In a bid to raise awareness of and contribute to efforts towards the early diagnosis of Autism Spectrum Disorder (ASD), a study co-authored by a Rhodes University researcher, Dr Nicola Wannenburg, of the Department of Psychology has identified and compiled key symptoms into a guide that healthcare professionals can use to diagnose the disorder at various stages of a child’s development.
The study was conducted in collaboration with Professor Roelf Van Niekerk from Nelson Mandela University.
The World Health Organization (WHO) estimates that 1 in 100 children suffers from ASD. On the African continent, ASD is overshadowed by a greater focus on communicable diseases in healthcare curricula, which in turn impedes the possibility of early diagnoses of this neurodevelopmental disorder.
The researchers observe how the urgency and focus required by many infectious diseases in Africa have led to ASD not receiving enough attention even at the level of the healthcare curriculum.
The study identifies nurses as the target of its findings because of the instrumental role these professionals play as the face of the healthcare sector in various African countries.
“Nurses are often the first professionals whose advice is sought about worrisome symptoms, either by high-functioning individuals with autism or by a worried parent of a newborn or toddler,” explains the study. “Nurses being able to recognize symptoms of ASD will lead to more diagnoses as well as an increase in the possibility of intervention and assistance for families.”
In the South African context, nurses are the most and often only accessible healthcare professionals for many parents and their children, even in the most remote corner of the country, because of the availability of government clinics. In the hands of nurses, the findings or symptoms detailed in a guide in the study have the potential to bring relief to many.
The study classified symptoms for diagnosis according to five developmental stages: Birth to 18 months, 18 months to 3 years, Age 4 to 5 years, 6 to 12 years, and Adolescence.
In the first stage of development (Birth to 18 months), the study finds that children with ASD may display a lack of emotional responsiveness and awareness of possible danger or crisis.
“Symptoms of ASD such as not making eye contact, not interacting with caregivers in any way, or not wanting to be held/touched may be present before the infant is 12 months,” explains the study.
From 18 months to 3 years, ASD manifests itself through the child’s inability to relate to others and communication failure. Symptoms of ASD at this stage include “lack of interest in others or surroundings”, “disinterest in playing more generally and playing with other children”, “absence or delay in speech, as well as an inability to communicate”, “obsessive or repetitive actions”, and “intellectual disability”, explain researchers in the study. The study also cautions that at this stage of development, various sounds, tastes and textures may cause an outburst or violent reaction.
At Ages 4 to 5 years, children with ASD will seem more different from other children of a similar age.
“Children’s inability to make eye contact may be more apparent during this stage,” the study finds. “A child’s withdrawn state and inability to make friends will be noticeable.”
Researchers also find that it is at this stage that ASD is often misdiagnosed as infantile schizophrenia or psychosis.
The study recommends speech therapy or joining social activities, such as drama groups, to assist children with ASD in communicating.
At Ages 6 to 12 years, symptoms of ASD include the need for routine, continuous difficulty in speaking and communicating effectively, extreme difficulty with physical contact, and lack of awareness of the bigger picture.
During the Adolescence stage, many of the symptoms from the previous stages can persist. These include a change in the routine being met with an outburst by adolescents with ASD; difficulty with physical contact, eye contact and communication; and behaviour that may seem childish compared to peers. Being noticeably different from children of the same age could lead to isolation.
“They may suffer from depression due to bullying and the isolation of not fitting in and not understanding the nature of teenage friendships or romantic relationships,” warns the study. “Distinguishing depression from the withdrawn state often associated with ASD may be difficult for caregivers and medical professionals.”
While the study acknowledged that access to treatment interventions for ASD is still problematic, diagnosis is an important starting point to help families understand their child’s situation. Armed with these findings, nurses will play an important role in identifying and diagnosing ASD.
The study, titled “Increasing Health Professionals’ Ability to Recognise, Diagnose, and Intervene in Autism Spectrum Disorder Cases in Africa: Examples from Specific Developmental Stages – A Longitudinal Case Study” – is published in the Student’s Journal of Health Research.
