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Chapter 1
Introduction
Background and Rationale of the Study
Autism spectrum disorder (ASD) is a general term for a group of complex
disorders of brain development that are group in varying degrees, by difficulties in social
interaction, verbal and nonverbal communication and repetitive behaviors. With the May
2013 publication of the DSM-5 diagnostic manual, all autism disorders were merged into
one umbrella diagnosis of ASD (Mayes, Black & Tierney, 2013). The diagnosis of these
disorders can sometimes be detected at 18 months or younger. By age 2, a diagnosis by
an experienced professional can be considered very reliable (Center for Disease Control
and Prevention, 2014). There is no known single cause for autism, but it is generally
accepted that it is caused genetic vulnerability, environmental factors, and psychological
factors (Autism Society Organization, 2014).
In the last decade, multiple genes have been implicated in autism, although
genetic factors might be largely responsible for the occurrence of autism they cannot fully
account for all cases and it is likely that in addition to a certain combination of autismrelated genes, specific environmental factors might act as risk factors triggering the
development of autism (Grabrucker, 2013). Prenatal exposure to the chemicals
thalidomide and valproic acid has been linked to increased risk of autism. It also appears
to include such influences as parental age at conception, maternal nutrition, infection
during pregnancy and prematurity (Autism Speaks, 2014). Pregnancy-related exposures
have been the focus of a significant amount of epidemiological research on possible risk
factors for autism. Maternal stress, nutrition, maternal illness and complication,

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medications taken, and trauma, during the prenatal period are also linked to the high
prevalence rate of ASD. Type of delivery, feeding method of the child, age of gestation as
well as low birth weight of the child also contributes to the occurrence of ASD.

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more parents and clinicians become aware of the signs and symptoms of ASD, over time,
it becomes easily detected and diagnosed thus prevalence goes up. Recent reviews
estimate a global median prevalence of 62/10 000, that is one child in 160 has an autism
spectrum disorder (WHO, 2013). From one in 10,000 children during 1980’s, prevalence
rate continues to increase as years passed by. In 2014, the Centers for Disease Control
and Prevention’s (CDC) Autism and Developmental Disabilities Monitoring Network
(ADDMN) reported that approximately one in 68 children in the United States have an
Autism Spectrum Disorder during their 2008 survey.
Autism is a condition affecting populations worldwide. Posserud et al. (2010),
the Autism Society (2010), Autism Speaks (2008) and Wong (2007) as cited by Kopetz
and Lee (2012) calculated and identified respective country’s approximate prevalence
rates of autism diagnoses of children living in other countries throughout the world.
Rough estimation suggests population of autism people in the Philippines as 500,000 in
total. With this, the researcher aims to know the prevalence rate of children in Inayawan,
Cebu City. Knowing how many children have autism can help communities develop
realistic plans to support these children and their families. Understanding the number and
characteristics of children who have ASD is a key to promoting awareness of the
condition and identifying important clues for further research.

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Statement of Objectives
1. To determine the prevalence rate according to ASD risk category of children aged
16-30 months in Inayawan, Cebu City.
2. To determine the similarities of risk cases of ASD based on certain risk factors
through cluster analysis.
Hypothesis
There is an occurrence of risk for ASD among the children aging 16 to 30 months
in barangay Inayawan, Cebu City and there are several factors identified that probably
cause the condition, such as, familial history of mother and father, age upon pregnancy,
maternal illness, presence of major stressors, medications taken during pregnancy,
trauma, exposure to teratogens, type of delivery, maternal complications and feeding
method of the child.
Significance of the Study
This study aims to classify the risk of ASD occurring in children here in the city
and determines its prevalence rate as well as the factors that contribute to the occurrence
of such disorder. These data will aid health care professionals especially the nursing field
for basis of health teachings and appropriate interventions towards the public regarding
ASD, thus creating awareness and knowledge.
The study will be beneficial to the following:
Parents. The awareness that the study impart serves as a primary prevention to
parents and future parents on the development of ASD. The knowledge on the modifiable
contributing factors aids their practices to have fewer chances in the development of ASD
in their children.

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Department of Health (DOH). This can be utilize by the DOH in obtaining the
national prevalence rate of ASD in the Philippines and thus may aid in the development
of evidence-based health policies and clinical process guidelines necessary to
comprehensively manage ASD in the Philippines. This will enable the government to
formulate action plans for ASD in the aspects of health, social welfare and education.
Children with ASD. This study indirectly helps in the improvement of
interventions and management of children with moderate and higher risk of having ASD
with the aid of the national government specifically the DOH.
Researchers. This helps the researchers in determining the prevalence of children
having the risk of developing ASD and the factors that contribute to the development of
such disorder in Cebu City. The findings of this study can used as basis for further
evidenced-based research for future researchers. This can become their base knowledge
and may lead to future improvement of this study in a broader concept of the prevalence
of ASD and prevention and consequences of the disorder.
Scope and Delimitation
This study is mainly focused on determining the similarities of risk cases of ASD
based on certain risk factors such as the family on father and mother’s familial history
and age, child’s information upon birth. The respondents selected by the researchers are
Filipino mothers who are living in Barangay Inayawan for at least a year, with children
between the ages of 16 to 30 months. They must be able to understand Bisaya, Tagalog
and English.
Definition of Terms
Age. This refers to chronological age of the parents during the pregnancy.

