ArticlePDF Available

Autism Spectrum Disorder and International Travel



The literature on international travellers with psychiatric disorders is limited. This perspective article highlights various travel-related aspects of autism spectrum disorder (ASD), including its aetiological association with maternal migration, the difficulties faced by longterm travelers with autistic children, and the facilitation of international travel for autistic individuals by the travel industry. Depending on the severity of their condition, autistic individuals may find specific aspects of the travel experience particularly distressing. Travel medicine practitioners should be aware of the unique needs of autistic travelers when providing pre-travel health counseling. There is also an onus on the travel industry to facilitate safe and enjoyable travel and remove barriers faced by autistic travellers.
People living with mental illness are among the most
vulnerable groups of international travellers.1,2 The literature
on international travellers with psychiatric disorders is
limited.3 Autism spectrum disorders (ASDs) comprise a
group of neurodevelopmental disorders. Affected patients
exhibit difficulties with communication and social interaction
and demonstrate restricted, repetitive patterns of behavior,
interest, and activities.4 A prevalence for ASD of 0.6%-1.13%
has been reported, and there is a marked male predominance
in this condition.5 Deka et al described the domestic travel
patterns, needs, and barriers of adults with ASD in the United
States and identified unique transportation challenges such as
negotiating fixed-route transit and crossing roads safely.6 It can
reasonably be assumed that overseas travel would pose even
greater challenges for the autistic individual. This perspective
article will reflect on various international travel-related
aspects of ASD, including its putative link with maternal
migration, the difficulties faced by long-term travelers with
autistic children, and the facilitation of international travel for
autistic individuals.
Migration as a Risk Factor for Autism
Apart from the recognized underlying genetic causes such as
fragile X syndrome, Rett syndrome and tuberous sclerosis,
risk factors for ASD include advanced maternal age,7 preterm
delivery, and intra-uterine growth restriction. Maternal
migration has recently been postulated as an independent
risk factor for the development of low-functioning ASD. A
retrospective analysis of children presenting to the National
Child Developmental Service in Ireland revealed an increased
rate of low-cognitive functioning ASD in children born
to mothers who migrated from sub-Saharan Africa.8 The
authors hypothesize a role for maternal vitamin D deficiency
as a basis for this phenomenon. The prevalence of ASD
was three to four times higher in children born to Somali
migrants than in a matched cohort.9 The majority of autistic
children were male, and all affected children had evidence of
intellectual disability. Most of the Somali mothers had resided
in Sweden for the entire gestation period. A further Swedish
study of almost 5000 children with ASD observed a lower
risk of high-functioning autism and a higher risk of low-
functioning autism in children of parents who had migrated
from regions with a low human development index.10 A
case-control study of second-generation migrants in Finland
found a positive association between ASD and the migration
of both parents, immigrant mothers, but not immigrant
fathers.11 Paradoxically, a lower prevalence of autism has been
documented in the children of Hispanic migrants living in
the United States, presumably owing to epigenetic changes
resulting from larger social networks and improved obstetric
Int J Travel Med Glob Health. 2019 Mar;7(1):1-3 doi 10.15171/ijtmgh.2019.01
International Journal of Travel Medicine and Global Health
Perspective Open Access
Autism Spectrum Disorder and International Travel
Wee Xuan Neo1, Gerard Thomas Flaherty1,2*
1School of Medicine, National University of Ireland Galway, Galway, Ireland
2School of Medicine, International Medical University, Kuala Lumpur, Malaysia
Corresponding Author: Gerard Thomas Flaherty, MD, Professor, School of Medicine, National University of Ireland
Galway, Galway, Ireland. Tel: +353-91495469, Fax: +353-91494540, Email:
Copyright © 2019 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Citation: Neo WX, Flaherty GT. Autism spectrum disorder and international travel. Int J Travel Med Glob Health. 2019;7(1):1-3. doi:10.15171/
The literature on international travellers with psychiatric disorders is limited. This perspective article highlights various travel-related
aspects of autism spectrum disorder (ASD), including its aetiological association with maternal migration, the difficulties faced by long-
term travelers with autistic children, and the facilitation of international travel for autistic individuals by the travel industry. Depending
on the severity of their condition, autistic individuals may find specific aspects of the travel experience particularly distressing. Travel
medicine practitioners should be aware of the unique needs of autistic travelers when providing pre-travel health counseling. There is also
an onus on the travel industry to facilitate safe and enjoyable travel and remove barriers faced by autistic travellers.
Keywords: Migrants, Travel, Autistic Disorder, Mental Health
Received June 28, 2018; Accepted October 1, 2018; Online Published November 24, 2018
Neo and Flaherty
International Journal of Travel Medicine and Global Health. 2019;7(1):x–x
Autism in Long-Term Travellers
Modern approaches to the management of ASD in childhood
emphasize the importance of timely diagnosis and intervention,
with access to multidisciplinary paediatric developmental
services which can manage issues related to speech and
language delay, motor problems, and behavioral challenges.
