Investigation of Screen Time and Symptom Severity in Children with Autistic Spectrum Disorder

Kevser Nalbant; Semih Erden

doi:10.26650/jchild.2022.946883

Research Article

Investigation of Screen Time and Symptom Severity in Children with Autistic Spectrum Disorder

Year 2022, Volume: 22 Issue: 1, 48 - 57, 18.05.2022

Kevser Nalbant , Semih Erden

https://doi.org/10.26650/jchild.2022.946883

Abstract

Objective: Screen-based media (e.g. television, computer, cell phone, tablet) has become an increasingly important part of our life. Children with autism spectrum disorder (ASD) are known to be interested in limited subjects and highly attracted to screens. The purpose of this study is to investigate the time of screen use in newly diagnosed children with ASD and the association between screen time and symptom severity of ASD. Methods: The symptom severity of ASD was determined using the Childhood Autism Rating Scale. Information concerning socio-demographic characteristics, clinical data, and frequency and duration of children’s screen exposure since birth were collected during clinical interviews from the primary caregivers. Linear regression analysis was performed to examine the associated factors on symptom severity of ASD. Results: In our study, it was found that children with ASD use screens at an earlier age and for a longer period of time when compared to the recommendations of the American Academy of Pediatrics. Also, our results indicated that longer daily screen time and longer periods of no interaction during screen time <24 months, >1 h ⁄ day were associated with the symptom severity of ASD. Discussion: This study suggests that longer daily screen time in early childhood might increase the symptom severity of ASD. These results support that appropriate guidance and education for parents on how to optimize the benefits and potential harms of screen use may be a substantial preventive mental and public health service to support the socio-emotional development for early childhood.

