Children from developed English-speaking countries improved less than children from non-English-speaking countries.
By Andrey Vyshedskiy
The Centers for Disease Control estimates that 1 in 59 children is affected by autism spectrum disorder (ASD), a neurological disorder that disrupts early development in cognition and communication. Approximately two-thirds of children with ASD grow up to have a significant cognitive and social impairment, and difficulty in acquiring new adaptive behaviors. There is broad scientific consensus that early and intensive behavioral intervention can result in sizeable gains in cognitive, communication, social, academic, and adaptive skills, and has the greatest chance of significantly improving outcomes, sometimes even resulting in a complete loss of diagnosis. And, large epidemiological studies can help us understand what treatments work best for children with ASD.
My research team set out to learn more about the differences between groups of children with Autism. We detailed our approach and findings in a paper published in the Journal of Autism and Developmental Disorders last month.
Our collaborator Steven M. Edelson of the Autism Research Institute assembled a big database that monitors improvement of symptoms in children diagnosed with ASD. The data was provided by parents who completed many evaluations of their children symptoms over several years. The study included 2,272 children age two to 12. Each evaluation consisted of 77 questions assessing the child’s communication, sociability, cognitive awareness, and behavior. The scores from each question are combined in order to calculate a Total Score, which ranges from 0 to 179 points with lower scores indicating a lower severity of ASD symptoms and higher scores correlating with more severe symptoms of ASD.
Having the evaluation scores in-hand, we divided children into groups and investigated the differences. And, while all groups improved their symptoms over time, we also noticed that there were significant differences between the groups.
Younger children improved more than the older children. Children with milder autism improved more than children with more severe autism. There was no difference in improvement between females vs. males.
One unanticipated finding was that children from developed English-speaking countries improved less than children from non-English-speaking countries. And, in our two year observation and measurement we found that this improvement continued at a rate that can mean the difference between having ASD and a complete loss of diagnosis.
This finding surprised us. English-speaking countries spend significantly more resources on children with ASD. Therefore, a greater rate of symptom improvement in non-English-speaking countries was completely unexpected to us. This observation runs contrary to conventional thought and underscores the consensus that there is potential for further improving the treatment of children with ASD in the developed world.
While it is difficult to speculate on the reason for this disparity between developed English-speaking countries and non-English-speaking countries, it is notable that child treatment is more often outsourced in the developed English-speaking countries. Whereas in more traditional societies where grandparents are more commonly available and a family member is more likely to stay at home to personally take care of a child. Behavioral and language therapists, expertise and resources that many families in English-speaking countries utilize, are only available for a few hours a day, several days a week, and they do not usually stay with the same child for more than a few months. As it can be difficult to make a connection with a child with ASD, this limited exposure may result in valuable therapy time lost. On the other hand, parents and grandparents have an ongoing, long-term relationship with their child, and often know their quirks and idiosyncrasies. As a result, devoted caretakers can sometimes dedicate more time to therapy.
Other factors, such a social integration, can also play a role. Latin countries, from where the majority of non-English-speaking participants came from in our study, tend to have bigger families and increased attention to social integration. Connecting to a sibling or a friend may make a big difference for a child with ASD.
Still other factors, such as differences in diet, reliance on technology and prescription medications, could also play a role.
Currently, we do not know the exact cause of the difference in symptom improvement between English-speaking countries and non-English-speaking countries. The improvements could result from a combination of many factors. But, our recent research raises many interesting questions and compels us to rethink some of our assumptions. As we accumulate data in the coming years, we will have the opportunity to provide greater insights into the best therapy practices for children with ASD.
Andrey Vyshedskiy received a PhD in Neuroscience from Boston University and has conducted research in child psychology, neuroscience, cardiopulmonary acoustics, and optical vibrometry. He teaches at Boston University Metropolitan College.
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