User:Allisonshields/sandbox

=Global perceptions of autism=

Autism Overview
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, defines a person with Autism Spectrum Disorder as having persistent deficits in social communication and social interaction. This includes having deficits in social-emotional reciprocity, deficits in nonverbal communicative behaviors used for social interaction, and deficits in developing, maintaining, and understanding relationships. Autism is a pervasive developmental disorder, meaning that it is characterized by developmental delays in basic functioning such as socialization and communication.

Diagnosis in western countries
The median prevalence rate of autism spectrum disorders in Europe is 61.9 per 10,000 people, while the median prevalence estimated in the United States is 65.5 per 10,000. In western nations, children who show developmental problems are referred for evaluation by a pediatrician. Preliminary screening instruments include the Modified Checklist for Autism in Toddlers (M-CHAT), Social Communication Questionnaire (SCQ), and Autism Spectrum Screening Questionnaire (ASSQ). Autism spectrum evaluations are typically conducted by professionals who specialize in developmental disorders, such as psychologists, psychiatrists, or neurologists. Diagnostic instruments that assessing clinicians may use include the Autism Diagnostic Interview-Revised, Autism Diagnostic Observation Schedule, and Childhood Autism Rating Scale, as well as clinical judgment using criteria from the Diagnostic and Statistical Manual.

Treatment in western countries
Behavioral intervention and medications are frequently used to manage the symptoms of autism. Early intervention programs can improve cognitive and language skills in children who have been diagnosed with autism spectrum disorder. Behavioral interventions include Applied Behavioral Analysis, Developmental, Individual Difference, Relationship-based (DIR)/Floortime Model, and Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH). Applied behavioral analysis is a widely used intervention that uses operant conditioning to reward and increase prosocial behaviors and diminish behaviors that negatively impact learning. The DIR/Floortime Model allows those conducting treatment to tailor the treatment to individual children. Its focus is on the mastery of social, emotional, and intellectual capacities rather than focusing on skills and specific behaviors. TEACCH also uses a behavioral approach and teaches children skills for self-care and to manage inappropriate behavior.

There are no medications that have been approved to treat autism spectrum disorder, but some medications may be prescribed off-label to treat symptoms of ASD. Antipsychotic medications may be used to reduce irritability and aggression in children with autism. Stimulant medications are used to treat symptoms of hyperactivity and inattentiveness. Antidepressant medications are occasionally prescribed to reduce the restricted and repetitive behaviors associated with autism. While these medications may help reduce symptoms of autism spectrum disorder, more research is necessary before medications can be advocated as safe and effective.

Experience in western countries
The estimated lifetime cost of caring for an individual with autism is between $1.4 million and $2.4 million, using data from the United Kingdom and the United States. While some of these costs are incurred for diagnosis and treatment costs, the problem is exacerbated by reduced family earnings when a family member may forgo working in order to care for a family member with autism.

Autism Speaks is an autism advocacy organization that has partnerships in over 40 countries, though it was begun in the United States. The Autism Speaks website offers a resource guide in which families of individuals with autism can find support including adult programs, financial resources, community support organizations, health services, and interventions for toddlers, children, and adults. The plethora of resources and opportunities noted on the website is indicative of the widespread availability of services available for individuals with autism in western nations.

Developing nations
As recently as 1984, researchers questioned whether autism was a universal phenomenon. Some scientists believed that autism was a condition limited to Western and technologically developed nations; however, now there is evidence of increased prevalence of and knowledge about ASD cross-culturally and internationally. Although autism has a biological basis and there are clear criteria for an autism diagnosis, its symptoms may differ cross-culturally. These differences may extend to the perception of autism in different cultures and perceptions of the most effective treatment options.

