Vaccine Hesitancy: Insights from Parents of Children with Autism Spectrum Disorder and Other Neurodevelopmental Disorders

Desislava  Maslinkova; Mihaela  Hristova; Dora  Simeonova; Atanaska  Avramova; Harieta  Manolova; Svetla  Staykova; Lyubomir  Manolov; Nadia  Polnareva

doi:10.6000/2292-2598.2026.14.02.5

Authors

Desislava Maslinkova Clinic of Child Psychiatry “St. Nicholas”, University Multiprofile Hospital for Active Treatment “Alexandrovska”, Sofia, Bulgaria and Department of Psychiatry and Medical Psychology, Medical University - Sofia, Sofia, Bulgaria
Mihaela Hristova Clinic of Child Psychiatry “St. Nicholas”, University Multiprofile Hospital for Active Treatment “Alexandrovska”, Sofia, Bulgaria and Department of Psychiatry and Medical Psychology, Medical University - Sofia, Sofia, Bulgaria
Dora Simeonova Clinic of Child Psychiatry “St. Nicholas”, University Multiprofile Hospital for Active Treatment “Alexandrovska”, Sofia, Bulgaria and Department of Psychiatry and Medical Psychology, Medical University - Sofia, Sofia, Bulgaria
Atanaska Avramova Clinic of Child Psychiatry “St. Nicholas”, University Multiprofile Hospital for Active Treatment “Alexandrovska”, Sofia, Bulgaria and Department of Psychiatry and Medical Psychology, Medical University - Sofia, Sofia, Bulgaria
Harieta Manolova Clinic of Child Psychiatry “St. Nicholas”, University Multiprofile Hospital for Active Treatment “Alexandrovska”, Sofia, Bulgaria and Department of Psychiatry and Medical Psychology, Medical University - Sofia, Sofia, Bulgaria
Svetla Staykova Department of Sensory Neurobiology, Bulgarian Academy of Sciences, Sofia, Bulgaria
Lyubomir Manolov Clinic of Child Psychiatry “St. Nicholas”, University Multiprofile Hospital for Active Treatment “Alexandrovska”, Sofia, Bulgaria
Nadia Polnareva Clinic of Child Psychiatry “St. Nicholas”, University Multiprofile Hospital for Active Treatment “Alexandrovska”, Sofia, Bulgaria

DOI:

https://doi.org/10.6000/2292-2598.2026.14.02.5

Keywords:

Vaccination, parental attitudes, ASD, NDD, vaccine hesitancy

Abstract

Vaccine hesitancy presents significant challenges and risks to public health worldwide. Certain groups, such as parents of children with Autism Spectrum Disorder (ASD), are more vulnerable to vaccine hesitancy due to concerns about safety, past controversies, and misinformation surrounding autism and immunization. This research aimed to evaluate various aspects of vaccine hesitancy among parents of children with ASD and other neurodevelopmental disorders (NDDs), highlighting key concerns that may influence their vaccination decisions. The study was based on data collected from a researcher-developed questionnaire examining parental attitudes and concerns regarding childhood vaccination. Participants included 225 parents of children diagnosed with NDD (ASD or other). Results revealed significant differences between the two groups of parents at the item, factor, and total-score levels, with the most prominent discrepancies regarding vaccine-related concerns (safety, side effects, and autism causality) and trust and acceptance of vaccination practices. However, vaccination decisions did not differ significantly by diagnosis, indicating that while attitudes and trust levels vary, vaccination behaviors remain consistent across diagnoses. Implications for practice include the need for tailored health messaging that addresses the specific fears and distrust of parents of children with neurodevelopmental disorders, particularly those with ASD. Effective communication strategies should be employed to provide emotional support, not just information, to improve vaccine acceptance and reduce hesitancy.

References

MacDonald N. Vaccine hesitancy: definition, scope and determinants. Vaccine 2015; 33(34): 4161-4.

McKee C, Bohannon K. Exploring the reasons behind parental refusal of vaccines. J Pediatr Pharmacol Ther 2016; 21(2): 104-9.

Gust DA, Darling N, Kennedy A, Schwartz B. Parents with doubts about vaccines: which vaccines and reasons why. Pediatrics 2008; 122(4): 718-25.

Bonsu NEM, Mire SS, Sahni LC, Berry LN, Dowell LR, Minard CG, et al. Understanding vaccine hesitancy among parents of children with autism spectrum disorder and parents of children with non-autism developmental delays. J Child Neurol 2021; 36(10): 911-8.

Sahni LC, Boom JA, Mire SS, Berry LN, Dowell LR, Minard CG, et al. Vaccine hesitancy and illness perceptions: com-paring parents of children with autism spectrum disorder to other parent groups. Child Health Care 2020; 49(4): 385-402.

