Abstract
Background
Autism is a global disorder, but relatively little is known about its presentation and occurrence in many developing countries, including Libya.
Aims
To estimate the prevalence of autistic spectrum disorders in children referred to Al-Khadra hospital (KH).
To increase the awareness among pediatrician and primary health care providers of the importance of considering autism in children presenting with speech and language disorders.
Methods
Prospective hospital-based study of all children referred to a neurodevelopment clinic between 2005 and 2009 with the diagnosis of either speech and language difficulties or behavioral difficulties.
Results
A total of 38,508 children were seen in the pediatric outpatient clinics of KH, Tripoli, between 2005 and 2009. Of these, 180 children were referred to the neurodevelopment clinic with history of delayed speech and language and or behavioral difficulties. A diagnosis of autism was made in 128 children, which gives a prevalence of approximately 1 in 300.
Conclusion
The prevalence of autism in Libya is probably similar to that seen in the USA and the UK. No data were available for comparison from either Arab or other developing countries. Autism is an important differential diagnosis of any language disorder ‘and behavioral difficulties’.
Early detection is likely to have a critical impact on the health and education of children with autism. Although autism is a global disorder, relatively little is known about its presentation and occurrence in many developing countries, including Libya.
In a hospital-based chart review of 38,508 children referred to the neurodevelopment clinic at Al-Khadra Hospital, Tripoli, Libya between 2005 and 2009, 180 children had a diagnosis of either delayed speech and language, no speech or language or behavioral difficulties. Of these 128 were diagnosed with autism spectrum disorder (ASD). This translates to a prevalence of approximately 1 in 300 among those seen in the clinic. The neurodevelopment clinic is the primary source of evaluation for children with developmental problems in Tripoli. The age of presentation to the neurodevelopment clinic varied from as early the first year of life (3%) to as a late as 10 years of age (5%) (Figure 1). The most common age of presentation was between two and five years of age (58%), with a median age of four years and six months.
Age of presentation to neurodevelopment clinic.
Given that this was an enriched sample in which one would expect to see a prevalence higher than that in the community, it raises significant concerns about under-diagnosis of ASD in Libya. Most data would suggest that the community prevalence of ASD in Libya is similar to that in the USA and the UK. Applying recent CDC estimates of the prevalence of ASD to the child population of Libya suggests that 11,000 would meet the criteria.
The findings of this hospital-based study suggest considerable under-diagnosis of ASD among Libyan children. The biggest problem in any developing country, including Libya, may be the lack of parental and professional awareness of ASD, as well as lack of early intervention services. In addition, there are no organizations whose mission it is to advocate for these children and their families. In Libya, as in, we assume, other developing countries, children with autism attend expensive special schools, which are the only facilities available for children to receive an appropriate education.
The problems described in this letter should not come as a surprise, given that in Africa less than 2% of children are served through schools capable of providing education to children with special education needs. Even if ASD is diagnosed in an accurate and timely manner, therefore, improving care for children with ASD will require dramatic changes to the service system for children with developmental delays. Currently, a general tendency of decision makers in Libya has been to suggest that there are many more pressing problems, some of which are more easily solvable, and therefore not to devote resources to addressing the needs of children with developmental disabilities such as autism. This attitude will need to change if we are to improve detection, treatment and outcomes for children with autism in Libya.
Footnotes
Acknowledgements
The authors extend great thanks and appreciation to all the parents for their support and to all who has been involved in conducting this study. Thanks also to our doctor colleagues, seniors and juniors, for referring these children to the clinic. I am grateful to Dr Suad Al-Hmadi and Dr Fawzeya Abou-Riana, who gave vital assistance and made substantial contributions to this study. We would also like to thank Dr Rabie Said for all his help and Mr Khalifa Al-Sourmani of the supply department for his assistance in conducting the study.