AUTISM: Community perception, implication for social development and

learning in childhood

Muideen O. Bakare, M.B.B.S, FMCPsych, MNIM

Senior Consultant Psychiatrist & Head, Training & Research

Child & Adolescent Unit, Federal Neuropsychiatric Hospital, Enugu, Enugu State, Nigeria

&Chairman, Childhood Neuropsychiatric Disorders

Initiatives (CNDI)E-mail – mobakare2000@yahoo.comWebsite - http://cndinitiatives.com/

- Community Perception of Autism

- Implication for social development and learning in childhood

Diagnostic ProfilingIs there Autism in Nigeria / Africa?

- Some schools of thoughts, just as Sanua, (1984) opined still believes Autism is a disorder of children living in Western Industrialized Countries with high technological development and as a result, may be uncommon among African Children. - This is not true with our present level of knowledge on the subject today.

Autism: The Previous Diagnostic Profiling

Autism is a Spectrum- Perception and Understanding of Autism in Africa may be skewed towards very Severe Spectrum as reflected in available Case Reports and Case Series from African Sub-culture (Mankoski et al, 2006, Bakare & Munir, 2011a, 2011b).

- Milder Spectrum, previously referred to as Asperger’s Syndrome may be construed as part of normal behavior in most African Sub-cultures.

- Evidence abound of extra-ordinary talents in children with Autism of milder spectrum.

PLEASE, DON’T TELL ME I AM NORMAL: Faith Jegede reflected on her two Brothers with Autism

Community Perception: Misdiagnosis & Confusion with other Early Onset Neurological

Conditions- Autism may be confused with some of the co-morbid disorders like Intellectual Disability and Epilepsy and early onset infectious neurological conditions.

- Research findings suggest that period of onset of ASD symptoms among African children coincide with the period of less than five years that is characterized by vulnerabilities of African children to physical illness and infectious diseases associated with neurological consequences (Mankoski et al, 2006).

Cultural Background and Perception of Autism in African Sub-Cultures

- Are there Local Language Synonyms for Autism in most African Sub-cultures?- Knowledge and Perception on Clinical Presentation.- Knowledge and Perception on what are responsible Etiological Factors.- Perception about Prognosis and Community Inclusion.

Local Language Synonyms for Autism in most African Sub-cultures

Hausa - ????

Igbo - ????

Yoruba - ????

Ijaw - ????

Knowledge and Perception on Clinical Presentation

Research findings suggest that continuous education of healthcare workers and the general public in Africa is essential to raise the level of knowledge on clinical presentation and awareness about ASD which is presently low, as improved knowledge would help in early recognition and intervention for African children with ASD (Bakare & Munir, 2011a, 2011b).

Knowledge and Perception on what are responsible Etiological Factors

- Research finding observed that the etiological basis of ASD is still being explained by supernatural causes (Bakare et al, 2009b).- In Africa, witchcraft, demonic afflictions, evil spirits are common acceptable mode of explaining etiology of ASD and other.- Individuals with ASD and their families are often faced with rejection, negative and derogatory comments, further promoting stigma.- To avoid stigma, families tend to hide away the affected children from the society. This may lead to late presentation and diagnosis of the disorder among African children.

Perception about Preventability, Prognosis and Community Inclusion

- In a previous study in Nigeria among healthcare workers, a total of 54.5% of the healthcare workers were of the opinion that childhood autism is treatable and the rest thought otherwise, while 32.1% of the healthcare workers were of the opinion that childhood autism is preventable, the rest thought otherwise (Bakare et al. 2009).

- The healthcare workers that subscribed to the opinion that childhood autism is treatable cited special education and behavioral therapy among others as possible modalities of treatment (Bakare et al. 2009).

Perception about Preventability, Prognosis and Community Inclusion

- The healthcare workers who were of the opinion that childhood autism is preventable cited avoiding maternal infection during pregnancy, avoiding birth injury, pleasing the ancestral spirit and avoiding sins, among others, as modalities of prevention (Bakare et al. 2009).- The above explanations among the healthcare workers are further reflection of community perception on Autism.

Implication for social development and learning in childhood

-The above community perceptions in different dimension may reduce understanding of what Autism is.

-These perceptions can in turn promote stigma, resulting in community exclusion of affected children and adults, which often leads to little or no interventions (Bakare & Munir, 2011c).

Collective Vs Individual Approach to Learning

-Previous study had suggested that many of affected children do not have access to any form of education (Bakare & Munir, 2011c).-Lack of policy for widely available special education facilities within the normal mainstream schools in Nigeria and other African Countries may be as a result of negative community perception of Autism.-Individual Approach to Learning is largely recommended for Children with Autism

Summary: Community Perception of Autism in Africa as documented by VOA

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References- Bakare, M.O, Munir, K.M (2011a). Autism Spectrum Disorders in Africa, A Comprehensive Book on Autism SpectrumDisorders, Mohammad-Reza Mohammadi (Ed.), Chapter 10; ISBN: 978-953-307-494-8, InTech, Available from: http://www.intechopen.com/articles/show/title/autism-spectrum-disorders-in-africa. - Bakare, M.O & Munir, K.M (2011b): Autism spectrum disorders (ASD) in Africa: a perspective: Afr J Psychiatry; 208-210. - Bakare, M.O, Agomoh, A.O, Ebigbo, P.O, Eaton, J, Okonkwo, K.O, Onwukwe, J.U & Onyeama, G.M (2009b): Etiological explanation, treat-ability and preventability of childhood autism: a survey of Nigerian healthcare workers’ opinion; Ann Gen Psychiatry; 8: 6.- Bakare, M.O & Munir, K.M (2011c): Excess of non-verbal cases of autism spectrum disorders presenting to orthodox practice in Africa – a trend possibly resulting from late diagnosis and intervention; South African Journal of Psychiatry; 17(4): 118 – 120.- Mankoski, R.E, Collins, M, Ndosi, N.K, Mgalla, E.H, Sarwatt, V.V, & Folstein, S.E (2006): Etiologies of autism in a case-series from Tanzania; J Autism Dev Disord; 36(8); 1039 – 1051.- Sanua, V.D (1984): Is infantile autism a universal phenomenon? An open question; Int J Soc Psychiatry; 30(3): 163 – 177.

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