Long-term travelers and expatriates whose children have been
diagnosed with ASD may encounter difficulties in identifying
and accessing reliable therapeutic services overseas. This
may be compounded by discontinuities in care which may
be detrimental to their special needs children. An example
stems from the relocation abroad of families where one or
more parents serve in the military. Frequent redeployment
may hinder efforts to develop a therapeutic relationship with
the autism care provider. Coupled with the lack of social
support, this may lead to greater behavioral disturbances in
affected children when parental redeployment compromises
the continuity of family-centered care.13
Challenges of Travel for Autistic Individuals
Depending on the severity of their condition, autistic
individuals may find specific aspects of the travel experience
particularly distressing. The desire for predictability and
maintenance of a fixed routine may be diffic ult to satisfy during
international travel, especially where the travel itinerary
itself is uncertain.14 Auditory overload may be prominent
in airports and in crowded destinations with a high urban
population density and traffic volume. Queuing in airports
may be difficult for some travelers with ASD, and manual
body searches at security stations may be poorly tolerated. A
lack of familiarity with a foreign environment can provoke
significant anxiety, depression, and social isolation in autistic
travelers. A recent qualitative study of mothers of autistic
children provided insight into the triggers of underlying
emotional and behavioral disturbances, including the need
to avoid spontaneous, unplanned, and highly stimulating
activities during travel.15 The difficulties autistic children
encounter during routine transportation were highlighted in
a retrospective study of 82 children who had escaped from
their child safety restraint during road travel.16 It is reasonable
to suggest that these issues may be amplified during
international travel, including on commercial airplanes and
in taxis, with obvious safety implications for those involved.
Role of the Travel Industry
Travel medicine practitioners should be aware of the unique
needs of autistic travelers when providing pre-travel health
advice. There is also a responsibility on the travel industry
to facilitate enjoyable travel and remove barriers faced by
autistic travelers. A study from Northern Ireland evaluated
a video modeling technique based on applied behavior
analysis research to prepare autistic children for travel by
airplane.17 Shannon Airport in the Republic of Ireland was the
first airport in Europe to create a sensory room for autistic
travelers which is located air-side, adjacent to the departure
lounge. This quiet, dimly lit room is designed to provide
relief from the hectic airport environment and includes
features such as an undulating wavy wall, an aquatic bubble
tube, color-changing, light-emitting diodes, and a wheel
projector. There have been efforts to design tourism websites
to make them more acceptable for travelers with ASD based
on a greater use of icons, symbols, and simple text with less
structural variation between webpages.18 Hamed underscored
the need for quieter accommodations and a greater focus on
nature tourism and exposure to cultural and historic sites of
interest to the autistic traveler.19
Travel is a recognized risk factor for the development of autism
in children whose mothers migrated during pregnancy.
International travel poses significant challenges for autistic
individuals, many of which can be addressed by promoting
greater awareness throughout the travel industry about
the special needs associated with this common psychiatric
disorder. There is a need for greater qualitative research
that would serve to illuminate aspects of the autistic travel
experience which have not heretofore been discussed in the
Authors’ Contributions
Both authors contributed equally to the conception, planning,
writing, and editing of the article. The final version was read
and approved by both authors.
Conflict of Interest Disclosures
None declared.
Ethical Approval
Not applicable.
None received.
1. Seeman MV. Travel risks for those with serious mental illness.
Int J Travel Med Glob Health. 2016;4(3):76-81. doi:10.21859/
2. Felkai P, Kurimay T. Patients with mental problems - the most
defenseless travellers. J Travel Med. 2017;24(5). doi:10.1093/jtm/
3. Flaherty GT, Lim Yap K. Bibliometric analysis and curriculum
mapping of travel medicine research. J Travel Med. 2017;24(5).
4. American Psychiatric Association (APA). Diagnostic and Statistical
Manual of Mental Disorders (DSM-V5). 5th ed. APA; 2013.
5. Elsabbagh M, Divan G, Koh YJ, et al. Global prevalence of
autism and other pervasive developmental disorders. Autism Res.
2012;5(3):160-179. doi:10.1002/aur.239.
6. Deka D, Feeley C, Lubin A. Travel patterns, needs, and barriers of
adults with autism spectrum disorder: report from a survey. Transp
Res Rec. 2016;2542:9-16. doi:10.3141/2542-02.
7. Sandin S, Hultman CM, Kolevzon A, Gross R, MacCabe JH,
Reichenberg A. Advancing maternal age is associated with
increasing risk for autism: a review and meta-analysis. J Am
Acad Child Adolesc Psychiatry. 2012;51(5):477-486.e471.
8. Bolton S, McDonald D, Curtis E, Kelly S, Gallagher L. Autism
in a recently arrived immigrant population. Eur J Pediatr.
2014;173(3):337-343. doi:10.1007/s00431-013-2149-6.
Autism and Travel
International Journal of Travel Medicine and Global Health. 2019;7(1):x–x 3
9. Barnevik-Olsson M, Gillberg C, Fernell E. Prevalence of autism in
children born to Somali parents living in Sweden: a brief report.
