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Advancing Autism Screening in Developing Countries

Autism Speaks study finds non-experts can use new, simple test to screen for autism among children in poor world regions
February 13, 2014


Researchers have shown that a simple screening test for autism and other neurodevelopmental disorders is both practical and effective for use in world regions lacking in resources and expertise.

The study, funded by Autism Speaks, was conducted in two poor neighborhoods of Dhaka, Bangladesh. It found that non-experts can quickly and reliably identify school-age children who would benefit from behavioral therapy. An earlier study, funded by the same Autism Speaks grant, showed that this approach can effectively identify toddlers and preschoolers who could benefit from early intervention therapies.

Such reliable yet easily administered tests are urgently needed in the world’s developing regions. While global infant mortality has decreased in recent decades, malnutrition and extreme poverty continues. This puts hundreds of millions of young children at risk for developmental disabilities.

In Bangladesh, for example, research shows that the percentage of children at risk for autism rose from 8 percent in 1988 to 20 percent in 2005.

“The development of screening methods that work in the real world is an important part of Autism Speaks’ commitment to serve the most vulnerable members of our global community,” says epidemiologist Michael Rosanoff, Autism Speaks associate director for public health research.

The diagnosis of autism is a particular challenge in regions with few child psychologists trained to perform diagnostic evaluations, Rosanoff explains. Autism Speaks continues to fund research on new and alternative methods for serving these populations.

The lessons learned in the developing world can, in turn, improve services in underserved American communities, Rosanoff adds. These communities include rural areas distant from major medical centers and ethnic neighborhoods where stigma or lack of awareness poses a barrier to identifying autism.

The Rapid Neurodevelopmental Assessment
Researchers in Bangladesh evaluated the usefulness of a 53-question checklist called the Rapid Neurodevelopmental Assessment (RNDA). The screening tool is unique in that it's designed for use by non-experts. It includes yes/no questions on developmental milestones such as walking and pointing to objects of interest.

In the new study, investigators evaluated the RNDA’s reliability in the hands of therapists without college educations and special-education teachers without experience administering assessments. After a 2-week training course, they could all reliably and consistently administer the RNDA to children ages 5 to 9.

These non-experts administered the test to more than 100 Bangladeshi children identified by community workers as having some developmental delays. The test identified neurodevelopmental disabilities in around a third of the children.

The researchers offered the parents guidance on home-therapy activities such as interactive play and story-telling. They also provided counseling designed to reduce parent stress, which research shows is especially important to improving child development in poor communities. Finally, the children were referred to specialists for a full evaluation and additional services.

“As a freely accessible and easily administered screening tool, the RNDA can be a game changer,” says Rosanoff. “Autism Speaks, in partnership with the World Health Organization, is pioneering the development of such instruments to improve research and increase access to services for those with autism and other developmental disorders in low-resource communities.”

This study was made possible through Autism Speaks Global Autism Public Health initiative. Read more about GAPH here; about Autism Speaks’ partnership with the World Health Organization here; and about the global importance of tools like the RNDA here.