Adaptation of the "ten questions" to screen for autism and other neurodevelopmental disorders in Uganda
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Published on: March 14, 2018
Angelina Kakooza-Mwesige1, Keron Ssebyala, Charles Karamagi
11Makerere University-Mulago National Referral Hospital, Uganda.
Insights
A new 23-question screener effectively identifies neurodevelopmental disorders, including autism spectrum disorder, in Ugandan children. This tool is crucial for developing public health strategies in low-resource settings.
Area of Science:
- Global Health
- Developmental Pediatrics
- Public Health
Background:
- Neurodevelopmental disorders are common in developing nations, yet data for intervention planning is scarce.
- Autism spectrum disorder (ASD) prevalence and characteristics in low-resource settings remain understudied.
- Effective screening tools are needed to address the data gap for neurodevelopmental disorders in Uganda.
Purpose of the Study:
- To develop and validate a novel 23-question screener (23Q) for neurodevelopmental disorders, including ASD, in Ugandan children.
- To assess the prevalence of neurodevelopmental disorders in a Ugandan child population.
- To evaluate the diagnostic accuracy of the 23Q in identifying children with neurodevelopmental disorders.
Main Methods:
- Household screening of 1169 children aged 2-9 years using the 23Q.
- Clinical assessment of children who screened positive and a subset of those who screened negative.
- Statistical analysis to determine the prevalence and validity (sensitivity, specificity) of the 23Q.
Main Results:
- 320 children (27%) screened positive for neurodevelopmental disorders.
- 68 children received a clinical diagnosis of moderate to severe neurodevelopmental disorders, including 8 with ASD.
- The 23Q demonstrated sensitivity ranging from 0.55 to 0.80 for identifying neurodevelopmental disorders.
Conclusions:
- The 23Q is a valuable tool for identifying children with neurodevelopmental disorders, including ASD, in low-resource settings like Uganda.
- Integrating ASD and related behavioral disorder screening into broader neurodevelopmental disorder studies is essential for public health planning.
- The findings support the need for targeted interventions and improved data collection for neurodevelopmental disorders in developing countries.
Abstract:
Neurodevelopmental disorders are recognized to be relatively common in developing countries but little data exist for planning effective prevention and intervention strategies. In particular, data on autism spectrum disorders are lacking. For application in Uganda, we developed a 23-question screener (23Q) that includes the Ten Questions screener and additional questions on autism spectrum disorder behaviors. We then conducted household screening of 1169 children, 2-9 years of age, followed by clinical assessment of children who screened positive and a sample of those who screened negative to evaluate the validity of the screener. We found that 320 children (27% of the total) screened positive and 68 children received a clinical diagnosis of one or more moderate to severe neurodevelopmental disorders (autism spectrum disorder; cerebral palsy; epilepsy; cognitive, speech and language, hearing, or vision impairment), including 8 children with autism spectrum disorders. Prevalence and validity of the screener were evaluated under different statistical assumptions. Sensitivity of the 23Q ranged from 0.55 to 0.80 and prevalence for ≥1 neurodevelopmental disorders from 7.7/100 children to 12.8/100 children depending on which assumptions were used. The combination of screening positive on both autism spectrum disorders and Ten Questions items was modestly successful in identifying a subgroup of children at especially high risk of autism spectrum disorders. We recommend that autism spectrum disorders and related behavioral disorders be included in studies of neurodevelopmental disorders in low-resource settings to obtain essential data for planning local and global public health responses.