Keywords

Autism, Children, Screen time, Socioemotional development

References

1. Association AP. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013. google scholar
2. Lyall K, Croen L, Daniels J, Fallin MD, Ladd-Acosta C, Lee BK, Park BY, Snyder NW, Schendel D, Volk H. The changing epidemiology of autism spectrum disorders. Annual review of public health 2017;38:81-102. google scholar
3. Hertz-Picciotto I, Delwiche L. The rise in autism and the role of age at diagnosis. Epidemiology (Cambridge, Mass) 2009;20:84. google scholar
4. Tordjman S, Somogyi E, Coulon N, Kermarrec S, Cohen D, Bronsard G, Bonnot O, Weismann-Arcache C, Botbol M, Lauth B. Genex Environment interactions in autism spectrum disorders: role of epigenetic mechanisms. Frontiers in psychiatry 2014;5:53. google scholar
5. Stamou M, Streifel KM, Goines PE, Lein PJ. Neuronal connectivity as a convergent target of gene x environment interactions that confer risk for Autism Spectrum Disorders. Neurotoxicol Teratol 2013;36:3-16. google scholar
6. Hallmayer J, Cleveland S, Torres A, Phillips J, Cohen B, Torigoe T, Miller J, Fedele A, Collins J, Smith K, Lotspeich L, Croen LA, Ozonoff S, Lajonchere C, Grether JK, Risch N. Genetic heritability and shared environmental factors among twin pairs with autism. Arch Gen Psychiatry 2011;68:1095-1102. google scholar
7. Sandin S, Lichtenstein P, Kuja-Halkola R, Larsson H, Hultman CM, Reichenberg A. The familial risk of autism. JAMA 2014;311:1770-1777. google scholar
8. Johnson MH. Functional brain development in humans. Nat Rev Neurosci 2001;2:475-483. google scholar
9. Heffler KF, Oestreicher LM. Causation model of autism: Audiovisual brain specialization in infancy competes with social brain networks. Med Hypotheses 2016;91:114-122. google scholar
10. Pontoppidan M, Niss NK, Pejtersen JH, Julian MM, Vaever MS. Parent report measures of infant and toddler social-emotional development: a systematic review. Fam Pract 2017;34:127-137. google scholar
11. Gerhold M, Laucht M, Texdorf C, Schmidt MH, Esser G. Early mother-infant interaction as a precursor to childhood social withdrawal. Child Psychiatry Hum Dev 2002;32:277-293. google scholar
12. Westby C. Screen Time and Children with Autism Spectrum Disorder. Folia Phoniatr Logop 2020:1-8. google scholar
13. Charlton CT, Kellems RO, Black B, Bussey HC, Ferguson R, Goncalves B, Jensen M, Vallejo S. Effectiveness of avatar-delivered instruction on social initiations by children with autism spectrum disorder. Research in Autism Spectrum Disorders 2020;71:101494. google scholar
14. Valencia K, Rusu C, Quinones D, Jamet E. The impact of technology on people with autism spectrum disorder: a systematic literature review. Sensors 2019;19:4485. google scholar
15. Radesky JS, Silverstein M, Zuckerman B, Christakis DA. Infant self-regulation and early childhood media exposure. Pediatrics 2014;133:e1172-1178. google scholar
16. Chonchaiya W, Sirachairat C, Vijakkhana N, Wilaisakditipakorn T, Pruksananonda C. Elevated background TV exposure over time increases behavioural scores of 18-month-old toddlers. Acta Paediatr 2015;104:1039-1046. google scholar
17. Zimmerman FJ, Christakis DA, Meltzoff AN. Television and DVD/ video viewing in children younger than 2 years. Arch Pediatr Adolesc Med 2007;161:473-479. google scholar
18. Chonchaiya W, Pruksananonda C. Television viewing associates with delayed language development. Acta Paediatr 2008;97:977-982. google scholar
19. Cerniglia L, Cimino S, Ammaniti M. What are the effects of screen time on emotion regulation and academic achievements? A three-wave longitudinal study on children from 4 to 8 years of age. Journal of Early Childhood Research 2020:1476718X20969846. google scholar
20. American Academy of Pediatrics. Handheld Screen Time Linked with Speech Delays in Young Children. 2017 Retrieved from https:// www.healthychildren.org/English/news/Pag- es/Handheld-Screen-Time-Linked-with- Speech-Delays-in-Young-Children.aspx google scholar
21. Kabali HK, Irigoyen MM, Nunez-Davis R, Budacki JG, Mohanty SH, Leister KP, Bonner RL. Exposure and use of mobile media devices by young children. Pediatrics 2015;136:1044-1050. google scholar
22. Christakis DA. The effects of infant media usage: what do we know and what should we learn? Acta Paediatr 2009;98:8-16. google scholar
23. Rideout VJ, Vandewater EA, Wartella EA. Zero to six: Electronic media in the lives of infants, toddlers and preschoolers. 2003. google scholar
24. Tuncer AM, Yalcin SS. Multimedia and children in Turkey. Turk J Pediatr 1999;41(Suppl):27-34. google scholar
25. McEachin JJ, Smith T, Lovaas OI. Long-term outcome for children with autism who received early intensive behavioral treatment. Am J Ment Retard 1993;97:359- 372; discussion 373-391. google scholar
26. Sallows GO, Graupner TD. Intensive behavioral treatment for children with autism: four-year outcome and predictors. Am J Ment Retard 2005;110:417-438. google scholar
27. Volkmar FR, Paul R, Klin A, Cohen DJ. Handbook of autism and pervasive developmental disorders, diagnosis, development, neurobiology, and behavior. John Wiley & Sons; 2005. google scholar
28. Mazurek MO, Wenstrup C. Television, video game and social media use among children with ASD and typically developing siblings. J Autism Dev Disord 2013;43:1258-1271. google scholar
29. Engelhardt CR, Mazurek MO. Video game access, parental rules, and problem behavior: a study of boys with autism spectrum disorder. Autism 2014;18:529-537. google scholar
30. Mazurek MO, Wenstrup C. Television, video game and social media use among children with ASD and typically developing siblings. Journal of autism and developmental disorders 2013;43:1258-1271. google scholar
31. Nally B, Houlton B, Ralph S. Researches in brief: The management of television and video by parents of children with autism. Autism 2000;4:331-337. google scholar
32. Slobodin O, Heffler KF, Davidovitch M. Screen Media and Autism Spectrum Disorder: A Systematic Literature Review. J Dev Behav Pediatr 2019;40:303-311. google scholar
33. Chonchaiya W, Nuntnarumit P, Pruksananonda C. Comparison of television viewing between children with autism spectrum disorder and controls. Acta Paediatrica 2011;100:1033-1037. google scholar
34. Unal F, Oktem F, Cetin Cuhadaroglu F, Cengel Kultur SE, Akdemir D, Foto Ozdemir D, Cak HT, Unal D, Tiras K, Aslan C, Kalayci BM, Aydos BS, Kutuk F, Tasyurek E, Karaokur R, Karabucak B, Karakok B, Karaer Y, Artik A. [Reliability and Validity of the Schedule for Affective Disorders and Schizophrenia for School-Age Children- Present and Lifetime Version, DSM-5 November 2016-Turkish Adaptation (K-SADS-PL-DSM-5-T)]. Turk Psikiyatri Derg 2019;30:42-50. google scholar
35. Andreasen NC, Flaum M, Arndt S. The Comprehensive Assessment of Symptoms and History (CASH): an instrument for assessing diagnosis and psychopathology. Archives of general psychiatry 1992;49:615-623. google scholar
36. Kaufman J, Birmaher B, Axelson D, Perepletchikova F, Brent D, Ryan N. Schedule for Affective Disorders and Schizophrenia for School-Aged Children: Present and Lifetime Version (K-SADS-PL) DSM-5 November 2016 Working draft. New Haven, Yale University. Child and Adolescent Research and Education 2016. google scholar
37. Schopler E, Reichler RJ, DeVellis RF, Daly K. Toward objective classification of childhood autism: Childhood Autism Rating Scale (CARS). Journal of autism and developmental disorders 1980. google scholar
38. İncekaş Gassaloğlu S, Baykara B, Avcil S, Demiral Y. Validity and Reliability Analysis of Turkish Version of Childhood Autism Rating Scale. Turkish Journal of Psychiatry 2016;27. google scholar
39. Chen JY, Strodl E, Wu CA, Huang LH, Yin XN, Wen GM, Sun DL, Xian DX, Chen YJ, Yang GY, Chen WQ. Screen time and autistic-like behaviors among preschool children in China. Psychol Health Med 2020:1-14. google scholar
40. Dawson G, Rogers S, Munson J, Smith M, Winter J, Greenson J, Donaldson A, Varley J. Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model. Pediatrics 2010;125:e17-23. google scholar
41. Uhls YT, Michikyan M, Morris J, Garcia D, Small GW, Zgourou E, Greenfield PM. Five days at outdoor education camp without screens improves preteen skills with nonverbal emotion cues. Computers in Human Behavior 2014;39:387-392. google scholar
42. Pea R, Nass C, Meheula L, Rance M, Kumar A, Bamford H, Nass M, Simha A, Stillerman B, Yang S. Media use, face-to-face communication, media multitasking, and social well-being among 8-to 12-year-old girls. Developmental psychology 2012;48:327. google scholar

