Background

Although Autism Spectrum Disorder (ASD) can be identified as early as 12 months and diagnosed by 24 months, the mean age of diagnosis of ASD in Nepal is ∼58 months, with children missing the opportunity for early intervention.

Aims

This study implemented and evaluated a Nepali version of the Social Attention and Communication Surveillance (SACS-N) tool, to identify children between 11–30 months who are at “high likelihood” of ASD in a local community in Nepal.

Methods

Sixty Female Community Health Volunteers (FCHVs) were trained to monitor and identify the early signs of ASD using SACS-N.

Results

Overall, 1926 children were monitored with the SACS-N, with 11 children (0.57 %) referred for further assessments at 11–15 months (n = 4), 16–21 months (n = 4), and 22–30 months (n = 3). Of these children, 10 children had a developmental disorder, including ASD and Global Developmental Delay; no information was available on one child who migrated. Hence, the positive predictive value (PPV) of SACS-N for all developmental disorders was 100 %. Of seven children attending a gold standard diagnostic/ developmental assessment, three had ASD (43 % PPV for ASD). The estimated prevalence of ASD ranged between 0.16 % to 0.26 %.

Conclusion

Community-based developmental monitoring of ASD and other developmental delays by FCHVs is a feasible, cost-effective and sustainable approach to promoting early identification of ASD in Nepal. Further training and awareness of autism is needed for more accurate and increased referral rates using the SACS-N, including regular supervision of FCHVs.

中文翻译：

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实施和评估社会关注和交流监测 (SACS)，以前瞻性地识别尼泊尔幼儿的自闭症

背景

尽管自闭症谱系障碍 (ASD) 最早可在 12 个月内被识别并在 24 个月内确诊，但尼泊尔 ASD 的平均诊断年龄为 58 个月左右，儿童错过了早期干预的机会。

宗旨

本研究实施并评估了尼泊尔版的社会关注和交流监测 (SACS-N) 工具，以识别尼泊尔当地社区中 11-30 个月之间“极有可能”患 ASD 的儿童。

方法

60 名女性社区健康志愿者 (FCHV) 接受了培训，以使用 SACS-N 监测和识别 ASD 的早期迹象。

结果

总体而言，1926 名儿童接受了 SACS-N 监测，其中 11 名儿童 (0.57 %) 在 11-15 个月 ( n = 4)、16-21 个月 ( n = 4) 和 22-30 个月 ( n = 3）。在这些儿童中，有 10 名儿童患有发育障碍，包括 ASD 和全球发育迟缓；没有关于一名移徙儿童的信息。因此，SACS-N 对所有发育障碍的阳性预测值 (PPV) 为 100%。在参加黄金标准诊断/发育评估的七名儿童中，三名患有 ASD（ASD 的 PPV 为 43%）。ASD 的估计患病率在 0.16% 到 0.26% 之间。

结论

FCHV 对 ASD 和其他发育迟缓的基于社区的发育监测是促进尼泊尔早期识别 ASD 的可行、具有成本效益和可持续的方法。需要进一步培训和提高自闭症意识，以使用 SACS-N 更准确和提高转诊率，包括定期监督 FCHV。