Autism is a global phenomenon. Yet, there is a dearth of knowledge of how it is understood and its impact in low-income countries. We examined parents' and professionals' understanding of autism in one low-income country, Nepal. We conducted focus groups and semi-structured interviews with parents of autistic and non-autistic children and education and health professionals from urban and rural settings ( n = 106), asking questions about typical and atypical development and presenting vignettes of children to prompt discussion. Overall, parents of typically developing children and professionals had little explicit awareness of autism. They did, however, use some distinctive terms to describe children with autism from children with other developmental conditions. Furthermore, most participants felt that environmental factors, including in-utero stressors and birth complications, parenting style and home or school environment were key causes of atypical child development and further called for greater efforts to raise awareness and build community capacity to address autism. This is the first study to show the striking lack of awareness of autism by parents and professionals alike. These results have important implications for future work in Nepal aiming both to estimate the prevalence of autism and to enhance support available for autistic children and their families.
This report discusses the relationship between mental health care and post-conflict rehabilitation in Sierra Leone and Liberia. Data were collected during the author's involvement in mental health programmes for extremely distressed so called 'child soldiers' in both countries, as well as involvement in co-ordinating and supporting professionals in charge of the war-affected population. Analysis suggested that mental health was neglected. However consideration of mental health is crucial to rehabilitation efforts because it facilitates understanding and appropriate responses to the difficulties encountered by both professionals and demobilized youth, and needs to be incorporated into designing policy, training and interventions.
Few data exist on the prevalence of autism in low-income countries. We translated, adapted and tested the acceptability of a Nepali-language version of a screening tool for autism (Autism Quotient-10). Using this tool, we estimated autism prevalence in 4098 rural Nepali children aged 9–13 years. Fourteen children scored > 6 out of 10, indicative of elevated autistic symptomatology, of which 13 also screened positive for disability. If the AQ-10 screening tool is as sensitive and specific in the Nepali population as it is in the UK, this would yield an estimated true prevalence of 3 in 1000 (95% confidence interval 2–5 in 1000). Future research is required to validate this tool through in-depth assessments of high-scoring children.Electronic supplementary materialThe online version of this article (10.1007/s10803-018-3610-1) contains supplementary material, which is available to authorized users.
Little is known about the longitudinal effects of early age involvement of young people in armed groups and their well-being as they return to strongly affected, politicised communities. Current research and policy are often driven by the assumption of a causal relationship between participation in this war experience and psychological damage. This article explores the role of young people’s armed group experience during the Nepal People’s War, compared with post-conflict stressors, in shaping intra-psychic impact and distress, and which processes enable well-being and resilient functioning. Findings are reported from an 18-month clinical ethnography of a cohort of 17 Nepalese young subjects, where participant-observation methods were used to explore their daily lives after exiting the armed group and follow-up research conducted six years later. The findings highlighted limited evidence for on-going intra-psychic impact and distress related directly to their armed group experience; when such distress occurred, it appeared to be generated more by the structural violence of their environments. The key constituents determining their well-being included: a sense of closeness through emotional connectedness with their family, ideological proximity with the values of the armed group, closeness in their bond with the community, and the social-emotional-economic capital available to them to navigate the harsh structural constraints of post-conflict life. These data further challenge the prevailing assumption that this war experience inevitably leads to psychological damage, and the article argues that structural violence often plays a predominant role in cases where psychological distress does arise.
Background Autism spectrum disorder (ASD) is a global phenomenon. While in Western countries such as the US and UK, prevalence estimates of ASD are around 1%, much less is known about its prevalence in other settings. Cross-cultural differences (e.g., in eye gaze processing) have caused some researchers to call for the need to determine culturally specific understandings of ASD, especially in developing and underserved populations like Nepal. Aims To examine parents and professionals’ understanding of typical and atypical development in both rural (Makwanpur District) and urban (Kathmandu Valley) Nepal, focusing specifically on ASD. Methods In collaboration with our community partners, Autism Care Nepal and Mother and Infant Activities Nepal, we conducted 9 focus groups with health workers, junior and senior paediatricians, primary school teachers and parents of autistic and non-autistic children and 9 semi-structured interviews with early childhood development (ECD) teachers, faith healers, paediatricians and other people working in the disability sector in Makwanpur. The focus group and interview schedules included questions about typical development and vignettes of typically and atypically developing children. Results Overall, those parents and professionals who were not directly involved with atypically developing children had very little awareness of autism. Participants, particularly parents of non-autistic children, used terms such as “doggedly child”, “lonely child”, “introvert, “egoistic”, “dumb”, or “mental patient” to describe vignettes of children with autism. Most participants felt that environmental factors (e.g., parenting style, home or school environment) were key causes of atypical child development. Health and education professionals reported they had received limited training in identification and in particular management of children with atypical development. Many participants called for wider awareness of autism in the community through special schools or media awareness campaigns. Conclusions This is the first study to examine parents and professionals’ understanding of typical and atypical child behaviour and development in rural and urban Nepal. These findings clearly show the lack of awareness of developmental disorders, such as autism, from both parents and professionals alike. These results have important implications for future work aiming to increase awareness and enhance support available for autistic children and families in Nepal.
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