Otistik Spektrum Bozukluğu Olan Çocuklarda Ekran Süresi ve Belirti Şiddetinin Araştırılması

Year 2022, Volume: 22 Issue: 1, 48 - 57, 18.05.2022

Kevser Nalbant , Semih Erden

https://doi.org/10.26650/jchild.2022.946883

Abstract

Amaç: Ekran tabanlı medya (ör. televizyon, bilgisayar, cep telefonu, tablet), giderek hayatımızın önemli bir parçası haline gelmiştir. Otizm spektrum bozukluğu (OSB) olan çocukların sınırlı ilgi alanları olduğu ve ekranlardan oldukça etkilendikleri bilinmektedir. Bu çalışmanın amacı, yeni tanı almış OSB’li çocuklarda ekrana maruz kalma süresi ile OSB’nin semptom şiddeti arasındaki ilişkiyi araştırmaktır. Yöntem: OSB’nin belirti şiddeti Çocukluk Otizmi Derecelendirme Ölçeği kullanılarak belirlenmiştir. Çocukların sosyo-demografik özellikleri, klinik verileri ve ekran maruz kalma sıklıkları ve süreleri ile ilgili bilgiler, birincil bakım verenlerinden klinik görüşme esnasında toplanmıştır. OSB semptom şiddeti ile ilişkili faktörleri incelemek için lineer regresyon analizi yapılmıştır. Bulgular: Çalışmamızda OSB’li çocukların Amerikan Pediatri Akademisi önerilerine göre daha erken yaşta ve daha uzun süre ekran başında kaldıkları bulunmuştur. Ayrıca sonuçlar, günlük ekran süresinin artmasının, ekran süresi boyunca etkileşim olmadan <24 ay,> 1 saat ⁄ gün ekran başında kalmanın OSB semptom şiddeti ile ilişkili olduğunu göstermiştir. Tartışma: Bu çalışma, erken çocukluk döneminde daha uzun günlük ekran süresinin OSB’nin semptom şiddetini artırabileceğini düşündürmüştür. Bu sonuçlar, ebeveynler için ekran kullanımının yararlarının ve potansiyel zararlarının nasıl optimize edileceğine dair uygun rehberlik ve eğitimin, erken çocukluk döneminde sosyo-duygusal gelişimi desteklemek için önemli bir koruyucu zihinsel ve halk sağlığı hizmeti olabileceğini desteklemektedir.

