The Development and Evaluation of a Culturally Appropriate Home-based Intervention for Children with Autism Spectrum Disorders in the Kingdom of Saudi Arabia

The limited research regarding Autism Spectrum Disorders (ASD) within the Kingdom of Saudi Arabia (KSA) suggests a serious lack of understanding of the disorder, a scarcity of ASD services, and few trained professionals. In addition, there are few studies of evidence-based practices to support families of children with ASD which are culturally appropriate in KSA. Research on families’ experiences of raising children with ASD indicated an urgent need for professional support. Home-based interventions (HBIs) administered by parents of children with ASD have been found to be an effective method to receive ASD services within the naturalised home environment. The purpose of this project was to develop and evaluate a culturally appropriate HBI to support families and their children with ASD in KSA

An exploratory study on educating learners with ASD in primary inclusive setting in Saudi Arabia: issues, attitudes, and challenges

The purpose of this research is to facilitate the development and understanding of inclusive education for students with Autism Spectrum Disorder (ASD) in Saudi Arabia. The study is located within Riyadh, a city in Saudi Arabia. The culture and religion of Saudi society are central themes in this study. ASD is a complex disorder due to its characteristics, which include a lack of social skills, communication difficulties, and behaviour problems. A range of qualitative methods were adopted; interviews with twenty general education teachers (GT) and special education teachers (SET) as well as participant observation in five schools. The research seeks to identify the attitudes and practices of primary school teachers in terms of their support for children in mainstream schools. The study shows that teachers are mostly supportive and have positive attitudes toward the inclusive education of learners with ASD. The study shows barriers to inclusive education, for example, lack of time, overcrowded classrooms, curriculum, attitudes, lack of training, teaching methods and school environments and the extent to which mainstream school buildings and classrooms are suitable for inclusion of students with Special Educational Needs (SEN) in general and, more specifically, for students with ASD. Another factor that emerged from the study to support inclusive education was peer tutoring. All the teachers involved in the study are qualified in education but they need additional training and knowledge about inclusion and ASD. Finally, the study provides some practical recommendations as well as some ideas for future research and other activities

Children with autism spectrum disorder in the context of Arab countries and cultures

The field of Autism Spectrum Disorder (ASD) in the Arab world is new. The dearth of ASD research in the Arab world is well recognised. There were no data available in the field of ASD in the Arab context collectively. Therefore, ASD researchers should attempt to discover the state of ASD from the Arab perspective. This thesis has attempted to expand our knowledge of the field of ASD in the Arab context, in particular children with ASD and their families. In Chapter 1 an introduction on Arab countries was presented including geography, religion, language, culture, and information about typical family systems. Further, the current state of ASD in Arab countries and cultures was discussed in terms of its diagnosis, prevalence, services available for individuals with ASD, and Arab parents’ stress and needs profiles. Four empirical studies then followed (Chapters 2, 3, 4, 5). In the first study (Chapter 2) a systematic scoping review of social, educational, and psychological research on individuals with ASD and their family members in Arab countries and cultures was undertaken, highlighting many unexplored areas for research. Chapter 3 then presented an investigation of support needs of Arab families of children with ASD living in the United Kingdom (UK). Chapter 4 explored experiences of special educators from a special school on using a structured numeracy intervention with their pupils with ASD. The final study (Chapter 5) then carried out an initial evaluation of a structured numeracy intervention with children with ASD in Arab families living in the UK by training and supporting their parents to deliver the intervention at home. In Chapter 6 the findings from the four empirical studies were discussed, along with their implications for practice and future research. Overall this thesis has contributed new knowledge in relation to the field of ASD in the Arab context

The Effects of Disability Labeling on Teachers’ Referrals of Twice-Exceptional Children to Gifted Programs in Saudi Arabia