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Age of Gestation. It is the common term used during pregnancy to describe how far
along the pregnancy is. It is measured in weeks, from the first day of the woman's last
menstrual cycle to the date of birth (University of Maryland Meedical Center, 2014).
Birth Weight. It refers to the first weight of the baby, taken just after he or she is born
(National Institute of Health, 2014).
Familial History. It is the tracing of their lineage in order to know if they are
predisposed to Autism Spectrum Disorder.
Occurrence. This refers to the existence of autism spectrum disorder (ASD) in the
specified locale.
Prevalence. This refers to the total number of ASD cases from the population of the
specified locale.
Sex. It refers to the state of being male or female (Merriam Webster’s Dictionary, 2014).

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Chapter 2
Review of Related Literature and Studies
The etiology of autism is still unclear but recent studies suggest genetics plays a
major role in conferring susceptibility. Researchers suspect that there are a number of
different genes that, when combined together, increase the risk of getting autism. In
families with one child with autism, the risk of having another child with autism is 3% to
8%. A number of studies have found that first-degree relatives of children with autism
also have an increased risk of autism spectrum disorders. Furthermore, studies have
shown that parents from families with autistic members are more likely to have autistic
children (Caglayan, 2010). In addition, parents who have a child with ASD have a 2%18% chance of having a second child who is also affected (Center for Disease Control
and Prevention, 2014).
According to the study of Croen, Najjar, Fireman, and Grether (2007), advance
maternal and paternal age are independently associated with ASD risk due to ageassociated increase in de novo mutations in male germ cells. Furthermore, in the study of
Foldi, Eyles, Flatscher-Bader, McGrath and Burne (2011), offspring of older fathers have
an increased risk of having autism and schizophrenia. This leads to more opportunities
for copy error mutations in germ cells from older fathers. Evidence also suggests that
epigenetic patterning in the sperm from older men is altered.
However, genetics alone do not account for all instances of autism. For good
reason, the increasing prevalence of autism has generated great interest in the potential
involvement of toxins in our environment. For example, prenatal exposure to the
chemicals thalidomide and valproic acid has been linked to increased risk of autism

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(Autism Speak, 2014). Autism risk factors, for example, appear to include such
influences as parental age at conception, maternal nutrition, infection during pregnancy
and prematurity.
In a new study, researchers identified an association between autism spectrum
disorder risk and prenatal weight gain, after accounting for important related factors such
as a woman’s pre-pregnancy BMI (University of Utah Health Sciences, 2013).
Pregnancy-related exposures have been the focus of a significant amount of
epidemiological research on possible risk factors for autism. Although many studies
support the hypothesis that obstetrical complications may increase the risk of autism
(Kolevson, Gross, Reichenberg, 2007), the specific complications, magnitude of effect
and overall conclusions of these studies are inconsistent. More so, maternal illness is also
deeming to be related to the increase risk for ASD and developmental delay. Though
Benaroch (2012) states that there is a low risk for ASD following influenza, recent
studies shows that hospital-diagnosed maternal bacterial infections during pregnancy
were associated with an increased risk of autism spectrum disorders in children. Women
with bacterial infections diagnosed during a hospitalization had a 58 percent greater risk
of having a child with an Autism Spectrum Disorder (ASD). Infections diagnosed during
a hospitalization in the second trimester were associated with children having more than a
three-fold increased risk of developing ASD (Zerbo et.al, 2013).
Khashan, Mcnamee, Henriksen, Pedersen, Kenny and Abel (2011) and the study
of Kinney, Munir, Cowley and Miller (2008) suggested that the effect of prenatal stress
on neurodevelopment varies according to the timing of exposure, and can cause a variety
of postnatal abnormalities, including not only the behaviors that resemble the defining