Dev Med Child Neurol. 2008;50(8):598-601. doi:10.1111/j.1469-
10. Magnusson C, Rai D, Goodman A, et al. Migration and autism
spectrum disorder: population-based study. Br J Psychiatry.
2012;201:109-115. doi:10.1192/bjp.bp.111.095125.
11. Lehti V, Hinkka-Yli-Salomaki S, Cheslack-Postava K, Gissler M,
Brown AS, Sourander A. The risk of childhood autism among
second-generation migrants in Finland: a case-control study. BMC
Pediatr. 2013;13:171. doi:10.1186/1471-2431-13-171.
12. Palmer RF, Walker T, Mandell D, Bayles B, Miller CS. Explaining
low rates of autism among Hispanic schoolchildren in Texas.
Am J Public Health. 2010;100(2):270-272. doi:10.2105/
13. Davis JM, Finke EH. The Experience of Military Families with
Children with Autism Spectrum Disorders During Relocation
and Separation. J Autism Dev Disord. 2015;45(7):2019-2034.
14. Flaherty G, Md Nor MN. Travel itinerary uncertainty and the
pre-travel consultation--a pilot study. J Travel Med. 2016;23(1).
15. Sedgley D, Pritchard A, Morgan N, Hanna P. Tourism and autism:
Journeys of mixed emotions. Ann Tour Res. 2017;66:14-25.
16. Yonkman J, Lawler B, Talty J, O’Neil J, Bull M. Safely transporting
children with autism spectrum disorder: evaluation and
intervention. Am J Occup Ther. 2013;67(6):711-716. doi:10.5014/
17. Ruddy L, Booth N, Gaw M, Liao Y, Dounavi K, Dillenburger K.
Autism in the air: using point of view video priming and natural
environment teaching to help children with autism travel by plane.
Good Autism Practice. 2015;16(2):25-32.
18. Dattolo A, Luccio FL, Pirone E. Web accessibility recommendations
for the design of tourism websites for people with autism spectrum
disorders. Int J Adv Life Sci. 2016;8(3-4):297-308.
19. Hamed HM. Tourism and autism: An initiative study for how travel
companies can plan tourism trips for autistic people. Am J Tour
Manag. 2013;2(1):1-14. doi:10.5923/j.tourism.20130201.01.
... Apart from these factors, families with disabilities tend to have similar travel motivations as non-disabled people, such as the need to change environment and to see and live new experiences (Dominguez, Darcy & González, 2015). Neo and Flaherty (2018) examined the difficulties that travelers with autism face during long-term travels in their study. The study stated that the excessive noise, traffic, and population density to which autistic individuals were exposed during travel and manual controls for security purposes were disturbing for those people. ...
... In foreign literature, some studies address autism spectrum disorder with different aspects of tourism such as travel, accommodation, gastronomy, and recreation (Freund et al. 2019;Neo & Flaherty, 2018;McKercher & Darcy, 2018;Sedgley et al. 2017;Stuhl & Porter, 2015;Amet, 2013;Hamed, 2013). When these studies are examined, it is seen that their findings support the results of this study. ...
... It was also observed that families having children with autism avoid public transportation for similar reasons, especially for long distances in the study. Neo and Flaherty (2018) also found that families with ASD child, face several difficulties during travel such as overcrowd, loud noise, waiting in long queues, heavy traffic, and increased waiting time due to delays in vehicles. Studies in the literature have shown that internal limitations and the severity of the disease affect travel to accessible accommodation and tourism facilities. ...
Full-text available
ÖZ Otizm Spektrum Bozukluğu (OSB) teşhisi konulmuş çocukların aileleri hem tatilde hem de seyahat esnasında çeşitli zorluklarla karşılaşmaktadırlar. Bu çalışmanın amacı, OSB'ye sahip çocukları olan ailelerin tatil deneyimlerini belirlemek, tatilde yaşadıkları sorunları tespit etmek ve buna uygun pazarlama stratejileri geliştirmek adına ilgili paydaşlara öneriler sunmaktır. Araştırmada yarı yapılandırılmış odak grup görüşme tekniği kullanılmış ve Konya'da yaşayan OSB'li çocuk sahibi 17 aile ile mülakatlar gerçekleştirilmiştir. Araştırma bulguları, OSB tanısı olan çocuklara sahip ailelerin tatilleri esnasında karşılaştığı en önemli sorunların; konaklama işletmelerinin sunduğu hizmetlerin bu tür aileler için erişilebilir olmadığını ve seyahat esnasında yaşanılan sorunların ailelerin tatil deneyimlerini olumsuz etkilediğini göstermiştir. Bu durum, OSB teşhisi konulmuş çocukların ve ailelerin topluma kazandırılmasının, toplumun otizm hakkındaki farkındalığının artırılmasının gerekliliğine dikkat çekmektedir. A B S T R A C T Families of children diagnosed with Autism Spectrum Disorder (ASD) face various difficulties both on vacation and during travel. This study aims to determine the holiday experiences of families with children diagnosed with ASD, identify the problems they experience throughout the vacation, and provide suggestions to relevant stakeholders to develop related marketing strategies. A semi-structured focus group interview technique was conducted with 17 families in Konya. Research findings show the most critical problems of the families are that the services offered by accommodation businesses are not accessible for them, the hotel staff and other families do not have sufficient awareness of the subject. This situation draws attention to the necessity of providing more accessible holiday options for them.