The issue of biases associated with labeling students as gifted or as having a disability presents a significant challenge to educational professionals with regard to identification and the provision of services. In the presence of labels indicating giftedness, disability, and twice exceptionality, research consistently demonstrated biases on the part of parents, teachers, and even other students. These biases could prevent students from receiving the services they need to achieve their fullest potential (Bianco & Leech, 2010). The current study systematically replicated a study by Bianco and Leech (2010) and examined the influence of disability labels on teachers’ decisions to refer students to gifted programming. Further, this study investigated whether there were any differences in teachers’ responses based on the type of teaching certificate they held (i.e., gifted education, special education, general education). Three groups of in-service teachers (85 general, 59 special, and 43 gifted education teachers) from the Western region of Saudi Arabia participated in the study. A cross-sectional survey methodology was employed. Teachers were randomly assigned to one of three survey conditions that consisted of a vignette that described a student with both giftedness and high potential traits, differing only with respect to one of three labeling conditions (no label, learning disability [LD], autism spectrum disorder [ASD]). Multinomial logistic regression was used to assess the influence of teacher type and the labeling condition on the teachers’ ratings. Responses to an open-ended question that asked teachers to provide a reason for their referral decisions were analyzed qualitatively. The quantitative analysis showed neither teacher type nor the presence or absence of a disability label had a significant influence on the overall ratings, which was in sharp contrast to Bianco and Leech’s (2010) results. The interaction of the two variables was also nonsignificant. Most of the participants (94%) chose to agree or strongly agree with a referral. However, of the few nonreferrals, most were for students with ASD. Three themes emerged from the qualitative analysis of the teachers’ rationales including (a) the student shows gifted traits, (b) the student’s skills could be cultivated with support, and (c) the student does not fit the definition for giftedness. Findings from this study provided insights into the issues of labeling students and the status of twice-exceptionality in Saudi Arabia. The results indicated limited, negative bias among different types of teachers with respect to students with disabilities. Also, the participants in this study showed a strong orientation toward supporting the growth and development of the student in all three vignette conditions. However, it remained clear that Saudi Arabia would still greatly benefit from establishing a clear policy on twice-exceptionality and providing training programs to educators with respect to defining, identifying, and educating students with giftedness and disabilities

Ethnographic study of the religious coping forms of mothers’ experiences of bringing up a child with ASD in Saudi Arabia

Autism is increasing in prevalence and has become a global concern. It has been long recognised that the presence of autism can have a significant impact on family members and that autism can result in greater parental stress than other disabilities. A growing recognition in research has emerged about the religious beliefs held by the families of children with disabilities due to the significant role played by religion in shaping parents’ interpretation and understanding of the disability. Therefore, religious parents may draw upon their faith to help them cope, make sense and construct meanings around their child’s disability. A gap exists in the literature regarding the needs, concerns, and overall experiences of Arab Muslim parents of children with autism. A scarcity in the literature examining autism in the Gulf region has been acknowledged with no research to date in Saudi Arabia which has investigated the burden of autism on the family, child and society. What little research there is in this area has predominantly explored the experiences of parents in Western societies and mostly from a quantitative paradigm. We quite simply do not yet know how autism impacts on families in Gulf counties such as Saudi Arabia. Up until this point it has been quite unfathomable to ask about such experiences in this context, particularly of those most involved in their child’s care; mothers. This ethnographic study therefore set out to explore how Saudi mothers caring for a child with autism recognized and understood autism, what their cultural beliefs and understanding of autism were, and how they coped and adapted with their concerns, worries and needs regarding their children. Two ethnographic methods were employed in the study; participant observation and qualitative interviews. Data analysis showed that mothers’ responses clustered around particular themes. Three major themes emerged from the data (Autism invisibility within the wider society and the difficulties of getting and dealing with the diagnosis; Autism causality and the explanatory frameworks used by mothers to understand the condition; Various internalised and externalised stigmas associated with autism and the relationship of the condition to disability and disablement), each of which offered insight into Saudi mothers’ unique experience of coping, adapting and bringing up a child with autism. Mothers’ Unfinished journey, is the overarching global theme within which all three major organizing themes and sub-themes were grouped. The findings of this study are discussed in detail, as well as the implications of the findings and recommendations for future research

Professional-parent collaboration in behavioural interventions for children with autism spectrum disorders in Saudi Arabia