Keywords

Otizm, Çocuklar, Ekran süresi, Sosyo-duygusal gelişim

References

1. Association AP. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013. google scholar
2. Lyall K, Croen L, Daniels J, Fallin MD, Ladd-Acosta C, Lee BK, Park BY, Snyder NW, Schendel D, Volk H. The changing epidemiology of autism spectrum disorders. Annual review of public health 2017;38:81-102. google scholar
3. Hertz-Picciotto I, Delwiche L. The rise in autism and the role of age at diagnosis. Epidemiology (Cambridge, Mass) 2009;20:84. google scholar
4. Tordjman S, Somogyi E, Coulon N, Kermarrec S, Cohen D, Bronsard G, Bonnot O, Weismann-Arcache C, Botbol M, Lauth B. Genex Environment interactions in autism spectrum disorders: role of epigenetic mechanisms. Frontiers in psychiatry 2014;5:53. google scholar
5. Stamou M, Streifel KM, Goines PE, Lein PJ. Neuronal connectivity as a convergent target of gene x environment interactions that confer risk for Autism Spectrum Disorders. Neurotoxicol Teratol 2013;36:3-16. google scholar
6. Hallmayer J, Cleveland S, Torres A, Phillips J, Cohen B, Torigoe T, Miller J, Fedele A, Collins J, Smith K, Lotspeich L, Croen LA, Ozonoff S, Lajonchere C, Grether JK, Risch N. Genetic heritability and shared environmental factors among twin pairs with autism. Arch Gen Psychiatry 2011;68:1095-1102. google scholar
7. Sandin S, Lichtenstein P, Kuja-Halkola R, Larsson H, Hultman CM, Reichenberg A. The familial risk of autism. JAMA 2014;311:1770-1777. google scholar
8. Johnson MH. Functional brain development in humans. Nat Rev Neurosci 2001;2:475-483. google scholar
9. Heffler KF, Oestreicher LM. Causation model of autism: Audiovisual brain specialization in infancy competes with social brain networks. Med Hypotheses 2016;91:114-122. google scholar
10. Pontoppidan M, Niss NK, Pejtersen JH, Julian MM, Vaever MS. Parent report measures of infant and toddler social-emotional development: a systematic review. Fam Pract 2017;34:127-137. google scholar
11. Gerhold M, Laucht M, Texdorf C, Schmidt MH, Esser G. Early mother-infant interaction as a precursor to childhood social withdrawal. Child Psychiatry Hum Dev 2002;32:277-293. google scholar
12. Westby C. Screen Time and Children with Autism Spectrum Disorder. Folia Phoniatr Logop 2020:1-8. google scholar
13. Charlton CT, Kellems RO, Black B, Bussey HC, Ferguson R, Goncalves B, Jensen M, Vallejo S. Effectiveness of avatar-delivered instruction on social initiations by children with autism spectrum disorder. Research in Autism Spectrum Disorders 2020;71:101494. google scholar
14. Valencia K, Rusu C, Quinones D, Jamet E. The impact of technology on people with autism spectrum disorder: a systematic literature review. Sensors 2019;19:4485. google scholar
15. Radesky JS, Silverstein M, Zuckerman B, Christakis DA. Infant self-regulation and early childhood media exposure. Pediatrics 2014;133:e1172-1178. google scholar
16. Chonchaiya W, Sirachairat C, Vijakkhana N, Wilaisakditipakorn T, Pruksananonda C. Elevated background TV exposure over time increases behavioural scores of 18-month-old toddlers. Acta Paediatr 2015;104:1039-1046. google scholar
17. Zimmerman FJ, Christakis DA, Meltzoff AN. Television and DVD/ video viewing in children younger than 2 years. Arch Pediatr Adolesc Med 2007;161:473-479. google scholar
18. Chonchaiya W, Pruksananonda C. Television viewing associates with delayed language development. Acta Paediatr 2008;97:977-982. google scholar
19. Cerniglia L, Cimino S, Ammaniti M. What are the effects of screen time on emotion regulation and academic achievements? A three-wave longitudinal study on children from 4 to 8 years of age. Journal of Early Childhood Research 2020:1476718X20969846. google scholar
20. American Academy of Pediatrics. Handheld Screen Time Linked with Speech Delays in Young Children. 2017 Retrieved from https:// www.healthychildren.org/English/news/Pag- es/Handheld-Screen-Time-Linked-with- Speech-Delays-in-Young-Children.aspx google scholar
21. Kabali HK, Irigoyen MM, Nunez-Davis R, Budacki JG, Mohanty SH, Leister KP, Bonner RL. Exposure and use of mobile media devices by young children. Pediatrics 2015;136:1044-1050. google scholar
22. Christakis DA. The effects of infant media usage: what do we know and what should we learn? Acta Paediatr 2009;98:8-16. google scholar