... The changes in routine, unpredictability, crowds, and new noises and sights can all make the experience difficult for children with ASD and their families. The literature on international travellers with psychiatric disorders is limited [1,2]. Public health officials should be aware of the unique needs of travellers with ASD when providing pre-travel health advice [2]. ...
... The literature on international travellers with psychiatric disorders is limited [1,2]. Public health officials should be aware of the unique needs of travellers with ASD when providing pre-travel health advice [2]. People living with mental illness are among the most vulnerable groups of international travellers [3,4]. ...
... In 2014, the World Health Organization [9] called for the access needs of people with ASD to be properly addressed. The travel industry and public health sector, therefore, should endeavour to eliminate the major constraints encountered by passengers with autism [2][3][4][5][6][7][8][9][10], yet research on international travellers with developmental or cognitive disabilities is limited [2]. Compared with the general population, children diagnosed with autism spectrum disorder (ASD) tend to have deficits in adaptive skills, which makes novel environments such as an airport very difficult to manage [11,12], and the airport experience for a child with ASD and their family can therefore be overwhelming [10]. ...
Full-text available
The literature on air travellers with psychiatric disorders is limited. This perspective article highlights various travel-related aspects of autism spectrum disorder (ASD). The airport experience can be stressful for families of children with autism spectrum disorder (FwASDs). The aim of this study was to explore the airport experience of FwASDs using the value co-creation process approach to assist airport managers in designing improved experiences for this specific passenger segment. This study responds to the current climate in which airports are developing awareness programmes in relation to children who require special assistance at airports. The prevalence of children with ASD is 1/68. While a number of airports throughout the world have adopted procedures addressing the needs of those with cognitive impairment, these advances are far from universal. As part of an academic–industry collaboration between Vueling airlines and the Spanish airport operator Aena, 25 FwASDs took part in an inclusive airport research project in the city of Barcelona from November 2015 to April 2016. Employing a qualitative methodology that incorporated focus groups, ethnographic techniques, and post-experience surveys, the study contributes to extending the body of knowledge on the management of the value co-creation process for challenging passenger segments within the airport context. The study explains how ensuring adequate resource allocation to this passenger segment can improve the family-inclusive design of the airport experience and offers managerial recommendations.
... Evidently, vacation experiences that involve out-of-routine activities at unusual environments can be distressing to the children with ASD. Auditory overload, crowds, queuing, and high-security check at the airport can provoke a significant level of anxiety, potentially overwhelming and leading to a meltdown (Neo & Flaherty 2018).Persons with autism pose a great variation, yet there are a few common challenges usually exhibit in the daily life of almost all autistic persons (see Table 1). Extremely interested in detailed information on 'how-it-works' and this stereotyped or repetitive behaviour challenge may increase during trip due to change in custom and surroundings. ...
The goal of the travel and tourism industry is to make all travellers happy. The activities in the sector consistently promote multitudinous benefits, such as wellness, rejoicing, and recuperation. The motivation for family tourists is to indulge in tourism activities that can instil family and social values through a family vacation. However, the vacation experience usually differs for families of children diagnosed with autism spectrum disorder (ASD) compared to regular families of regular children. The development difficulties in the intellectual and social communication of children with ASD involving a spectrum of emotion, namely happy, frustrated, distressed, and restlessness require special attention from their caregivers during vacation. The purpose of this paper was to analyse vacation experiences in families of children with ASD based on the literature of previous studies. The findings indicated that family vacation promotes self-improvement and opens room for learning about the real world in these targeted children. Nonetheless, the meaning of vacation to the parents of these children exudes notions of conflict and complication that locate mixed feelings. The study aimed at increasing the understanding on family tourists with children of special needs with different characteristics that may benefit the tourism providers and the autism therapists to collaborate on various innovative partnerships, producing platforms to facilitate a safe and enjoyable