The Estimated Prevalence of Autism in School-Aged Children Living in Rural Nepal Using a Population-Based Screening Tool.
Michelle Heys, Felicity Gibbons, Ed Haworth and 7 others
PMID 29855757WHAT IT FOUND
In rural Nepal, 14 of 4098 school-aged children screened positive for autistic traits using a translated parent questionnaire.
Thirteen of the 14 also screened positive for disability. This was a screen, not a diagnosis.
Key findings
01Of 4098 children screened with the adapted Nepali AQ-10, 14 scored 6 or more out of 10, indicating possible autistic symptomatology.
02Thirteen of the 14 children who screened positive on the AQ-10 also screened positive for disability, and 12 screened positive for difficulties in communication, forming relationships, coping with change, playing and attention.
03Parents considered the AQ-10 items acceptable and straightforward, but worried that parents without autism knowledge might not recognize atypical behaviours or accept a possible autism label.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study used a screening questionnaire, not a clinical diagnosis, so the 14 children may not all have autism. The Nepali AQ-10 was adapted and accepted by parents, but it was not validated against a gold-standard assessment in this population. The disability comparison tool, MCFD, was still under development and its wording had changed since this study. The sample came from children enrolled in an earlier perinatal trial follow-up, not a fresh random sample of all rural Nepali children. The analysis combined pilot and main data, and wave 1 had 4222 children while wave 2 had 4098, so some participants were lost between rounds. The estimated 3 in 1000 prevalence depends on assuming the UK sensitivity and specificity of the AQ-10 apply unchanged in Nepal. The screen may have missed milder autism, especially because parents and professionals had little awareness of autism in this setting.
Declared interests
The supplied text names Wellcome Trust, Research Trainees Coordinating Centre, Institute of Education/UCL Strategic Partnership Incubator Fund and Leverhulme Trust as funders. It does not state author conflicts of interest or whether funders designed the study.
The easy way to misread this
Do not read the 14 positive screens as confirmed autism diagnoses or as proof that the translated AQ-10 works in Nepal. None of these children had a known autism diagnosis, the tool was not validated here, and the 3 in 1000 estimate depends on assuming UK sensitivity and specificity apply unchanged.