To diagnose autism in Tanzania, researchers adapted several techniques used in the United States so they were culturally relevant and familiar to children and their parents.
There is no autism diagnostic measure validated for use in Swahili, a major language of the region.
“Historically in Tanzania, parents that have sought autism diagnoses had to go to other countries to receive those diagnoses,” says Ashley Johnson Harrison, a former postdoctoral fellow at Brown University who is now an assistant professor at University of Georgia.
Researchers used the new approach to conduct diagnostic evaluations with 41 Tanzanian children who came to clinical facilities in the cities of Moshi and Dar Es Salaam. Using the diagnostic panel, researchers were able to make diagnoses that consistently distinguished kids with autism spectrum disorder from those with other similar disorders.
Developing accurate diagnostic techniques is important because distinguishing between autism spectrum disorders and other conditions can ensure that children receive proper education and treatment, Johnson Harrison says.
Over three decades clinicians have refined diagnostic tools in the United States. Efforts are needed to help Tanzania catch up.
“Initially we only identified the most severe cases of autism,” says Johnson Harrison, who works under the mentorship of Eric Morrow in the department of psychiatry and human behavior at Brown.
“Now we can capture individuals who are all across this spectrum. We are able to accurately diagnose individuals who might have previously fallen through the cracks. Where Tanzania is right now is where we were years ago.”
The research is published online in the journal Intellectual and Developmental Disabilities and was presented at a meeting of the International Meeting for Autism Research.
The new diagnostic protocol is a blend of established instruments for interviews with parents, observations of behavior and play, and assessments of adaptive functioning and cognition.
Johnson Harrison chose instruments that would be culturally relevant or adaptable and piloted the approach with the help of Tanzanian clinicians, including Karim Manji of Muhimbili University of Health and Allied Sciences in Dar Es Salaam and Brenda Shuma and Anthony Ephraim at the Gabriella Centre in Moshi.
For example, the team designed a play interaction that included activities familiar to the children and omitted others that would be culturally irrelevant.
They used the Childhood Autism Rating Scale-Second Edition (CARS-2) to help rate child behavior because of the instrument’s flexible usage guidelines. Another advantage of the CARS-2, as well as subtests of the Kaufman Assessment Battery for Children selected for cognitive assessment, is that the behavioral observations and nonverbal cognitive testing don’t depend strongly on language.
Meanwhile, as a measure of adaptive functioning, Johnson Harrison and the team chose the Malawi Development Assessment Tool. Although Malawi and Tanzania have important differences, they also have significant similarities. They border and share similar governmental and educational infrastructures.
Johnson Harrison made assessments and then gave parents or guardians information about autism and guidance on using behavioral strategies to improve child skills.
Of the children she tested, 30 were diagnosed as having autism spectrum disorders and 11 as having other “global delay” conditions, such as suspected intellectual disabilities, Down syndrome, or other disorders.
BACK IN THE USA
After returning to the United States, Johnson Harrison tallied precise quantifications of the CARS-2 score and DSM-5 checklist symptoms to see if her diagnostic assessment had produced reliable, statistically significant differences between the autism and non-autism groups.
It did. The average CARS-2 score for the autism group was 28 percent higher (at 37.75), than the average for the global delays group (at 27.15), a statistically significant difference.
In addition, Tanzanian children diagnosed with autism scored in similar ranges on the CARS-2 as compared to children with autism in the United States. The autism group also had significantly more DSM-V autism symptoms than the global delays group, suggesting that the assessment measures were helpful in reliably eliciting the information needed to assess autism spectrum disorders.
Johnson Harrison says she hopes that the assessment protocol, if supported by further testing, could become a standard approach for clinicians in the country, at least while more rigorous tests used in the West, such as the ADOS-2, can be tailored for Tanzania.
The National Institutes of Health and Brown University funded the study.
Source: Brown University
《Observation-centered Approach to ASD Assessment in Tanzania》, Published on Journal《Intellectual and Developmental Disabilities》in Oct, 2014.