vacation experience to the targeted family as they travel together. Consequently, this effort can help dispel neglect in the social inclusion aspects regardless of the tourists' physical or developmental conditions. ABSTRAK Matlamat industri pelancongan adalah memastikan semua pelancong bergembira. Aktiviti-aktiviti yang terkandung di dalam sektor ini secara konsisten membentuk pelbagai faedah, seperti, kesejahteraan, kegembiraan, danpemulihan. Motivasi bagi para pelancong keluarga adalah untuk menikmati aktiviti-aktiviti pelanconganyang dapat membentuk nilai kekeluargaan dan sosialmelalui percutian keluarga. Walaubagaimanapun, pengalaman bercuti kebiasaannya berbeza di kalangan keluarga-keluarga yang mempunyai kanak-kanak yang didiagnosisdengan gangguan spektrum autisme (ASD) berbanding dengan keluarga-keluarga yang mempunyai kanak-kanak tumbesaran normal. Kesukaran perkembangan dalam intelektual dan komunikasi sosial yang dihadapi oleh kanak-kanak ASD melibatkan spektrum emosi, iaitu gembira, kecewa, tertekan, dan kegelishanmemerlukan perhatian yang khusus daripada para penjaga mereka semasa bercuti. Matlamat artikel ini adalah untuk menganalisa pengalaman-pengalaman bercuti di kalangan keluarga yang mempunyai kanak-kanak ASD berdasarkan literatur kajian-kajian yang lalu. Hasil kajian mendapati bahawa pelancongan keluarga dapat mendorong peningkatan diri dan membuka ruang untuk belajar mengenai dunia sebenar kepada kanak-kanak yang disasarkan ini. Walaupun begitu, erti percutian kepada ibu bapa anak-anak ini adalah suatu konflik dan rumit yang menunjukkan perasaan bercampur-baur. Kajian ini diharapkan dapat meningkatkan pengetahuan keperluan khas kumpulan pelancong keluarga yang mempunyai ciri-ciri berbeza yang dapat memberi manfaat kepada pihak penyedia dan ahli terapi carakerja untuk berkolaborasi dalam pelbagai platform inovasi perkongsian, menyediakan platform untuk memudahkan percutian yang selamat dan menyeronokkan kepada keluarga yang disasarkan semasa mereka melancong bersama. Oleh itu, usaha ini dapat membantu membendungpengabaian dalam aspek penyertaan sosial tanpa mengira keadaan fizikal atau keadaan perkembangan pelancong. Kata kunci: Pelancongan; percutian keluarga; gangguan spektrum autisme; kesukaran perkembangan; kanak-kanak.
... 2020), Malaysia juga mula mengorak langkah dalam usaha memastikan kesinambungan kemudahan dan perkhidmatan sokongan mesra-autisme yang terdapat di lapangan terbang antarabangsa di negara-negara luar juga dapat dialami oleh para pelancong berkeperluan khas autisme yang tiba atau transit di KLIA atau KLIA2. Lapangan terbang merupakan kawasan yang amat sibuk dan dipenuhi dengan pelbagai simulasi seperti pergerakan manusia, kenderaan dan bunyi bising yang boleh mengancam tingkah laku autistik (Neo & Flaherty, 2018). Maka penyediaan prasarana berbentuk mesra-autisme adalah dilihat sangat penting di lokasi seperti ini. ...
Keluarga merupakan antara kumpulan pasaran terbesar dan terpenting dalam industri pelancongan. Banyak destinasi pelancongan di pelbagai negara mensasarkan kumpulan ini dalam aktiviti promosi produk pelancongan mereka kerana peratusan pasaran pelancongan riadah di seluruh dunia didominasi oleh kumpulan pelancong berkeluarga iaitu sebanyak 30%. Namun, tidak semua keluarga mempunyai latar belakang dan keperluan produk atau perkhimatan pelancongan yang sama. Kumpulan keluarga dengan anak berkeperluan khas memerlukan perkhidmatan sokongan yang sedikit berbeza berbanding kumpulan keluarga dengan anak tipikal. Kumpulan keluarga dengan kanak-kanak berkeperluan khas seperti kanak-kanak mempunyai autisme perlu diberi perhatian serius memandangkan data menunjukkan insiden kanak-kanak mempunyai autisme di dunia telah meningkat pada kadar 1 daripada 160. Secara tidak langsung, peningkatan jumlah ini boleh memberi kesan kepada peningkatan permintaan produk dan perkhidmatan pelancongan bersifat mesra-autisme daripada kumpulan keluarga yang bercuti bersama anak mempunyai autisme. Oleh itu, kajian ini meneroka kemudahan mesra-autisme di sektor-sektor yang termasuk dalam kategori produk pelancongan untuk menilai persediaan Malaysia dalam menyantuni keperluan khas kanak-kanak mempunyai autisme ketika bercuti. Kajian ini dijalankan melalui kaedah kualitatif melalui teknik analisa dokumen terhadap bahan tertulis dan bahan yang digambarkan dan teknik pemerhatian secara terus bagi mengupas kemudahan mesra-autisme yang ditawarkan di negara ini. Hasil kajian mendapati bahawa kemudahan mesra-autisme di negara ini hanya terdapat di sektor beli-belah, pengangkutan, perkhidmatan makanan dan tarikan pelancong.
... In a survey of 703 adults with ASD in New Jersey regarding their travel experience, 291 had sensory issues [10]. Excessive sensory stimuli such as loud noises, unfamiliar smells, the touch of others such as security manual body searches, and spontaneous, unplanned, and highly stimulating activities during traveling trigger reactions to sensory stimuli [11]. Therefore, parents, caregivers, or people accompanying children with ASD on a trip have to prepare, for example, when dealing with noise during a trip, one can use noise-canceling earphones to provide relief [12]. ...