PhD ThesisProfessional-parent collaboration is a crucial issue for the success of behavioural interventions (BI) for children with autism spectrum disorders (ASD). Many studies have been conducted in western countries related to professional-parent collaboration in education and BI for children with ASD. However, as a new phenomenon in the Saudi literature, professional-parent collaboration is rarely discussed or researched within this specific context. Therefore, this study explores and explains parents’ and professionals’ perspectives on the practice of professional-parent collaboration in the planning, design and implementation of BI for children with ASD in Saudi Arabia (SA) from the perspective of educational professionals and parents. A mixed-methods approach is employed over two phases. In Phase One, an online questionnaire was administered with 353 educational professionals across SA. Phase Two was a series of semi-structured interviews with eight professionals and eight parents from SA’s Eastern Province. The findings from both phases generally suggest that parents and professionals value professional-parent collaboration and professionals expect parents to participate at all stages of BI. However, the findings also suggest that parents and professionals are seldom involved in the collaborative planning and delivery of BI. The findings from the interview phase identify perceived facilitators to professional-parent collaboration, including emotional support for parents and mutual trust between parents and professionals. Additionally, these findings suggest perceived barriers to collaboration. Parent-related barriers include a parental lack of understanding of ASD and parental preference for rapid solutions to their child’s behavioural issues. School-related barriers include poor school arrangements regarding flexible approaches to professional-parent collaboration, overcrowding in classrooms, and the lack of assistant teachers. Professional-related barriers include a lack of motivation for professionals to work collaboratively. Finally, the findings suggest a lack of BI training and collaboration skills for both professionals and parents. The study suggests various practical implications for practice, policy, and future research

Teachers’ perceptions of the use and effectiveness of Social Stories™ in the development of social skills for children with Autism Spectrum Disorder (ASD) in Saudi Arabia

The aim of this study was to analyse the comments and judgments of special education teachers concerning the use and efficacy of Social Stories™ as a social skills intervention for children with Autism Spectrum Disorder (ASD) in mainstream boys’ schools in Riyadh, Saudi Arabia. Specifically, the study focused on the usefulness of Social Stories™ in improving three types of daily social interaction which children with ASD encounter in mainstream schools in Riyadh: greeting people, playing with friends, and talking with friends at snack time. The study was informed by Vygotsky’s socio-cultural theory (Vygotsky, 1978), and was founded on the hypothesis that Social Stories™ can serve as an intervention to improve the social capacity of children with ASD in a supportive school setting The study explored the perceptions of 15 special needs teachers’ using semi-structured interviews and focused on three case studies of children with ASD at two mainstream boys’ schools in Riyadh, Saudi Arabia. The interviews provided qualitative information about the use of Social Stories™ for children with ASD. The information gained was categorised into eight themes: the concept; source of Social Stories™; methods of display; use as a social intervention; benefits and drawbacks; barriers to use; cultural and contextual considerations; and factors contributing to best use. The case studies also tracked the children’s social skills over a period of 15-17 weeks and were used to evaluate the efficacy of Social Stories™ as a behavioural skills intervention. Overall, the findings from the interviews and the case studies found that Social Stories™ displayed some effectiveness in improving the social skills of children with ASD, whether the stories were used independently or combined with other methods. The evidence indicated that the teachers were clear about the purpose of Social Stories™ as well as possible benefits, drawbacks and barriers around their use in the classroom. They were aware of specific cultural considerations influencing the implementation and acquisition of the stories. They also recognised various approaches to incorporating Social Stories™ in their classrooms and considered the children’s specific educational needs and interests when using them. The findings of the study contributed to understanding of the use of Social Stories™ in the Middle East in general and in Saudi Arabia in particular. This study suggests a tentative framework for evaluating Social Stories™ to ensure their appropriateness for the culture and environment of Saudi Arabia, and provides a piloted mechanism to evaluate both the written and visual content of a given Social Story™ under that cultural lens. Suggestions based on the study are offered to both the Ministry of Education in Saudi Arabia and to teachers working with children with ASD (in Saudi Arabia and beyond) for the development of best practices in the use of Social Stories™ as a behavioural intervention. Suggestions for future research are also discussed