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core symptoms of AD, but also other problems, such as seizure disorders, cognitive
deficits, and in immune function, that also have greatly elevated.
According to Roberts et.al. (2013) as cited in Harvard School of Public Health,
women in the U.S. exposed to high levels of air pollution while pregnant were up to twice
as likely to have a child with autism as women who lived in areas with low pollution.
Twelve to 13 percent of autism cases stem from pregnancy issues that result in
prematurity, low birth weight or Caesarian section, according to a new report by the
Centers for Disease Control and Prevention (CDC). To elaborate further, Anderson
(2010) said that premature children also seemed to be a higher risk of brain injury
because of their early birth, which could potentially contribute to some Autism likesymptoms. Johnson and Marlow (2011) also reported similar findings last April 2009, in
a study of 988 children born before the 28th week of pregnancy. In the extremely low
gestational age newborn (ELGAN) study group found that more than 21 percent of these
are premature babies tested positive on Modified Checklist for Autism in Toddlers at 2
years old. In this new study, children born before 26 weeks gestation are more likely to
have Autism like traits at age 11.
Moreover, breastfeeding has been associated with increases in cognitive ability
and academic performance (Jain, Concato, Leventhal, 2002). Absence of breastfeeding
and the use of infant formula without docosahexaenoic acid and arachidonic acid was
significantly associated with an increase in the odds of having autistic disorder. As a
result of this preliminary study indicate that children who were not breastfed or were fed
infant formula without docosahexaenoic acid/arachidonic acid supplementation were

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significantly more likely to have autistic disorder (International Breastfeeding Journal,
2014).

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Chapter 3
Research Methodology
Research Design
This study utilized a non-experimental quantitative, descriptive – normative
research design, specifically a cross – sectional survey. It makes use of survey method to
gather data at a particular point in time with the intention to describe the nature of
existing conditions, or identify standards against which existing conditions can be
compared or determine relationship that exist between specific events (Cohen, Manion &
Morrison, 2000 cited in Mangal & Mangal, 2013).
Research Locale
The research was conducted in Cebu City specifically in Barangay Inayawan. It is
part of the urbanized area in Cebu City ranked as the 4 th populous barangay with a total
population size of 28,329, with no known census on the different age groups available as
of May 2010 (National Statistics Office, 2012). The area has no known current
prevalence rate of ASD.
Research Respondents
The respondents of the study are the mothers residing in Barangay Inayawan,
Cebu City with children or child aged 16 to 30 months. They have to speak and
understand Bisaya, Tagalog or English.
Research Sample and Sampling Technique
Total enumeration was utilized by the researcher, where all that fits in the
inclusion criteria were subjected as respondents. To qualify in the study the following
criteria is made. The respondents must be currently living in Inayawan, Cebu City for at

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least a year, who has a child or children aging 16 to 30 months old and if they are able to
understand and speak Tagalog, Bisaya or English. The researchers screened 503 children
in Inayawan, Cebu City aged 16-30 months.
Research Instruments
In screening the children to determine the risk for ASD, the proponents utilized the
Modified Checklist for Autism in Children Revised with Follow-up (M-CHAT-R/F TM). It
is a 2-stage parent-report screening tool to assess risk for ASD and is a recommended tool
by the American Academy of Pediatrics (DOH, 2014). In scoring, for all items except 2,
5, and 12, the response “NO” indicates ASD risk; for items 2, 5, and 12, “YES” indicate
ASD risk. The child can either be in low risk, moderate risk or high risk of ASD. Low
risk: Total score is 0-2; if child is younger than 24 months, screen again after second
birthday. No further action required unless surveillance indicates risk for ASD. Moderate
risk: Total Score is 3-7; Administer the Follow-Up (second stage of M-CHAT-R/F) to get
additional information about at-risk responses. If M-CHAT-R/F score remains at 2 or
higher, the child has screened positive. Action required: refer child for diagnostic
evaluation and eligibility evaluation for early intervention. If score Follow-Up is 0-1,
child has screened negative. No further action required unless surveillance indicates risk
for ASD. Child should be rescreened at future well-child visits.High risk: Total score is 820; It is acceptable to bypass the Follow-Up and refer immediately for diagnostic
evaluation and eligibility evaluation for early intervention. If the child screens positive,
Follow-Up items based on which items the child failed on the M-CHAT- R is selected;
only those items that were originally failed need to be administered for a complete
interview. The child will either pass or fail then it is scored again. The interview is

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considered to be a screen positive if the child fails any two items on the Follow-Up. (See
appendix C.)
The study also used a standardized or structured interview. This style is most
useful when looking for very specific information, it keeps data concise and reduces
researcher bias (Santiago, 2009). The researchers used the interview guide to gather
necessary information about the respondents. It consists set of questions relating to
perinatal factors that would likely result to the occurrence of any disorder from the ASD.
The interview guide consists of two major parts, namely, parent’s information and child’s
information. Parent’s information is further subdivided into maternal and paternal factors
that may lead to the development of ASD. Under the paternal factors are information
about the father’s age, upon conception of the child 30 months and under, and any
familial history of ASD. While maternal factors is classified into prenatal, intranatal and
postnatal factors. Under the prenatal factors includes major stressors, maternal illness,
medications, trauma and exposure to teratogens. Intranatal factors include, type of
delivery, maternal complications, duration of labor and fetal presentation. And postnatal
factors include, method of breastfeeding. Other pertinent information from the parents are
also included like name or code, address, civil status and nationality. Child’s information
includes birthdate, current age, sex, birth weight and age of gestation upon delivery.
These compose the interview guide that the researchers will utilized in the study. To test
the suitability of the instrument, pilot testing is done before conducting the data gathering
procedure proper.

