts. Children with developmental disabilities including autism who live in low- and middle-income countries have very limited access to care and intervention. The World Health Organization initiated the caregiver skills training programme to support families with children with developmental disabilities. In Ethiopia, contextual factors such as poverty, low literacy and stigma may affect the success of the programme. In this study, we aimed to find out if the caregiver skills training programme is feasible to deliver in rural Ethiopia and acceptable to caregivers and programme facilitators. We trained non-specialist providers to facilitate the programme. Caregivers and non-specialist facilitators were asked about their experiences in interviews and group discussions. Caregivers found the programme relevant to their lives and reported benefits of participation. Facilitators highlighted the skills they had acquired but also emphasised the importance of support from supervisors during the programme. They described that some caregiver skills training programme topics were difficult to teach caregivers. In particular, the idea of play between caregiver and child was unfamiliar to many caregivers. Lack of available toys made it difficult to practise some of the caregiver skills training programme exercises. Participants indicated that the home visits and group training programme components of the caregiver skills training were acceptable and feasible, but there were some practical barriers, such as transportation issues and lack of time for homework practice. These findings may have importance to non-specialist delivery of the caregiver skills training programme in other low-income countries. [ABSTRACT FROM AUTHOR]

Introduction: Attention Deficit Hyperactivity Disorder (ADHD), a prevalent neurodevelopmental disorder affecting a significant portion of the population, is commonly managed with stimulant medications. These medications, while effective, have been associated with thermoregulatory dysfunction and an increased risk of heat-related adverse events. The current study sought to compare the incidence of such events in ADHD patients receiving stimulant medications with those not on these treatments., Methods: A retrospective cohort study was conducted utilizing de-identified electronic medical records from a Global Research Network. The study population comprised ADHD patients on stimulant medication aged 6-24 years, with a comparison group of ADHD patients not receiving stimulant medications. Patients were followed from the date of first cohort inclusion (index event) for one year to track heat-related illnesses, including dehydration, hyperthermia, heat stroke, and other heat-related conditions. Propensity score matching was employed to balance baseline characteristics (age, gender) between cohorts. Risk ratios, odds ratios, and hazard ratios were calculated to assess the incidence of heat-related illnesses between groups. Statistical analysis was performed on the TriNetX platform, with survival analysis conducted via Kaplan-Meier estimates., Results: Analysis revealed a decreased risk of heat-related illnesses in the stimulant medication group, with a risk ratio of 0.559(95% CI: 0.485, 0.644). The mean number of events was also lower in the stimulants medication group (p=0.028). Additionally, Kaplan-Meier survival analysis indicated a higher probability of remaining free from heat-related illnesses in the stimulant group over a one-year period, with a statistically significant difference (log-rank test, χ² = 93.035, p < 0.0001)., Discussion: These results suggest that stimulant medications may be associated with a reduced risk of heat-related illnesses in ADHD patients, potentially contributing to better overall outcomes in this population. Further research is warranted to explore the underlying mechanisms and to confirm these findings across larger and more varied patient populations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zinabu, Gasmelseed, Wheaton, Girma, Wong, Tabraiz, Mubasher, Mack, Lexima, Qazi, Mohammed, Sood and Michael.)