Saudi Arabian kindergarten teachers’ self-efficacy, attitudes, and perceptions of barriers towards inclusive education

Despite Saudi Arabia’s national and international commitments to adopting inclusive education to educate children with disabilities, there is a dearth of studies that investigate teachers’ self-efficacy and attitudes towards inclusive education in Saudi kindergarten settings and their perceptions of the barriers to inclusive education in such settings. Without this inquiry into teacher self-efficacy and attitudes and their perceptions of the barriers to inclusive education, the implementation of effective inclusive education in Saudi kindergartens remains challenging. Thus, to fill this gap in knowledge, this empirical study had four key aims. First, the study sought to verify the validity and reliability of two previously well-established measures—the Teacher Efficacy for Inclusive Practices (TEIP) scale and the Opinions Relative to the Integration of Students with Disabilities (ORI) scale—in terms of measuring both teachers’ self-efficacy and their attitudes regarding inclusive education in Saudi kindergarten settings, which has not yet been achieved. Second, the study sought to elucidate Saudi teachers’ self-efficacy and attitudes concerning inclusive education in kindergarten settings. Third, the study sought to investigate the influence of teacher-, child-, and context-related factors on teachers’ self-efficacy and attitudes concerning inclusive education in Saudi kindergarten settings. Fourth, the study sought to explore teachers’ perceptions of the barriers to the successful inclusion of children with disabilities in Saudi kindergarten settings. The present study is the first of its kind in Saudi Arabia to provide rigorous psychometric testing of the TEIP and ORI scales and this strengthens not only the current study findings but supports future research on teachers’ self-efficacy and attitudes towards inclusive education in Saudi kindergarten settings. The findings of the present study provide important recommendations to enhance inclusive education policies and practices within kindergarten settings and to develop an education system that provides the required support and resources for teachers to meet the needs of children with disabilities in inclusive kindergarten settings, which will enhance future educational outcomes for Saudi Arabia

The biopsychosocial impact of Autism on families and the contribution of solar irradiance to its aetiology

Autism Spectrum Disorder (ASD) is a lifelong disorder of unknown aetiology. A recent hypothesis is that a lack of Vitamin D is implicated in either the aetiology or maintenance of ASD. The human body synthesises Vitamin D from Ultraviolet-B (UVB) radiation found in sunlight. It follows that greater exposure to sunlight hours may be related to decreased rates of ASD. There are no interventions that target the causes of ASD rather therapies address either its symptoms or its comorbidities. ASD not only affects individuals, it also has an impact on their families. Family members have experienced social, occupational and personal costs associated with their child’s ASD which can result in parental separation or divorce. While researchers have established some of the factors which contribute to the impact on families, this research has not addressed families living in regional areas nor have empirical studies used domain-specific scales. The aims in this thesis were: Study 1) to determine whether the prevalence rates of ASD vary as a function of exposure to sunlight by reviewing reported prevalence rates by latitude where, the greater the distance from the equator, the higher the expected prevalence rates; Study 2) to conduct interviews with parents and caregivers of children with ASD who live in a regional area to determine the factors which affect them and those which might protect them; and Study 3) use the interview data to develop domain specific measures and test a model of living with a child with ASD. The results of Study 1 revealed that there is an increase in the prevalence of ASD as distance from the equator increases lending some support to the hypothesis that Vitamin D is implicated in ASD. The 16 interviews conducted in Study 2 revealed seven themes: impact on finances; family life; child’s health and behaviour, and schooling; child’s future; limited support, and regional living. In Study 3, with 178 participants, domain-specific scales were developed to test a model of the impact of living with a child with ASD. Resilience manifested by social support and coping strategies, explained 54% of the variance in impact of living with a child with ASD which, was operationalised by financial and relationship costs, social impact and feelings. Family life as assessed in this thesis, is significantly impacted by living with a child with ASD. The implications of these findings are discussed, especially around the need for greater exposure to outdoor activities and hence sunlight for children with ASD, more regional facilities and assistance for families, the importance of educational interventions for the public as well as enhancing levels of family resilience, as operationalised by support and coping strategies. Limitations of the studies and future research are discussed.Doctor of Philosoph