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Data Gathering Procedure
A preliminary procedure is done before conducting the data collection. The data
gathering procedure started with securing permission from the Dean of the College of
Nursing of Cebu Normal University for the conduction of the study after the approval
from the panelist. Then, transmittal letter was sent to the Barangay captain of Barangay
Inayawan, Cebu City seeking permission to conduct the study in the area.
Data collection is done in two levels. First, respondents of the study will be
determined with the help of the Barangay Health Workers (BHW) and the DOH. Consent
for the conduction of the study will be secured and participant’s code will be made by the
researchers to maintain anonymity of the respondents. This is made to give the
researchers the ability to trace back the respondents if needed so. The researchers then
conduct a house to house interview with the use of M-CHAT-R/F TM to assess all children
aged 16- 30 months. With the assessment tool, these children was scored then classified
according to their risk. They may be on the low risk, moderate risk or on high risk.
Follow-up will be administered in children that scored having moderate risk, to get
additional information about the at-risk responses. Second, among the children with
moderate and high risk of ASD in barangay Inayawan, Cebu City, The researchers then
interview the respondents using the guide questions (refer to appendix C) prepared by the
researchers. Pilot study was conducted to the guide questions a month before the
expected date of the gathering of data, in Inayawan, Cebu City. Then lastly, factors were
clustered.

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Statistical Treatment of Data
Statistical analysis of the data in the study composes of two parts – finding the
prevalence and clustering of factors contributing to the risk of ASD. In finding for the
prevalence rate, descriptive statistics is utilized, specifically, frequency count and
percentage distribution. Descriptive statistics is used to describe and summarize data.
Frequency count is an attempt to discover the number of occurrences of ASD in the
specified locale, while percentage is the sum of all frequencies expressed as a fraction of
100 (Polit & Tatano, 2012). In clustering the factors contributing to the risk of ASD,
cluster analysis is utilized. Cluster Analysis is a method for grouping sets of individuals
based on their characteristics. Characteristics being meant are the factors that influences
the tendency for ASD.
Role of Researcher
The researchers of the study identified the occurrence of risk in children in
Inayawan, Cebu City. They will also gather necessary data regarding the respondents and
their child or children to further cluster the factors that may contribute to the development
of ASD. With the data gathered, the researchers, who are also the interviewers, will
analyze the results and formulate conclusion of the study.
Ethical Considerations of the Study
As this study required the participation of human respondents, certain ethical
issues were addressed. The consideration of these ethical issues was necessary for the
purpose of ensuring the privacy as well as the safety of the participants. Among the
significant ethical issues that were considered in the research process include consent and
confidentiality. In order to secure the consent of the selected participants, the researcher

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relayed all important details of the study, including its aim and purpose. By explaining
these important details, the respondents were able to understand the importance of their
role in the completion of the research. The respondents were also advised that they could
withdraw from the study even during the process. With this, the participants were not
forced to participate in the research.

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Chapter 4
Result and Discussion
This chapter shows the results taken from the respondents that were gathered from
barangay Inayawan in the time frame of two months, from July-September 2014.
Table 1. The prevalence rate of children having risk of ASD
Low risk: Total score is 0-2 Moderate risk: Total Score is 3-7; High risk: Total score is
Category

Total
Number
of
Children

Percentag
e on Total
Number of
Children

Gend
er

Low Risk

Moderate
Risk

High Risk

Male

260
(51.69%)

7 (1.39%)

2 (0.40%)

269

53.48%

Fema
le

227
(45.13%)

6 (1.19%)

1 (0.19%)

234

46.52%

Total

487
(96.82%)

13 (2.58%)

3 (0.60%)

503

100%

8-20;
The researchers have interviewed 503 mothers of children aged 16 to 30 months
using the M-CHAT-R/FTM tool. As shown on the figures, there are more male respondents
with the total of 269 (53.48%) compared to the female respondents with only 234
(46.52%). Mostly, the children were classified on the lower risk but ta 2.58% were
classified on the moderate risk and 0.60% on the higher risk. Most children in both the
moderate and high risk category are males.