In recent years, international organizations such as Grand Challenges in Global Mental Health have been working with other health organizations to address concerns about the lack of autism research and services around the world. Autism-specific organizations such as Autism Speaks have similar advocacy goals. In 2008, Autism Speaks developed the Global Autism Public Health Initiative. The goals of the initiative include increasing public and professional awareness of Autism Spectrum Disorder, enhancing research expertise and collaboration, and enhancing the delivery of early diagnosis and treatment by providing training and expertise. Through this initiative, Autism Speaks has worked with partners in Central and South America, the Middle East, Asia, and Africa to increase training on recognizing autism and to promote awareness.

Diagnosis in South America
In Venezuela, the prevalence of autism is estimated at 1.1 per 1000 people, while the prevalence of autism spectrum disorder is estimated at 1.7 per 1000 people. This statistic may be an underestimation due to methods the researchers used; they provided rates only for identified cases of autism and did not estimate unidentified cases of autism that had not been documented. In Brazil, estimations of the international prevalence of autism suggest that 1.5 million Brazilians have Autism Spectrum Disorder. The first Brazilian Meeting for Autism Research indicated that one of the priorities for autism in Brazil includes promoting training in autism diagnosis and early detection. Additionally, utilization of school systems could facilitate early detection. In one study conducted in Colombia, parents reported that onset of autism-related symptoms occurred around 21 months of age, while average age of diagnosis was 45 months. Similar to other research, reported symptoms of autism in this study included a delay in language acquisition and impaired social behavior.

Treatment in South America
Considering the prevalence of autism in these nations, researchers suggest that health and education leaders should work to ensure that there are resources and services available to children and families affected by autism. In Brazil, the Brazilian Public Health System suggests that scientific evidence should govern public health policy; following, autism research is necessary for treatment and intervention strategies to become more prevalent. In the Colombian study, the subjects averaged 64 months of age at the start of treatment when diagnosis occurred at the average age of 45 months.

Experience in South America
Possible explanations for underestimation of prevalence in South America include that autism and other developmental disorders are more stigmatized in this area than in developed nations. Further, South Americans' limited knowledge and awareness of autism could be a factor in the limited access to resources. Researchers at the Brazilian Meeting for Autism Research discussed priorities for addressing the challenges facing autism research in Brazil. These include increasing autism research, providing more funding for autism organizations such as the Sao Paulo Research Foundation, increasing public awareness of autism, and increasing the capacity for autism services through professionals and established community services.

Diagnosis in Africa
Autism research conducted in Africa has been infrequent and unrepresentative of all African countries, making the prevalence of autism in Africa difficult to estimate. One study found that over half of reported ASD cases described children who were nonverbal, or lacked expressive language. Nonverbal rates of as high as 71% of children with autism in Africa have been reported, while the rate in the United States is 25% nonverbal. This suggests that prevalence may be underestimated because reported cases are skewed toward more severe, and thus more recognizable, cases of autism. In Africa, an autism diagnosis is often has comorbidity with epilepsy or intellectual disability.

Treatment in Africa
Possible reasons for the fact that many reported cases of autism in Africa are nonverbal cases include difficulty finding services even when a diagnosis is given. Educational and behavioral interventions for children with autism are largely unavailable, mental health care facilities are insufficient, and there are too few facilities and personnel trained to work with autistic children in reference to the estimated number of autism cases in Africa. Health care workers have low to average knowledge and awareness of autism spectrum disorder. In particular, psychiatric health care workers recognized symptoms of ASD better than pediatric health care workers, which implies that early recognition and intervention for children with autism in Africa is infrequent. Many Africans have spiritual beliefs about psychiatric disorders, which extends into perceived causes of autism. In one survey of Nigerian pediatric or psychiatric nurses, 40% cited preternatural causes of autism such as ancestral spirits or the action of the devil. Supernatural explanations of autism can influence treatment seeking by encouraging people to first seek help from spiritualists and traditional healers.

