Parents' Perceptions: Environments and the Contextual Strategies of Parents to Support the Participation of Children and Adolescents with Autism Spectrum Disorder-A Descriptive Population-Based Study from Switzerland.

The sample was self-selected and may not represent all families. After consent, the enrollment rate was 85% and the completion rate was 73%, meaning a quarter of participants were lost after instructions or during completion. The sample had higher education than official statistics, and rural families were overrepresented. In the study, 57% lived in rural areas and 42% were urban or suburban, while Swiss statistics report 74% urban or suburban. Children were described by parents as having high-functioning autism features, so findings may not apply to children with more severe communication, independence, or behaviour challenges. All information was parent-reported, with no child self-report or independent observation, and parent reports can under-rate or over-rate environment and participation. The study was cross-sectional, so it cannot show that any strategy caused better participation or that perceptions change from childhood to adolescence. Data were collected during lockdown, although parents were asked to answer about before lockdown; pandemic effects could not be controlled. Some answers were missing, including 15-20% for informal friendships and social media contacts, and attitudes had the lowest answer rate at 108 of 115.

Do not treat the reported strategies as tested interventions that improve participation. This was a parent survey of perceptions at one time, not a treatment trial, so it cannot show that any strategy caused better participation.