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Table 2. Factors Contributing to Risk in ASD per Category

Factors (Non
genetic and
genetic)

Category
Low Risk

Moderate
Risk

High Risk

Total number
of respondents

Percentage

Parent’s Profile
Paternal Age
Too young
Appropriate Age
Too old
Maternal Age
Too young
Appropriate Age
Too old
Familial History
Perinatal Factors
Prenatal
Maternal Illness
Medications
Trauma
Exposure to
Teratogens
Stress
Intranatal
Type of delivery
NSVD
Cesarean Section
Forceps
Induced delivery
Complications
Postnatal
Feeding Method
Breastfeed
Bottle feed
Mixed feeding
Weight
Large for
Gestational Age
Appropriate
weight
Small for

0
466
21

0
13
0

0
3
0

0
482
21

0%
95.83%
4.17%

55
409
23
159

4
9
0
9

1
2
0
2

60
420
23
170

11.93%
83.50%
4.57%
33.80%

72
45
10
79

10
5
0
7

2
1
0
3

84
51
0
89

16.70%
10.14%
0.02%
17.69%

487

13

3

503

100%

487
0
0
0
22

13
0
0
0
3

3
0
0
0
1

503
0
0
0
26

100%
0%
0%
0%
5.17%

442
15
30

10
2
1

2
1
0

454
18
31

90.26%
3.58%
6.16%

8

2

1

11

2.19%

420

7

1

428

85.09%

59

4

1

64

12.72%

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Gestational Age

Looking closely on the age aspect of both the mother and father of the identified
cases, there is no significant risk involve in the paternal and maternal age as shown in
Table 2, which most of the cases falls down in appropriate age.
On the other hand, maternal stress is highly observed in which all cases
experienced stress during pregnancy. As stated in Chapter 2 on the study of Kinney,
Munir, Cowley and Miller (2008) suggested that the effect of prenatal stress on
neurodevelopment varies according to the timing of exposure, and can cause a variety of
postnatal abnormalities, including not only the behaviors that resemble the defining core
symptoms of ASD.
In the aspect of familial history there is around 33.80% in the identified cases
which concludes that familial history is one of the etiology in the development of ASD.
In families with one child with autism, the risk of having another child with autism is 3%
to 8%. A number of studies have found that first-degree relatives of children with autism
also have an increased risk of autism spectrum disorders. Furthermore, studies have
shown that parents from families with autistic members are more likely to have autistic
children (Caglayan, 2010).
Though most of the identified cases have appropriate weight, there is still a
percentage of 12.72% that falls in small for gestational age. In which this result
reinforced the fact that twelve to 13 percent of autism cases stem from pregnancy issues
that result in prematurity, low birth weight, according to a new report by the Centers for

19

Disease Control and Prevention (CDC). To elaborate further, Anderson (2010) said that
premature children also seemed to be a higher risk of brain injury because of their early
birth, which could potentially contribute to some Autism like-symptoms.
To explain further, there is a low significant relation in terms of maternal illness
and exposure to teratogens during pregnancy based on the results above. The type of
delivery on the other hand showed no significant risk in the development of ASD since
all the cases identified delivered their baby via normal spontaneous vaginal delivery.
However there were cases identified who undergone maternal complications during
delivery, this signifies that complications is significant in ASD. Many studies support the
hypothesis that obstetrical complications may increase the risk of autism (Kolevson,
Gross, Reichenberg, 2007).

Table 3. Variable Exploration thru Forced Cluster Analysis
Variable
Gender
Weight
Family History
Paternal Age
Maternal Age

Maternal Illness
Medications
Trauma
Exposure to Teratogens
Stress
Type of Delivery
Complication
Feeding Method

Moderate Risk
1.6250
2.3750
1.6875
2.0000
1.6875

Low Risk
1.4148
2.0965
1.8480
2.0431
1.9343

1.4375

1.8501

1.8125
1.8750
1.6875
1.1250
1.0000
1.8125
1.0000

1.9138
1.9795
1.9405
1.1684
1.0000
1.9548
1.1643

Grand centroid
1.4215
2.1054
1.8429
2.0417
1.9264

1.8370
1.9105
1.9761
1.9324
1.1670
1.0000
1.9503
1.1590

It is shown on the table above that only maternal illness has a significant result in
terms of category. This implies that children whose mother experienced illness during
pregnancy have higher chances of having a child who will have a tendency of acquiring
ASD. Though the children in the study, only has the risk for ASD, recent studies have

20

shown that maternal illness is linked to ASD and developmental delays (Zerbo et.al,
2013). It is generally believed that this is due to the effect of the inflammatory process to
the development of the fetus.

Correlation: Category, Maternal Illness
Pearson correlation of Category and Maternal Illness = -0.188
P-Value = 0.000

To further test the relationship between category and maternal illness, Pearson’s
correlation was utilized. And it is seen that there is a negative correlation between
category and maternal illness.

21

Chapter 5
Conclusion and Recommendation
This chapter shows the conclusion and recommendations identified by the
researchers to further improve further researches relating to ASD.
Conclusion
Therefore it is concluded that only 16 among 503 children have moderate and
high risk for ASD and with the identified moderate and at high risk children. Maternal
illness has due influence in the tendency of acquiring risk for ASD.
Recommendation:
1. For the DOH to reassess and confirm the presence of ASD in the identified
children with moderate and high risk for ASD.
2. For future researchers to validate the current conclusion of the study.