Experience in Africa
Studies have not yet elucidated the clinical presentation of autism in African nations. Autism awareness is low, particularly in sub-Saharan Africa. Researchers suggest that education for the public and for health care workers is crucial for early diagnosis of ASD so that early intervention can be effective for African children. One study has focused on a community-based approach to autism research, in which the researchers identified cultural meanings of autism in South Africa and used these meanings to develop diagnostic tools. The study suggests that stigma against psychiatric disorders is a large barrier in recruiting participants for research. Existing organizations such as the International Child Neurology Association can be used to raise awareness about autism in Africa.

Diagnosis in Asia
Autism was not recognized until the 1980s in China. The estimated prevalence of autism is 11.8 per 10,000 people while the estimated prevalence of autism spectrum conditions is 26.6 per 10,000 people. In Japan, recent estimates of autism spectrum are as high as 13 per 10,000 people. This suggests that autism is more common in Asia than previously thought. The Child Autism Rating Scale (CARS), Clancy Autism Behavior Scale (CABS), Autism Behavior Checklist (ABC), and Checklist for Autism in Toddlers (CHAT) are frequently used as diagnostic instruments in China.

In India, there is a significant gap between initial symptom recognition and seeking a diagnosis. Because early interventions can lead to positive outcomes for children with autism, early diagnosis is very important. It is unclear whether symptoms appear later in Indian children than in children in the West, or whether the symptoms are recognized later. Initial symptoms of autism recognized by parents included social difficulties and withdrawal, speech delays, and developmental difficulties. After symptom recognition, an average of 7.15 months passes before some families take their child to a medical professional. Reasons include beliefs that the symptoms are not problematic and that the children will "outgrow" symptoms such as language impairments. Misdiagnosis of autism as "mental retardation" is common. Despite this, awareness of autism and its symptoms has increased in India in the past two decades.

Treatment in Asia
The lack of literature on the subject of treatment options for autistic Children in Asia's developing nations indicates that there are few options in these areas. There are a few special programs for autistic children in India, but most children attend the same educational programs as children diagnosed with mental retardation. In 2013, 8 South Asian countries adopted a charter at the South Asian Autism Network's first meeting. The nations plan on working with each other's ministries, and SAAN is advocating long-term health care as well as intervention programs for people with autism. Despite the lack of researched treatment options in Asia, the autism advocacy organization Autism Speaks offers informational pamphlets on their website in Cambodian, Chinese, Arabic, and Vietnamese. These pamphlets also explain how families can access further translated materials and resources.

Experience in Asia
In certain areas, diagnosis and treatment of autism may be difficult because of the lack of facilities or physicians capable of autism recognition. Some families must travel for hours or days to reach an area in which diagnostic facilities are available. Stigma is also a salient issue. Families of children with autism in Hong Kong and China may experience stigmatization from others, which can lead to self-stigmatization in cultures where people focus on their social identity rather than their individual identity. This suggests that parents in China and Hong Kong may experience more stress from raising a child with autism than parents in other areas. Support from friends, families, and professionals is critical to enhance the psychological well-being of parents experiencing stigma.

One researcher suggests that autism may be of particular significance in India because of its characteristic abnormalities in social relationships, which may cause particular concern due to the value of social relatedness and conformity to social norms in India.

Challenges
Obtaining reliable data about autism around the world is challenged by many factors. Awareness about autism differs from nation to nation. Services for people with autism and their families differs in availability. The behavior of people with autism may differ cross-culturally, and the capacity to do autism research can be impeded because of these differences. A further challenge is that caregivers and professionals must have knowledge that certain symptoms are associated with autism, and they must perceive these symptoms as problematic. In a certain culture, for example, if language delays are not seen as uncommon until a child is four or five, a professional may not see the delay as symptomatic of autism. Autism research is further complicated by the fact that families often have different perceptions of autism's etiology. Beliefs include the child being a product of witchcraft or parental misdeed or sin. Positive appraisals include parents beliefs that the child is a blessing to show that the parents are worthy of taking care of such a child. Negative appraisals of what autism means and its etiology can cause increased stress in families of children with autism.