23. Rideout VJ, Vandewater EA, Wartella EA. Zero to six: Electronic media in the lives of infants, toddlers and preschoolers. 2003. google scholar
24. Tuncer AM, Yalcin SS. Multimedia and children in Turkey. Turk J Pediatr 1999;41(Suppl):27-34. google scholar
25. McEachin JJ, Smith T, Lovaas OI. Long-term outcome for children with autism who received early intensive behavioral treatment. Am J Ment Retard 1993;97:359- 372; discussion 373-391. google scholar
26. Sallows GO, Graupner TD. Intensive behavioral treatment for children with autism: four-year outcome and predictors. Am J Ment Retard 2005;110:417-438. google scholar
27. Volkmar FR, Paul R, Klin A, Cohen DJ. Handbook of autism and pervasive developmental disorders, diagnosis, development, neurobiology, and behavior. John Wiley & Sons; 2005. google scholar
28. Mazurek MO, Wenstrup C. Television, video game and social media use among children with ASD and typically developing siblings. J Autism Dev Disord 2013;43:1258-1271. google scholar
29. Engelhardt CR, Mazurek MO. Video game access, parental rules, and problem behavior: a study of boys with autism spectrum disorder. Autism 2014;18:529-537. google scholar
30. Mazurek MO, Wenstrup C. Television, video game and social media use among children with ASD and typically developing siblings. Journal of autism and developmental disorders 2013;43:1258-1271. google scholar
31. Nally B, Houlton B, Ralph S. Researches in brief: The management of television and video by parents of children with autism. Autism 2000;4:331-337. google scholar
32. Slobodin O, Heffler KF, Davidovitch M. Screen Media and Autism Spectrum Disorder: A Systematic Literature Review. J Dev Behav Pediatr 2019;40:303-311. google scholar
33. Chonchaiya W, Nuntnarumit P, Pruksananonda C. Comparison of television viewing between children with autism spectrum disorder and controls. Acta Paediatrica 2011;100:1033-1037. google scholar
34. Unal F, Oktem F, Cetin Cuhadaroglu F, Cengel Kultur SE, Akdemir D, Foto Ozdemir D, Cak HT, Unal D, Tiras K, Aslan C, Kalayci BM, Aydos BS, Kutuk F, Tasyurek E, Karaokur R, Karabucak B, Karakok B, Karaer Y, Artik A. [Reliability and Validity of the Schedule for Affective Disorders and Schizophrenia for School-Age Children- Present and Lifetime Version, DSM-5 November 2016-Turkish Adaptation (K-SADS-PL-DSM-5-T)]. Turk Psikiyatri Derg 2019;30:42-50. google scholar
35. Andreasen NC, Flaum M, Arndt S. The Comprehensive Assessment of Symptoms and History (CASH): an instrument for assessing diagnosis and psychopathology. Archives of general psychiatry 1992;49:615-623. google scholar
36. Kaufman J, Birmaher B, Axelson D, Perepletchikova F, Brent D, Ryan N. Schedule for Affective Disorders and Schizophrenia for School-Aged Children: Present and Lifetime Version (K-SADS-PL) DSM-5 November 2016 Working draft. New Haven, Yale University. Child and Adolescent Research and Education 2016. google scholar
37. Schopler E, Reichler RJ, DeVellis RF, Daly K. Toward objective classification of childhood autism: Childhood Autism Rating Scale (CARS). Journal of autism and developmental disorders 1980. google scholar
38. İncekaş Gassaloğlu S, Baykara B, Avcil S, Demiral Y. Validity and Reliability Analysis of Turkish Version of Childhood Autism Rating Scale. Turkish Journal of Psychiatry 2016;27. google scholar
39. Chen JY, Strodl E, Wu CA, Huang LH, Yin XN, Wen GM, Sun DL, Xian DX, Chen YJ, Yang GY, Chen WQ. Screen time and autistic-like behaviors among preschool children in China. Psychol Health Med 2020:1-14. google scholar
40. Dawson G, Rogers S, Munson J, Smith M, Winter J, Greenson J, Donaldson A, Varley J. Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model. Pediatrics 2010;125:e17-23. google scholar
41. Uhls YT, Michikyan M, Morris J, Garcia D, Small GW, Zgourou E, Greenfield PM. Five days at outdoor education camp without screens improves preteen skills with nonverbal emotion cues. Computers in Human Behavior 2014;39:387-392. google scholar
42. Pea R, Nass C, Meheula L, Rance M, Kumar A, Bamford H, Nass M, Simha A, Stillerman B, Yang S. Media use, face-to-face communication, media multitasking, and social well-being among 8-to 12-year-old girls. Developmental psychology 2012;48:327. google scholar