22

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26

Appendix A
Transmittal Letter
July 4, 2014
Hon. Lutherlee I. Soon
Barangay Captain
Inayawan, Cebu City
Dear Hon. Soon,
Greetings!
We, the Level IV Students of Cebu Normal University - College of Nursing, would like to
implement an approved research with the title “Autism Spectrum Disorder (ASD): Prevalence and
Clustering among Children in Inayawan, Cebu City”. Significant findings from this research will aid
the government, specifically the Department of Health (DOH) in determining the national
prevalence rate. We have chosen Barangay Inayawan for our research because it is ranked as
the 4th populous barangay as of May 2010. The area also has no known current prevalence rate
of ASD and that will be of great contribution in identifying the prevalence of ASD among children
in Cebu City and nationally.
The researchers will utilize a standardized or structured interview with the use of an interview
guide to gather necessary information about the respondents. The researchers will then conduct
a house to house interview after the pilot study was made using the guide questions prepared by
the researchers. Children aging from 16 month to 30 months will be classified if there is risk of
occurrence of ASD and factors will be clustered. Participant’s code will be made by the
researchers to maintain anonymity of the respondents.
In line with this, we would like to request from your office that we be allowed to conduct a house
to house interview within the time frame of July to September 2014 to the parents of the identified
specific age group of children in your community.
Attached herewith are the approved research proposal and informed consent for your reference
and perusal.
May this request merit your approval.

Respectfully yours,
ELISHA GINE B. ANDALES
HENELLE VALERIE S. ENAD
SHARMAINE JOSH O. LI
CRISTEL B. ARESTANG
Proponents

27
Noted:

(Signed) JEZYL C. CUTAMORA
Research Adviser
Cebu Normal University

(Signed) LAURENCE L. GARCIA
Dean, College of Nursing
Cebu Normal University
Approved:

(Signed) HON. LUTHERLEE I. SOON
Barangay Captain
Inayawan, Cebu City

28

Appendix B
Cebu Normal University
College of Nursing
July 4, 2014
_________________________
_________________________

Good day,
We, the level IV students of Cebu Normal University - College of Nursing, are interested to study about the

prevalence of children having the risk of developing ASD and the factors that may contribute to
the occurrence of such disorder in Barangay Inayawan, Cebu City, of a specific age group. The study
will be of great help in determining the prevalence rate of children having the risk of developing ASD
locally and nationally, which will be of aid to the Department of Health (DOH). This will also be a help
towards community awareness of increasing incidence of ASD.
We, the researchers will collect a data by giving questionnaires to the parents and assess by observing their
children. To qualify in the study the child must be a resident of Barangay Inayawan, Cebu City, who is 16
to 30 months of age with a parent preferably his/her mother who speaks and understands Tagalog, English
and or Bisaya. All data that are gathered and collected will only be used by the researchers and advisers
within the duration of the study. These data will be treated with up most confidentiality. When the purpose
of the data had been served and after the completion and analysis of the data will be completed, copies of
these data will be destroyed.
Participation of the study is purely voluntary and will not entail monetary reimbursement and so as
monetary collection. Participants can withdraw or refuse in participating in the study. In the incidence of
withdrawal, no legal actions or consequences will be made and the data that had been gathered thus far will
not be included in the study.
For any questions and inquiries about the research, please contact any of the following researchers:
Name
Andales, Elisha Gine B.
Arestang, Cristel B.
Enad, Henelle Valerie
Li, Sharmaine Josh O.

Contact Number
09335092907
09322362873
09339288056
09437019585

Email Address
[email protected]
[email protected]
[email protected]
[email protected]

CERTIFICATE OF CONSENT

I, whose name and signature appears on this consent, give my authorization voluntarily for my daughter/s or
son/s and I to participate in this research study. I have read and understand the foregoing information or it has been read
and explained to me. I have had the opportunity to ask questions about it and any questions that I have asked have been
answered to my satisfaction.
Signature over printed name of Parents:
_________________________________
Date: ______/_______/________
Day Month Year