Pivetti M, Melotti G, Mancini C. Vaccines and autism: a preliminary qualitative study on the beliefs of concerned mothers in Italy. Int J Qual Stud Health Well-being 2020; 15(1): 1754086.

Aquino F, Donzelli G, De Franco E, Privitera G, Lopalco PL, Carducci A. The web and public confidence in MMR vaccination in Italy. Vaccine 2017; 35(35 Pt B): 4494-8.

Faasse K, Chatman CJ, Martin LR. A comparison of language use in pro- and anti-vaccination comments in response to a high-profile Facebook post. Vaccine 2016; 34(47): 5808-14.

Skafle I, Gabarron E, Nordahl-Hansen A. Social media shaping autism perception and identity. Autism 2024; 28(10): 13623613241230454.

Salmon DA, Dudley MZ, Glanz JM, Omer SB. Vaccine hesitancy: causes, consequences, and a call to action. Am J Prev Med 2015; 49(6 Suppl 4): S391-8.

Salmon DA, Moulton LH, Omer SB, DeHart MP, Stokley S, Halsey NA. Factors associated with refusal of childhood vaccines among parents of school-aged children: a case-control study. Arch Pediatr Adolesc Med 2005; 159(5): 470-6.

Wake AD. The willingness to receive COVID-19 vaccine and its associated factors: “vaccination refusal could prolong the war of this pandemic”—a systematic review. Risk Manag Healthc Policy 2021; 14: 2609-23.

Goin-Kochel RP, Fombonne E, Mire SS, Minard CG, Sahni LC, Cunningham RM, Boom JA. Beliefs about causes of autism and vaccine hesitancy among parents of children with autism spectrum disorder. Vaccine 2020; 38(40): 6327-33.

Olusanya OA, Bednarczyk RA, Davis RL, Shaban-Nejad A. Addressing parental vaccine hesitancy and other barriers to childhood/adolescent vaccination uptake during the coronavirus (COVID-19) pandemic. Front Immunol 2021; 12: 663074.

Smith LE, Amlôt R, Weinman J, Yiend J, Rubin GJ. A systematic review of factors affecting vaccine uptake in young children. Vaccine 2017; 35(45): 6059-69.

Wilson K, Barakat M, Vohra S, Ritvo P, Boon H. Parental views on pediatric vaccination: the impact of competing advocacy coalitions. Public Underst Sci 2008; 17(2): 231-43.

Dubé E, Vivion M, MacDonald NE. Vaccine hesitancy, vaccine refusal and the anti-vaccine movement: influence, impact and implications. Expert Rev Vaccines 2015; 14(1): 99-117.

Sahni LC, Minard CG, Berry LN, Mire SS, Mensah-Bonsu NEM, Dowell LR, et al. Vaccine hesitancy and illness perceptions: comparing parents of children with autism spectrum disorder to other parent groups. J Pediatr Psychol 2020; 45(9): 1025-34.

Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 1998; 351(9103): 637-41.

Godlee F, Smith J, Marcovitch H. Wakefield’s article linking MMR vaccine and autism was fraudulent. BMJ 2011; 342: c7452.

Bazzano A, Zeldin A, Schuster E, Barrett C, Lehrer D. Vaccine-related beliefs and practices of parents of children with autism spectrum disorders. Am J Intellect Dev Disabil 2012; 117(3): 233-42.

Stolle LB, Nalamasu R, Pergolizzi JV Jr, Varrassi G, Magnusson P, LeQuang J, Breve F; NEMA Research Group. Fact vs fallacy: the anti-vaccine discussion reloaded. Cureus 2020; 12(9): e10380.

Mensah-Bonsu NE, Bocchini CE, Nori-Sarma A, Wang J, Sharma NR. Understanding vaccine hesitancy among parents of children with autism spectrum disorder and parents of children with non-autism developmental delays. J Child Neurol 2021; 36(6): 473-80.

Gulle BT, Yassibas U, Sarigedik E. Vaccine hesitancy in the autism spectrum disorder context: parental vaccine decision-making and coping with stress strategies. J Autism Dev Disord 2024.

Sumra B, Tarek E. Vaccination and autism: debunking myths and analyzing parental concerns about infections. Int J Innov Res Eng Multidiscip Phys Sci 2024; 12(6).

Efe F, Aksoy H, Ok F, Kocak E, Gunes S. Perception of internalized stigma in parents of children with autism spectrum disorder: investigating the effects of depression, anxiety, and family functioning. Cureus 2024; 16(11): e73860.

Boom JA, Cunningham RM. Understanding and managing vaccine concerns. Cham: Springer International Publishing 2014.

Jacobson RM, Van Etta L, Bahta L. The C.A.S.E. approach: guidance for talking to vaccine-hesitant parents. Minn Med 2013; 96(4): 49-50.