"Pray to all four directions": a qualitative study of syncretic care seeking by Vietnamese families for their children with autism spectrum disorder.

This study looked at what treatments Vietnamese families use for their autistic children. Families tried many different approaches - averaging nearly 7 different treatments per child. These included speech therapy and ABA, but also alternative treatments like special diets and stem cell therapy. Even with limited money, families spent about $345 per month on treatments.

The study shows there's a big shortage of proper autism services in Vietnam, leading families to try anything that might help their children.

This qualitative study examined care-seeking behaviors among Vietnamese families with autistic children. Researchers conducted interviews with 27 parents and surveyed 112 parents to understand intervention choices in a low-resource setting. Findings revealed families used an average of 6.8 different interventions per child, combining evidence-based approaches (speech therapy, ABA) with alternative treatments (geomancy, stem cell therapy, special diets). Despite low incomes, families spent an average of USD $345 monthly on interventions, many lacking evidence.

The study highlights significant gaps in access to appropriate services and trained professionals in Vietnam, with stigma driving parents to seek all available options for potential 'cures'.

Findings highlight urgent need for accessible, evidence-based autism services in LMICs. Clinicians should be aware that families may combine multiple interventions when formal services are unavailable. Development of culturally appropriate guidelines and training programs for local professionals is essential to improve service quality and reduce reliance on unproven treatments.

Small qualitative sample (27 interviews) limits generalizability. Study focused on one country (Vietnam) which may not represent other LMIC contexts. Self-reported spending data may be subject to recall bias. Limited detail provided about intervention effectiveness or outcomes.

The aim is to understand what therapies and interventions families in a low and middle income (LMIC) country, such as Vietnam resort to in their attempts to seek care for their children with ASD and why they choose these therapies. We undertook semi-structured qualitative interviews with 27 parents of children with autism and an online survey of 112 parents as part of a broader ethnographic study over one year augmented with recent interactional observations and a review of social media. There is limited access to formal interventions for families with children with ASD in Vietnam. Rather, families resort to syncretic care using an average of 6.8 different interventions per child.

These included: speech therapy; physical therapy; prescribed medicines; and ABA as well as geomancy, special dietary regimes, biochemical testing, stem cell therapies and religious and cultural practices. Despite having low incomes, the families surveyed spent an average USD 345 per month on interventions, many of which are not evidence-based. Desire to care and potentially "cure" their children within a context of stigma associated with ASD drives parents to seek all possible interventions for their children. There remains a large gap in access to appropriate evidence-based interventions or trained therapists for families.

Further information for parents, culturally appropriate guidelines for effective interventions, more trained rehabilitation professionals and regulation is required.IMPLICATIONS FOR REHABILITATIONWithin low and middle income countries (LMIC), such as Vietnam there is a lack of intervention services, difficulties in accessing appropriate specialists, poor quality care and the costs of care.Families seek a range of formal interventions and costly informal therapies as well as culturally specific practices to care for their child/ren and require information on effective therapies.In LMIC training programs to build capacity for allied health professionals need to be implemented on the latest evidence-based therapies.It is important to develop culturally appropriate Vietnamese guidelines to support interventions for children with ASD.