title: Autism in Brazil: a systematic review of family challenges and coping strategies.
abstract: OBJECTIVE
  To describe the challenges faced by families caring for children with autism spectrum disorder (ASD) in Brazil and the coping strategies employed.
  
  
  METHODS
  Systematic review of articles published until September of 2013, without language restrictions, using quality appraisal (AMSTAR and CASP/Oxford instruments).
  
  
  RESULTS
  The literature shows parental emotional overload as one of the main challenges faced by families, especially mothers. The main stressors were diagnostic postponement, difficulty dealing with the diagnosis and associated symptoms, and poor access to health services and social support. The predominant coping strategies found included information exchange between affected families and integrated healthcare network for patient and family support.
  
  
  CONCLUSIONS
  ASD exerts strong influence on family dynamics, resulting in caregiver overload, especially in mothers. The Brazilian Unified Health System needs to provide comprehensive, continuous, and coordinated care to strengthen the patient-family dyad and promote the full development and societal inclusion of children with ASD.
authors.affiliation: Faculdade de Ciências Médicas, Universidade José do Rosário Vellano (UNIFENAS), Belo Horizonte, MG, Brazil.
authors.forename: Paulyane T M
authors.initials: PT
authors.lastname: Gomes
authors.affiliation: Faculdade de Ciências Médicas, Universidade José do Rosário Vellano (UNIFENAS), Belo Horizonte, MG, Brazil.
authors.forename: Leonardo H L
authors.initials: LH
authors.lastname: Lima
authors.affiliation: Faculdade de Ciências Médicas, Universidade José do Rosário Vellano (UNIFENAS), Belo Horizonte, MG, Brazil.
authors.forename: Mayza K G
authors.initials: MK
authors.lastname: Bueno
authors.affiliation: Department of Pediatrics, Escola de Medicina, Universidade Federal de Ouro Preto (UFOP), Ouro Preto, MG, Brazil.
authors.forename: Liubiana A
authors.initials: LA
authors.lastname: Araújo
authors.affiliation: Department of Collective Health and Family and Community Medicine, Escola de Medicina, Universidade Federal de Ouro Preto (UFOP), Ouro Preto, MG, Brazil. Electronic address: nathanmendes@hotmail.com.
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Souza
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D001294:Attitude to Health; D001321:Autistic Disorder / Q000175:diagnosis / Q000523:psychology*; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D057210:Delayed Diagnosis / Q000009:adverse effects; D006297:Health Services Accessibility; D006801:Humans; D009035:Mothers / Q000523:psychology; D010290:Parents / Q000523:psychology*; D012944:Social Support
keywords: Autism; Autismo; Autistic disorder; Brazilian Unified Health System; Caregivers; Cuidadores; Family relations; Relações Familiares; Sistema Único de Saúde; Transtorno Autístico