Full-text available
Traveling with children with autism can be very challenging for parents due to their reactions to sensory stimuli resulting in behavioral problems, which lead to self-injury and danger for themselves and others. Deep pressure was reported to have a calming effect on people with autism. This study was designed to investigate the physiological effect of deep pressure, which is an autism hug machine portable seat (AHMPS) in children with autism spectrum disorders (ASD) in public transportation settings. The study was conducted with 20 children with ASD (16 boys and 4 girls) at the Semarang Public Special School with an age ranging from 4 to 13 years (mean 10.9 ± 2.26 years), who were randomly assigned into two groups. The experiment consisted of group I who used the AHMPS inflatable wraps model and group II who used the AHMPS manual pull model. Heart rate (HR) and skin conductance (SC) were analyzed to measure the physiological calming effect using pulse oximeter oximetry and a galvanic skin response (GSR) sensor. Heart rate was significantly decreased during the treatment compared to the baseline (pre-test) session in group I (inflating wrap model) with p = 0.019, while no change of heart rate variability (HRV) was found in group II (manual pull model) with p = 0.111. There was no remaining effect of deep pressure using the HRV indicator after the treatment in both groups (group I with p = 0.159 and group II with p = 0.566). GSR captured the significant decrease in skin conductance during the treatment with p < 0.0001 in group I, but no significant decrease was recorded in group II with p = 0.062. A skin conductance indicator captured the remaining effect of deep pressure (after the treatment); it was better in group I (p = 0.003) than in group II (p = 0.773). In conclusion, the deep pressure of the AHMPS inflating wrap decreases physiological arousal in children with ASD during traveling.
... 12 The travel health considerations for individuals with autism spectrum disorder have been discussed previously in this journal. 13 Face masks may present sensory and social communication challenges to autistic children and adults, given that these individuals are highly sensitive to touch and may have difficulty making eye contact, preferring instead to focus on the lips during conversation. Conventional masks render lip reading impossible, which complicates communication efforts among autistic, deaf or partially deaf persons. ...
Full-text available
Face masks have been worn by members of the public for source control during pandemics and major outbreaks of infectious disease across the centuries. As the current coronavirus disease 2019 pandemic evolves, reluctance towards the wearing of face masks and anti-mask sentiments by some people have been encountered, with strongly held personal views and misinformation being disseminated through social media. Some of this resistance may arise from personal beliefs about the limited effectiveness of masks. Negative perceptions towards use of face masks have also been voiced by patients with pre-existing medical conditions such as chronic obstructive pulmonary disease and asthma. There are concerns that face coverings may not be suitable for children or individuals with autism. Health care professionals have an obligation to be advocates for this public health intervention. Individual patients’ concerns about mask use should be sensitively addressed by countering misinformation with reliable evidence from the scientific literature.
Full-text available
Araştırma, UNWTO (2019) verilerine göre Dünya’nın en çok turist alan ilk on ülkesinin destinasyon pazarlama sürecinde resmi web sitelerini gastronomi turizmi açısından değerlendirmeyi amaçlamaktadır. Bu amaç doğrultusunda araştırmada nitel araştırma yöntemlerinden doküman inceleme tekniği kullanılmıştır. Araştırmanın kapsamını dünyanın en çok turist alan ilk on ülkesinin resmi web sitelerinde yer alan gastronomi turizmine yönelik pazarlama ve tanıtım çalışmaları oluşturmaktadır. Bu kapsamda veriler, 1 Aralık 2020 ile 10 Ocak 2021 tarihleri arasında ilgili ülkelerin İngilizce dilindeki resmi turizm web sitelerinden metin, fotoğraf ve video şeklinde toplanmıştır. Elde edilen verilere içerik analizi uygulanmıştır. Analiz sonuçları incelenen ülkelerin tamamının gastronomiyle ilgili bir sayfası veya kategorisi bulunduğunu, bazı ülkelerin ciddi eksiklikleri olmasına rağmen genel olarak değerlendirildiğinde dünyanın en çok turist ağırlayan ilk on ülkesinin destinasyon pazarlama sürecinde resmi web sitelerinde gastronomi turizmine yönelik tanıtım ve pazarlama çalışmaları yaptıklarını göstermektedir.
Full-text available
Otizm Otizm Spektrum Bozukluğuna (OSB) sahip çocuğu olan aileler, hem tatilleri hem de seyahatleri boyunca çeşitli zorluklarla karşı karşıya kalmaktadırlar. Bu çalışmanın amacı, Otizm Spektrum Bozukluğu tanısı konmuş çocukların ve ailelerinin tatil deneyimlerini belirlemek, tatil sırasında karşılaştıkları sorunları tespit etmek ve ilgili paydaşlara uygun pazarlama stratejilerinin nasıl geliştirileceğine dair öneriler sunmaktır. Çalışmada yarı yapılandırılmış odak grup görüşme tekniği kullanılmıştır. Görüşme soru formu hazırlanmış ve Konya'da yaşayan OSB'li 12 çocuğun ailesiyle görüşülmüştür. Çalışma, OSB'li çocukları olan ailelerin tatilleri boyunca karşılaştıkları en kritik sorunlara dikkat çekmektedir. Çalışma verilerine göre; OSB’li çocuğu olan ailelerin turistik konaklama imkanlarına erişimde zorlandıkları, otel personeli ve diğer ailelerin otizm hakkında yeterince bilgi sahibi olmaması nedeniyle bu kişilerle iletişimin zorlaştığı ve seyahatlerde çeşitli zorluklarla karşılaşıldığı sonuçlarına ulaşılmıştır. Çalışma, OSB tanısı almış çocukların ve ailelerinin toplumla yeniden bütünleştirilmesinin, toplumun otizm konusunda bilinçlendirilmesinin ve onlara daha erişilebilir tatil seçenekleri sunulmasının önemine dikkat çekmektedir.