There are 42 citations in total.

Details

Primary Language	English
Subjects	Paediatrics
Journal Section	Research Articles
Authors	Kevser Nalbant 0000-0003-4261-1013 Semih Erden 0000-0002-7723-9584
Publication Date	May 18, 2022
Published in Issue	Year 2022 Volume: 22 Issue: 1

Cite

APA	Nalbant, K., & Erden, S. (2022). Investigation of Screen Time and Symptom Severity in Children with Autistic Spectrum Disorder. Journal of Child, 22(1), 48-57. https://doi.org/10.26650/jchild.2022.946883
AMA	Nalbant K, Erden S. Investigation of Screen Time and Symptom Severity in Children with Autistic Spectrum Disorder. Journal of Child. May 2022;22(1):48-57. doi:10.26650/jchild.2022.946883
Chicago	Nalbant, Kevser, and Semih Erden. “Investigation of Screen Time and Symptom Severity in Children With Autistic Spectrum Disorder”. Journal of Child 22, no. 1 (May 2022): 48-57. https://doi.org/10.26650/jchild.2022.946883.
EndNote	Nalbant K, Erden S (May 1, 2022) Investigation of Screen Time and Symptom Severity in Children with Autistic Spectrum Disorder. Journal of Child 22 1 48–57.
IEEE	K. Nalbant and S. Erden, “Investigation of Screen Time and Symptom Severity in Children with Autistic Spectrum Disorder”, Journal of Child, vol. 22, no. 1, pp. 48–57, 2022, doi: 10.26650/jchild.2022.946883.
ISNAD	Nalbant, Kevser - Erden, Semih. “Investigation of Screen Time and Symptom Severity in Children With Autistic Spectrum Disorder”. Journal of Child 22/1 (May 2022), 48-57. https://doi.org/10.26650/jchild.2022.946883.
JAMA	Nalbant K, Erden S. Investigation of Screen Time and Symptom Severity in Children with Autistic Spectrum Disorder. Journal of Child. 2022;22:48–57.
MLA	Nalbant, Kevser and Semih Erden. “Investigation of Screen Time and Symptom Severity in Children With Autistic Spectrum Disorder”. Journal of Child, vol. 22, no. 1, 2022, pp. 48-57, doi:10.26650/jchild.2022.946883.
Vancouver	Nalbant K, Erden S. Investigation of Screen Time and Symptom Severity in Children with Autistic Spectrum Disorder. Journal of Child. 2022;22(1):48-57.

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