_________________________________

29

Appendix C
Interview Guide
CHILD’S INFORMATION
Name (optional):
____________
Gender:____________ Birthday:_________________ AOG:___________
Weight upon birth (grams):_________
FATHER’S INFORMATION:
Name
(optional):________________________________________Age:________
Marital Status: __________Address:__________________________________________
Nationality:___________Familial History:___ NO ___Yes (Specify:________________)
MOTHER’S INFORMATION:
Name (optional): _____________________________________________Age:_____
GPTPAL Score: _____________Marital Status: __________
Address:___________________________________________Nationality:____________
Familial History: ___ No ___Yes (Specify:___________________)
PERINATAL INFORMATION:
Prenatal:
Maternal Illness: ____________________________________________________
Major Stressors: ___ No ___Yes (Specify:_______________________________)
Medications Taken: _________________________________________________
Trauma: ___No ___Yes (Specify: _____________________________________)
Exposure to Teratogens:
Alcohol intake: ____ No ____Yes
If yes: _____ quantity __________ type of beverage
______frequency __________ date of last drink
Smoking habits:____ No____Yes (Specify: ___sticks/day; ___packs/year)
Intranatal:
Type of Delivery: ____ Hospital: ____ Caesarean Section ___ NSVD
____ Forceps Delivery ____ Induced Delivery
____ Home delivery
Maternal Complications: ___No ___Yes (Specify:_______________________)
Duration of Labor: _________ Presentation of child upon birth: ________
Postnatal:
Feeding Method of the Child: ____ Breastfeed ____Bottlefeed____Mix

30

Appendix D
MCHAT-R/F
Scoring Algorithm
For all items except 2, 5, and 12, the response “NO” indicates ASD risk; for items 2, 5,
and 12, “YES” indicate ASD risk. The following algorithm maximizes psychometric
properties of the M-CHAT-R:
LOW-RISK: Total Score is 0-2; if child is younger than 24 months, screen again after
second birthday. No further action required unless surveillance indicates risk for ASD.
MEDIUM-RISK: Total Score is 3-7; Administer the Follow-Up (second stage of MCHAT-R/F) to get additional information about at-risk responses. If M-CHAT-R/F score
remains at 2 or higher, the child has screened positive. Action required: refer child for
diagnostic evaluation and eligibility evaluation for early intervention. If score on FollowUp is 0-1, child has screened negative. No further action required unless surveillance
indicates risk for ASD. Child should be rescreened at future well-child visits.
HIGH-RISK: Total Score is 8-20; It is acceptable to bypass the Follow-Up and refer
immediately for diagnostic evaluation and eligibility evaluation for early intervention.

Please answer these questions about your child. Keep in mind how your child usually
behaves. If you have seen your child do the behavior a few times, but he or she does not
usually do it, then please answer no. Please circle yes or no for every question. Thank you
very much.
1. If you point at something across the room, does your child look at it? (FOR
EXAMPLE, if you point at a toy or an animal, does your child look at the toy or animal?)
2. Have you ever wondered if your child might be deaf?
3. Does your child play pretend or make-believe? (FOR EXAMPLE, pretend to drink
from an empty cup, pretend to talk on a phone, or pretend to feed a doll or stuffed
animal?)
4. Does your child like climbing on things? (FOR EXAMPLE, furniture, playground
equipment, or stairs)
5. Does your child make unusual finger movements near his or her eyes? (FOR
EXAMPLE, does your child wiggle his or her fingers close to his or her eyes?)
6. Does your child point with one finger to ask for something or to get help? (FOR
EXAMPLE, pointing to a snack or toy that is out of reach)

31

7. Does your child point with one finger to show you something interesting? (FOR
EXAMPLE, pointing to an airplane in the sky or a big truck in the road)
8. Is your child interested in other children? (FOR EXAMPLE, does your child watch
other children, smile at them, or go to them?)
9. Does your child show you things by bringing them to you or holding them up for you
to see – not to get help, but just to share? (FOR EXAMPLE, showing you a flower, a
stuffed animal, or a toy truck)
10. Does your child respond when you call his or her name? (FOR EXAMPLE, does he
or she look up, talk or babble, or stop what he or she is doing when you call his or her
name?)
11. When you smile at your child, does he or she smile back at you?
12. Does your child get upset by everyday noises? (FOR EXAMPLE, does your child
scream or cry to noise such as a vacuum cleaner or loud music?)
13. Does your child walk?
14. Does your child look you in the eye when you are talking to him or her, playing with
him or her, or dressing him or her?
15. Does your child try to copy what you do? (FOR EXAMPLE, wave bye-bye, clap, or
make a funny noise when you do)
16. If you turn your head to look at something, does your child look around to see what
you are looking at?
17. Does your child try to get you to watch him or her? (FOR EXAMPLE, does your
child look at you for praise, or say “look” or “watch me”?)
18. Does your child understand when you tell him or her to do something? (FOR
EXAMPLE, if you don’t point, can your child understand “put the book on the chair” or
“bring me the blanket”?)
19. If something new happens, does your child look at your face to see how you feel
about it? (FOR EXAMPLE, if he or she hears a strange or funny noise, or sees a new toy,
will he or she look at your face?)
20. Does your child like movement activities? (FOR EXAMPLE, being swung or
bounced on your knee)

