Role of primary health care workers in early detection of Autism

AUTISM Spectrum Disorders (ASD) are neurodevelopmental disorders and are present from infancy or early childhood. Current prevalence rates of Autism are 1 in 160 children in Australia, 1 in 100 in United Kingdom and 1 in 91 in the United States. In India the estimated prevalence rate is 1 in 250. We do not know the prevalence rate for Bangladesh. There will be around 76,000 children with ASD under the age of five in Bangladesh if we consider prevalence rate of India. The number is quite large.

Although the DSM-IV-TR and International Classification of Disease-10 states that the onset of the impairments must be before 36 months, recent research findings show that at least half the parents of children with autism report being concerned about child development before 12 months, and many others recognise it between 12 and 24 months. A group of children is expected to develop typically in the first few months and lose skills between 13 and 18 months. The last decade observed a significant advance in the very early manifestations of ASD.

Early detection provides the best opportunity for early intervention, which can maximise the outcomes of affected children and their families. Young brains have more plasticity. The earlier the intervention begins the more chance to move the children toward a typical developmental trajectory. Moreover, the onset of secondary behaviours may be prevented or minimised. Early intervention can also prevent the loss of skills if the child gets the interventions before losing the skills.

In our country, delay in typical language development is usually the first concern of the parents that leads to seeking help from health care professionals. There are some children who develop their language at an early age but when it is time to socialise, there are difficulties in doing so. Parents of these children, who are diagnosed with Aspergers Syndrome, notice the difficulty and seek professional help usually when the children can't cope in school environment. This is particularly true in case of the first child of the family as parents do not have the experience of bringing up other children, or the child does not have the chance to socialise with other kids at home.

These concepts of late language development and lack of socialisation vary in different families under different circumstances. We often hear that "the father/ mother also started talking at a late age, therefore it will be overcome with time and we need to wait." By the time the parents seek professional help the children will have lost the most valuable years of their lives.

Our parents take their children to clinics for immunisation and once the immunisation is complete they do not realise the need for any more visits unless the children are physically ill. The contact with health professionals who have knowledge on child development is very helpful to pick up the early signs of developmental delays. Even the smile of a child can give professionals a clue about the child's development. In this case, primary health care workers are the best professionals to start with. They are the professionals who come in contact with the child the most at their early age when the child starts developing the skills necessary to attain typical development.

Training of these primary health care workers on typical and atypical development can help in early screening, which will lead to referral for proper diagnosis. Regular visits until age three will increase the contact of the children with primary health care workers, and with training on the early warning signs these professionals can help to pick out the children with signs of autism.

Therefore, compulsory and regular visit by a healthy child and the training of primary health care workers can serve as the first step towards early detection of autism in Bangladesh. It will result in getting early interventions. Ultimately, this approach will play a significant role in increasing the functionality of the individuals with autism and thereby decreasing the psychosocial stresses of the individuals and the families.

The writer is Autism Practitioner, Hope Autism Center, Bangladesh & La Trobe University, Australia.