**6. Family-centred interventions**

**4. Concepts of disability**

236 Autism Spectrum Disorder - Recent Advances

infrastructures at local and national.

to any medical and disability condition.

**5. Social and cultural factors**

concept of the Chronosystem.

understands individual behaviour in particular contexts.

ASD is predominantly conceived as a medical condition based on DSM or ICD definitions. The medical model tends to believe that the curing or managing of disability generally or com‐ pletely, revolves around identifying the illness or disability from an 'in-depth' clinical perspective involving doctors, therapists and psychologists. The irony is that ASD even in the medical sources is defined based on its behavioural manifestation rather than clinical symp‐ toms. Sole reliance on a medical condition sits outside modern conceptions of disability that acknowledge environmental influences such as family and society on a child/person's level of functioning. These may be particularly crucial in developing countries with their poor service

The International Classification of Functioning, Disability and Health (ICF, WHO, 2002) is an updated framework for the description of health and health-related states. The classification is focused on health and health-related domains based on what a person with a health condition can do in a standard environment compared to what they actually do in their usual environment (comparing the level of capacity to the level of performance). Thus social and environmental factors can have a major influence on a child's level of functioning in addition

The ICF also embodied the thinking in the bio-psycho-social frameworks which have been proposed in disability and mental health in which different biological, psychological, and social influences are brought together [8]. As Engel argues there is a reciprocal rather than a linear relationship between all these three main factors. According to this model, although a specific disability may require primary attention at the biological level – such as hearing impairment-it will also have an impact on psychological factors and both factors in turn may influence the social system of the person with disability and their parents. Thus ICF provides a comprehensive view of factors involving health, illness and health care and explains and

[1, 2] ecological framework of the different systems that impact on a child's development, could also help researchers and practitioners to better understand the situation of parents who are taking care of a child with ASD. He posits five different systems that can influence childhood development: the Microsystem, Mesosystem, Exosystem, Macrosystem and Chronosystem. A change in any one of these components can cause a change in the other components. Micro‐ systems are those closest to the child-such as family and school-as they directly impact on the child. These Microsystems are interrelated and together form a higher level system: the Mesosystem. However these take place within an Exosystem of community services and supports that in turn is influenced by the wider cultural Macrosystem, including ideologies, laws, economic and social policies and religious attitudes. All of these systems and the interactions between them can change over the course of a child's life which is captured in the There is also a shift from child-focussed interventions to family-focussed interventions. Family-centred practice is an umbrella term for both a philosophy and a method of service delivery consisting of a set of values, skills, behaviours and knowledge that recognises the centrality of families in the lives of their offspring. It puts family life, the strengths, needs and choices of people with a disability and their families as the focal point of service planning, development, implementation and evaluation. It is grounded in valuing the uniqueness of every person and family, and a commitment to partnering with families and communities to support children and young people with developmental delay or disability to learn, grow and thrive.

Family-centred approaches value the strengths and resourcefulness of all families and aims to support and encourage families in their efforts to meet the special needs of their child with a disability and of the parents in ways that are defined as independent, functional and appro‐ priate [4].The efficacy of family-centred practice has been well demonstrated in affluent countries [7] and applied across all developmental disabilities but may be less well developed in ASD.

With these criteria in mind, the three most promising frameworks for family empowerment were found to be: 1) Bronfenbrenner's theory on human ecology [1, 2], 2) the McMaster Model of family functioning [9, 10, 11], and 3) Enabling and Supporting Families [6]. Although other frameworks have been applied in family research, they were considered to be insufficient for the purpose of the research study undertaken in Iran. For example, the Lazarus Theory on Stress and Coping (Lazarus, 1966 cited in [14] had been used in many studies on parental stress and coping. Although this theory conceptualizes stress as an outcome of the relationship between individuals and their situation as parents of a child with disabilities, it emphasises more the personal rather than the social side of stress and coping.