32

Appendix F
Work Plan/Time Table of Activities
Date Started

Date Finished

Proposed Activities

March 1, 2014

April 7, 2014

Proposal Writing

April 2014

May 2014

Seeking Approval of the
LGU

May 2014

May 2014

May 2014

June 2014

Expected
Outputs
Full blown
proposal
Approved
transmittal
letter

Identification of
respondents
Pilot testing

June 2014

August 2014

Data collection

August 2014

September 2014

Data analysis

August 2014

September 2014

Completion of terminal
report

Completion
and
compilation
of all
necessary
data

Terminal
report

Months
Activity

1

2

3

Proposal Writing
Seeking Approval of
the LGU
Identification of
respondents
Pilot testing
Data collection
Data analysis
Completion of
terminal report
GANTT Chart
Note: Number of months depends on the project duration

4

5

6

7

33

Appendix G
Name of Project
Proponents
Project Affiliation
Fiscal Year

LINE ITEM BUDGET
: Autism Spectrum Disorder: Prevalence and Clustering
amongChildren in Inayawan, Cebu City
: Elisha Gine B. Andales, Cristel B. Arestang, Henelle Valerie
S. Enad, Sharmaine Josh O. Li
: College of Nursing
: 2014

Items/Particulars
MAINTENANCE AND OTHER OPERATING
EXPENSES
1. Office Supplies and Reproduction
2. Communications
3. Meals and venue for meetings, participant
interaction and data analysis
4. Research assistance
5. Transportation
6. Token
TOTAL

Amount
2,000.00
500.00
1,000.00
5,000.00
2,000.00
1,500.00
Php 12,000.00

Prepared by:
ELISHA GINE B. ANDALES
CRISTEL B. ARESTANG
HENELLE VALERIE S. ENAD
SHARMAINE JOSH O. LI
Research Members
Approved by:

JEZYL C. CUTAMORA
Research Adviser

34

CURRICULUM VITAE
PERSONAL INFORMATION

Name:
Elisha Gine B. Andales
Gender:
Female
Address:
Molave, Zamboanga del Sur
Contact Number:
09335092907
E-mail Address:
[email protected]
Religion:
Christian
Birthday:
April 6, 1995
Civil Status:
Single
EDUCATIONAL BACKGROUND
College:
Cebu Normal University - College of Nursing
Osmeña Boulevard Cebu City
School Year 2011-present
Secondary:
Molave Vocational Technical School
Mabini St., Molave Zamboanga del Sur
School Year 2007-2011
Primary:
Molave Regional Pilot School
Capistrano St., Molave Zamboanga del Sur
School Year 2001-2007

CURRICULUM VITAE
PERSONAL INFORMATION

35

Henelle Valerie S. Enad

Name:
Gender:
Address:

Female
#10 Vincent Drive S. Osmena St.
Gun-ob Lapu-Lapu City
Contact Number:
09339588056
E-mail Address:
[email protected]
Religion:
Roman Catholic
Birthday:
December 8, 1994
Civil Status:
Single
EDUCATIONAL BACKGROUND
College:
Cebu Normal University - College of Nursing
Osmeña Boulevard, Cebu City
School Year 2011-present
Secondary:
St. Alphonsus Catholic School
Poblacion, Lapu-Lapu City
School Year 2007-2011
Primary:
St. Alphonsus Catholic School
Poblacion, Lapu-Lapu City
School Year 2001-2007

CURRICULUM VITAE
PERSONAL INFORMATION

Name:
Gender:
Address:

Sharmaine Josh O. Li
Female
Elisa Valley, Lahug, Cebu City

36
Contact Number:
09437019585
E-mail Address:
[email protected]
Religion:
Christian
Birthday:
October 3, 1994
Civil Status:
Single
EDUCATIONAL BACKGROUND
College:
Cebu Normal University - College of Nursing
Osmeña Boulevard, Cebu City
School Year 2011-present
Secondary:
Bethany Christian School
Buena Hills Subdivision, Guadalupe, Cebu City
School Year 2007-2011
Primary:
Bethany Christian School
Buena Hills Subdivision, Guadalupe, Cebu City
School Year 2001-2007

CURRICULUM VITAE
PERSONAL INFORMATION

Name:
Gender:
Address:

Cristel B. Arestang

Female
National Road Catmon- Daan,
Catmon, Cebu City
Contact Number:
09322362873
E-mail Address:
[email protected]

37
Religion:
Birthday:
Civil Status:

Roman Catholic
August 10, 1994
Single
EDUCATIONAL BACKGROUND

College:
Cebu Normal University - College of Nursing
Osmeña Boulevard, Cebu City
School Year 2011-present
Secondary:
Cebu Academy
Poblacion, Carmen, Cebu
School Year 2007-2011
Primary:
Carmen Central Primary School
Cogon East, Kangyan, Carmen, Cebu
School Year 2001-2007

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