Conference Paper
Full-text available
Bu çalışmanın amacı, kültürel miras turizmi amacıyla kültürel miras alanlarını ziyaret eden turistlerin memnuniyeti ve hizmet kalitesi ile alanı tekrar ziyaret etme niyeti arasındaki ilişkiyi araştırmaktır. Bu amaçla, 2019 yılı Ağustos ayında Bergama kültürel miras alanlarını ziyarete gelen toplam 400 yerli ve yabancı turiste anket tekniği uygulanarak araştırmanın verileri elde edilmiştir. Çalışmada, turist memnuniyeti ve hizmet kalitesinin, turistlerin kültürel miras alanını tekrar ziyaret etme niyeti ile arasındaki ilişkiyi incelemeye yönelik hipotezler geliştirilmiştir. Geliştirilen hipotezlerin analizinde iki yönlü ki-kare bağımsızlık testinden faydalanılmıştır. Çalışmanın bulguları değerlendirildiğinde, turistlerin harcadığı masraflara ve zamana göre memnuniyetin kültürel miras alanını tekrar ziyaret etme niyeti ile ilişkisi olduğu tespit edilmiştir. Diğer bir bulgu da hizmet kalitesi ile kültürel miras alanını tekrar ziyaret etme niyeti arasında ilişkinin bulunmasıdır. Sonuç olarak, turistlerin tekrar ziyaret etme niyeti ile istatistiksel olarak anlamlı ilişkisi bulunan turist memnuniyetinin ve hizmet kalitesinin sağlanması, turistik destinasyon olan kültürel miras alanlarının temel amaçlar arasında olmalıdır.
Full-text available
There is an evolving tourism literature around psychological wellbeing, social exclusion and disability. This paper advances tourism knowledge into the terrain of psychological health and developmental complexities, and psychological distress. It draws on a phenomenological position to understand the lived experiences of mothers of children with developmental difficulties, in this case diagnosed with autism spectrum disorder (ASD). It discusses the emotional and everyday challenges of caring for a child diagnosed with ASD on holiday, discusses the perceived benefits holidays offer and outlines care-giving strategies adopted by mothers to manage their children’s tourism experiences. The paper discusses the uniqueness of the context of autism and problematizes popular discourses, which predominantly frame tourism as pleasurable settings of escape, stimulation, novelty and relaxation.
Full-text available
Background: It has been known for a long time in the French-speaking, but not the English-speaking literature that travel can exacerbate pre-existing psychosis. Objective: The purpose of this article was to review the literature on this subject and present recommendations for prevention. Method: For this narrative review of the literature on travel risks in individuals with pre-existing psychosis, Appropriate terms were used to search Google Scholar, and all identified English, French, and Polish references were investigated. Results: Potential psychotogenic stresses of travel were found to be: mental confusion due to rapid transition into unfamiliar roles, physical discomfort and malaise seeding delusional beliefs, reawakening of old fears, loss of usual supports, overuse of substances to quiet fears, irregular scheduling or interruption of medications, jet lag with insomnia and hormonal shifts, the shock of acculturation, and unaccustomed interpersonal encounters. Women and the elderly were at greatest risk for symptom escalation related to travel. Conclusion: Travel risks need to be recognized and anticipated in vulnerable populations because many travel stressors are preventable.
Full-text available
Editorial comment This paper describes a study that used video materials and visits to an airport to prepare children on the autism spectrum for travel by plane. Twenty parents and carers took part in the study with children aged from 3 to 16 years. The authors explain that the methods they used were based on Applied Behaviour Analysis (ABA) research; a video modelling technique called Point of View (POV) Video Priming and during visits to an airport they used procedures known as Natural Environment Teaching. The findings suggest that using video and preparing children by taking them through what is likely to happen in the real environment when they travel by plane is effective and the authors suggest these strategies could be used to support children with autism with other experiences they need or would like to engage in such as visits to the dentist or hairdressers and access to leisure centres and other public spaces.
