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Where Are All the Children with Autism Spectrum Disorder (ASD) in South Africa? a Comprehensive Database Search for All School-Aged Children with ASD in the Western Cape Province
Little is known about Autism Spectrum Disorder (ASD) in Africa where the prevalence remains unknown. However, even in Africa the increase in ASD combined with better awareness and knowledge has resulted in more children being diagnosed and referred to educational services.
South Africa is considered one of the best resourced African countries in terms of ASD services. However, no study to date has sought to identify children with ASD in a specific education system in order to evaluate needs, determine capacity, and generate comprehensive, evidence-based, sustainable and scaleable solutions to the increasing demand for appropriate education for children with ASD.
Objectives:
The study objective was to perform a comprehensive database search of all children with ASD in the formal education system in the Western Cape Province of South Africa. An understanding of the number, ages, gender, geographical distribution and other socio-economic and cultural variables would contribute to a larger-scale situational analysis of services and service needs for school-aged children with ASD.
Methods:
A quantitative non-experimental descriptive design was used to provide numeric descriptions of the population of children with ASD on the Western Cape Education Departments (WCED) database. The Centralised Education Management Information System (CEMIS) is a web-enabled information management system used for registration and tracking of all children in the WCED. All data relating to children with ASD were extracted on 27 June 2016 from the existing dataset. The main variables of interest included disability information, demographic information and educational information.
Results:
A total of 940 children with a primary or secondary diagnosis of ASD were reported from a population of 1 063 349 school-going children in the province. This accounts for 0.0884% of the school-aged population. The overall male: female ratio was 5.48:1. Self-reported race and language patterns show that the majority of children with ASD in the province were Coloured (42%) and English speaking (61%). 90% of children with ASD were in schools for children with Special Educational Needs and only 10% were in Ordinary/Mainstream schools. 83% of the ASD school-going population were in urban areas and 17% attend schools in rural areas. Intellectual disability was reported in only 19% of the population. Low rates of co-morbid mental health disorders such as attention deficit disorder (2%) and epilepsy (1%) were reported. Interestingly data shows a 76.03% increase in ASD in schools from 2012 to 2016, with an average increase of 15.18% per annum.
Conclusions:
The comprehensive database search in the Western Cape Province of South Africa, showed a concerningly low rate of children identified with ASD. Most of those were in special educational settings, with very low identification of comorbid neurodevelopmental and mental health diagnoses. Results suggests that, even in one of the best resourced provinces of South Africa, there is likely to be a very significant under-identification of ASD in school settings. We propose that large-scale and systematic evaluation of educational systems for children with ASD in the Province and in South Africa should be performed.