The state of autism in ghana: A focus on cultural understanding and challenges in the Ghanaian setting

•69• Chapter 7 The state of autism in Ghana: A focus on cultural understanding and challenges in the Ghanaian setting Joana Salifu and C.Charles Mate-Kole Introduction Autism is a lifelong neuro-developmental disability that presents with impairments in social skills, verbal and nonverbal communication, repetitive behaviours and unusual interests (American Psychological Association, APA, 2000). People with autism do not usually participate in pretend play; they have difﬁculties initiating social interactions, and they engage in self-stimulatory behaviours such as hand ﬂapping, making unusual noises, rocking from side to side and toe-walking (Centres for Disease Control, CDC, 2007). These impairments may range from severe to subtle symptoms of social and communication deﬁcits (Caronna, Milunsky, & Tager-Flusberg, 2008). Autism was ﬁrst described by Leo Kanner in 1943. In his original paper, Autistics Disturbances of Affective Contact, Kanner described 11 children who had a rare syndrome of “extreme autistic aloneness”. Children described by Kanner exhibited severe language impairment, social isolation, instances of sameness, and motor stereotypies (Kanner, 1943). Kanner named the syndrome “infantile autism” because he discovered that the children in his study started exhibiting symptoms in the early ages, precisely before the age of 36 months. Hans Asperger in 1944 also described a group of children with similar symptoms. The difference between Kanner’s autism and Asperger’s lies in the degree of severity. Asperger’s deﬁnition was far broader than Kanner’s and included children with higher functioning and intact language abilities (Anthony, 2009). Autism is classiﬁed under a broader diagnostic category of pervasive developmental disorders (PDD; Diagnostic and Statistical Manual of Mental Disorders •70• Chapter 7 – Fourth Edition, Text Revision; (DSM-IV-TR – American Psychiatric Association, APA, 2002). Autism is now viewed as a ‘spectrum’ presenting on a continuum from mild to severe handicap. AutismSpectrumDisorder(ASD)ispresentlyusedtoclassifyautism, Asperger’s disorder and other non-speciﬁed disorders. Asperger’s syndrome is used to describe individuals with milder form of autistic disorder. These individuals may have relatively normal intelligence levels and intact language abilities or minimal language delays but usually have impaired social skills. Individuals with ‘classic autism’ are non-verbal and present symptoms of severe cognitive impairment, as well as severe motor stereotypic and disruptive behaviours (Caronna et al., 2008). Besides behavioural deﬁcits, individuals with autism present with cognitive deﬁcits. Some of the cognitive deﬁcits include perceptual problems, information processing difﬁculties, memory impairment, deﬁcits in executive function and attention, and in acquisition of theory of mind (this provides the explanation for impairment in social reciprocity and communication) (Frith, 1989; Hill, 2004a; TagerFlusberg , 2007). Deﬁcits in central coherence explain the tendency for autistic individuals to lack focus on local features of the environment (Jolliffe & Baron-Cohen, 1999). One of the most prominent features of autism is executive function deﬁcits which have profound impact on the autistic individual (Ozonoff, Pennington, & Rogers, 1991). Executive function is traditionally used as an umbrella term for functions such as planning, working memory, impulse control, inhibition, and shifting set, as well as the initiation and monitoring of one’s action (Hill, 2004a; Happe, Booth, Charlton, & Hughes, 2006; Hill, 2004b; Hughes, 1998). The theory of executive function deﬁcit can be used to address behavioural problems such as a need for sameness, a strong liking for repetitive behaviours, lack of impulse control, difﬁculty initiating new non-routine actions and difﬁculty switching between tasks (Hill, 2004a; Lopez, Lincoln, Ozonoff, & Lai, 2005; Rajendran & Mitchell, 2007). Besides the cognitive deﬁcits, studies have consistently found deﬁcits in adaptive behaviour in autism (Bolte & Pouska, 2002; Liss et al., 2001). Adaptive behaviours are everyday living skills that people •71• The state of autism in Ghana use to adjust to situations in their environment (Liss et al., 2001). The dimension of adaptive skills includes motor, communication, socialization, home living and community living skills, self-care and functional academic skills. These behaviours are known to promote independence, social adjustment and quality of life (Matson, Mayville, & Laud, 2003). Additionally, adaptive behaviours allow people to substitute disruptive behaviours with constructive ones (Gillham, Carter, Volkmar, & Sparrow, 2000). Prevalence The prevalence of autism is reported in the range between 1 to 21.1 per 10 ,000 children (World Health Organization; WHO, 2003). In the United States, it is estimated that 1 in every 150 people suffer from autism (CDC, 2007). Studies in Europe and Scandinavia report as many as 12 in 10,000 children (Baird, Simonoff, Pickles, et al., 2006; Kadesjo, Gillberg, & Hagberg, 1999). Recent epidemiological studies...

Source: UG