Background: Severe mental illness occurring abroad is a difficult situation for patients, their families, and for the local medical community. Patients with mental problem are doublely stigmatized due to their mental illness and because they are foreigners in an unfamiliar country. The appropriate treatment is often delayed, while patients are often dealt with in a manner that violates their human rights. Moreover, repatriation - which is vital in this case - is often delayed due to the lack of international protocols for the transportation and treatment of mentally ill travelers. Methods: Authors analyzed several factors related to acute mental health problems during travel: the etiology of symptoms, the appropriate treatment possibilities abroad, and medical evacuation and repatriation of the psychotic patient. The article presents a brief review of travel-related mental disorders, the epidemiology of mental health issues faced by travelers, and the significance of pre-travel advice for these patients. The first problem is to recognize (and redress) the particular challenges faced by a psychotic patient in a strange country. The second challenge is to prepare the patients, often in a poor psychiatric state, for medical evacuation by commercial aircraft. Another important question is the best way to take the patient through customs and security control. All of these, as yet unresolved, issues can make the mental patient virtually defenseless. Conclusions: Although timely repatriation of a mentally ill patient is vital and urgent, most travel insurance policies exclude treatment and repatriation costs incurred due to acute mental illness. The high cost of treatment and repatriation must be paid by the patient or their family, which could lead to severe financial strain or insolvency. Changing the approaches taken by the local mental health care community, police, airport security, and insurance companies remain a challenge for psychiatrists.
Evidence-based travel medicine requires that research priorities reflect the wide knowledge base of this discipline. Bibliometric analysis of articles published in Journal of Travel Medicine yielded the following results: epidemiology (6%, n = 105); immunology/vaccinology (8.5%, n = 148); pre-travel assessment/consultation (30.5%, n = 533); diseases contracted during travel (48.3%, n = 843); other clinical conditions associated with travel (6.8%, n = 119); post-travel assessment (5.2%, n = 91) and administrative and general travel medicine issues (6%, n = 105).
The universal Web design represents an ambitious and open challenge for the current research on the Web. Key aspects are Web accessibility and Web usability by people with the widest possible range of abilities, operating within the widest possible range of situations. Universal design is adaptive for the users, and provides personalised answers to different users. A recent study shows an estimation of the global burden of people with Autism Spectrum Disorders. In the last 24 years, the incidence of autism has a stable prevalence of 7.6 per 1000 or one in 132 persons. They represent a significant number of people. People with Autism Spectrum Disorders are usually solitary and visual thinkers and they could take advantage by the use of the Web. This paper discusses of tourism, website and people with Autism Spectrum Disorders. The aim is to define a set of recommendations for the design of tourist websites for people with Autism Spectrum Disorders, and to present a case study articulated in two tourist, autistic-friendly, websites. The first website considers the area of Rieti, central Italy; it has been validated through expert reviews, and several trials with many autistic, verbal users of a specialised centre for neurological and physical disabilities. The second website contains as a tourist destination the area around Mestre, close to Venice, Italy. In this case, the website has been validated on a single, non-verbal autistic user.
Risk assessment relies on the accuracy of the information provided by the traveller. A questionnaire was administered to 83 consecutive travellers attending a travel medicine clinic. The majority of travellers was uncertain about destinations within countries, transportation or type of accommodation. Most travellers were uncertain if they would be visiting malaria regions. The degree of uncertainty about itinerary potentially impacts on the ability of the travel medicine specialist to perform an adequate risk assessment, select appropriate vaccinations and prescribe malaria prophylaxis. This study reveals high levels of traveller uncertainty about their itinerary which may potentially reduce the effectiveness of their pre-travel consultation. © The Author 2016. Published by Oxford University Press on behalf of International society of travel medicine. All rights reserved. For permissions, please e-mail: [email protected]/* */
Although autism spectrum disorder (ASD) has received a substantial amount of attention in other fields, very little appears in the transportation literature about people with ASD. Because the National Household Travel Survey and metropolitan travel surveys do not classify people with ASD as a separate category of persons with disabilities, very little information is available about their travel patterns, needs, or barriers. To bridge the existing information gap, this paper provides results from a recent survey that focused exclusively on adults with ASD in New Jersey to learn about their travel patterns, the importance of the various types of trips they make, and the barriers they encounter regarding the use of different transportation modes. The survey, distributed through various organizations throughout the state, was completed by or for 703 adults. Because the objective of the paper is to provide as much information as possible from the survey, no attempt has been made to compare the travel patterns, needs, and barriers of the survey respondents with those of the general population. However, other researchers can easily compare the survey results provided in this paper with data from other sources. Although the survey generated other valuable information, the most revealing information pertained to barriers to walking, driving, taking public transit, and even taking rides from others. The information collected through this research is being shared through outreach efforts with agencies that provide or fund transportation to persons with disabilities in New Jersey.
Military families with a child with autism spectrum disorder (ASD) are underrepresented in the literature. In order to provide appropriate services, research must be done to determine the needs of these families. A qualitative methodology was used to interview military spouses with children with ASD about their experiences with therapeutic services. Overall, results indicate military families with a child with ASD experience challenges associated with both the military lifestyle and having a child with special needs. Due to their membership in two groups prone to support limitations and therapeutic service accessibility issues, military families with a child with ASD may be at additional risk for high levels of stress and difficulty obtaining and maintaining ASD related services.