3. .
UAE NEWSPAPERS
LIFE & STYLE | HEALTH
The rise of autism in the UAE
With more and more children being diagnosed as autistic in the
UAE, parents have to deal with the financial burden of treatment
and therapy, as well as the emotional fall-out, discovers Suchitra
Bajpai Chaudhary
By Suchitra Bajpai Chaudhary, Friday magazine
Published: 00:00 May 11, 2012
Credit: Dennis B. Mallari/GNM
Many UAE residents are still ‘clueless’ about
autism
This comes in face of the recent statistic that indicates a child
is diagnosed with autism every 20 minutes in the UAE
By Bindu Suresh Rai
Published Sunday, April 08, 2012
The blank stares that reflected in the eyes of many UAE
residents when quizzed over their knowledge of autism backed
the claim that more needs to be done in raising awareness for
this medical condition in the country.
The recently concluded World Autism Day on April 2, which was
also marked in Dubai, saw awareness for this developmental
condition still at its grassroots level with several members of
the public; this was supported further via the results of a spot
poll conducted by Emirates 24|7 that indicated only six per
cent of the 123 people questioned were aware of autism. A child undergoes therapy at the Dubai Autism Centre.
According to local experts, a child is diagnosed with autism
every 20 minutes in the UAE and one out of every 110 children
is autistic.
4. What we know…
• ASD Prevalence is increasing (1992: 1 in 1500)
CDC - ASD in 8 year olds: California DDS on Autism:
2002: 1 in 150 12 fold inc from 1987 – 2007
2006: 1 in 110 13% annual growth
8. Diagnostic and Statistical
Manual of Mental Disorders
o Published by the American Psychiatric Association
oClassification of mental disorders used in the US
oInfantile autism included for
first time in DSM-III
oChanged to autism in DSM-III-R
oDSM – IV published in 1994
o Text Revision in 2000
9. Pervasive Developmental
Disorders
o Come under section in DSM-IV-TR entitled…
o Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
o Includes
o Mental retardation
o Learning disorders
o Motor skills disorders
o Communication disorders
o Pervasive developmental disorders
o Attention-deficit and disruptive behavior disorders
o Feeding and eating disorders of infancy or early childhood
o Tic disorders
o Elimination disorders
o Others: separation anxiety disorder, selective mutism, reactive attachment disorder of
infancy or early childhood, stereotypic movement disorder, disorder of infancy,
childhood, or adolescence - NOS
10. DSM Category: PDDs
Pervasive Developmental Disorders
Childhood
Autistic Rett’s
Disintegrative
Disorder Disorder
Disorder
PDD-
Asperger’s
Not Otherwise
Disorder
Specified
• PDDs are characterized by severe and pervasive impairment in 3 main areas
• Social interaction
• Communication
• Repetitive and restricted behaviors
11. Autism
Sensory
Sensory
sensitivity
sensitivity
Seizures
Communication Repetitive
& language & Self-injurious
deficit stereotyped behavior
behaviors
Mental
retardation
Social Sleep
interaction disturbance
deficits
GI problems
Immune
Immune
problems
problems
12. DSM 5 Autism Spectrum Disorder
Must meet criteria A, B, C, and D:
A. Persistent deficits in social communication and social interaction across
contexts, not accounted for by general developmental delays, and manifest by
all 3 of the following:
1. Deficits in social-emotional reciprocity; ranging from abnormal social
approach and failure of normal back and forth conversation through reduced
sharing of interests, emotions, and affect and response to total lack of
initiation of social interaction,
2. Deficits in nonverbal communicative behaviors used for social interaction;
ranging from poorly integrated- verbal and nonverbal communication, through
abnormalities in eye contact and body-language, or deficits in understanding
and use of nonverbal communication, to total lack of facial expression or
gestures.
3. Deficits in developing and maintaining relationships, appropriate to
developmental level (beyond those with caregivers); ranging from difficulties
adjusting behavior to suit different social contexts through difficulties in
sharing imaginative play and in making friends to an apparent absence of
interest in people
13. B. Restricted, repetitive patterns of behavior, interests, or activities as
manifested by at least two of the following:
1. Stereotyped or repetitive speech, motor movements, or use of objects;
(such as simple motor stereotypies, echolalia, repetitive use of objects, or
idiosyncratic phrases).
2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal
behavior, or excessive resistance to change; (such as motoric rituals, insistence
on same route or food, repetitive questioning or extreme distress at small
changes).
3. Highly restricted, fixated interests that are abnormal in intensity or focus;
(such as strong attachment to or preoccupation with unusual objects,
excessively circumscribed or perseverative interests).
4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory
aspects of environment; (such as apparent indifference to pain/heat/cold,
adverse response to specific sounds or textures, excessive smelling or touching
of objects, fascination with lights or spinning objects).
C. Symptoms must be present in early childhood (but may not become fully
manifest until social demands exceed limited capacities)
D. Symptoms together limit and impair everyday functioning
14. Planned changes in autism diagnostic criteria
• Revisions to the current DSM-IV are being finalized in 2012, with DSM-V
due for publication in May, 2013.
• Reason for proposed changes: attempt to establish more
reproducibility and homogeneity in diagnosis.
15. Planned changes in autism diagnostic criteria
Proposed changes:
– Eliminate subcategories including Asperger’s syndrome, PDD-
NOS, Rett syndrome, and childhood disintegrative disorder. All of
these would be subsumed under the umbrella term, autism spectrum
disorder (ASD).
– Instead of 3 domains of autism symptoms (repetitive behaviors
and deficits in social interaction and language), 2 categories would
be used: impairment in social communication and interaction, and
restricted interests/repetitive behaviors. No mention of verbal
language – it will be considered a co-morbidity.
– A new symptom would be included in the second category: hyper-
or hypo-reactivity to sensory input, or unusual interest in sensory
aspects of the environment.
– Each person will also be evaluated in terms of known genetic
causes, level of language and IQ, and presence of seizures and/or
GI problems.
– A new category of Social Communication Disorder will be added
to the DSM (people without repetitive behaviors).
16. Planned changes in autism diagnostic criteria
• Positives: The subtypes that will be eliminated cannot be reliably
distinguished by expert clinicians; more information will be required in
the diagnosis (genetics, IQ, GI issues, seizures, regression history,
nature of language impairment), so subtyping will be more
straightforward.
• Negatives: There is some concern that the criteria will exclude some
people who currently have the diagnosis, particularly the higher
functioning, milder cases, that do not display repetitive behaviors, for
instance. This may result in denying medical treatment and social
services to some people on the autism spectrum.
17. Planned changes in autism diagnostic criteria
• Three published studies suggest that 25-78% of Asperger's or high
functioning autism will be excluded from the autism diagnosis in DSM-V.
Two other, small studies did not support these conclusions, however.
• The Autism Speaks foundation is currently funding studies to determine
how many people might be excluded and what the healthcare
consequences might be.
• A significant change in diagnostic criteria in 2013 would complicate
future longitudinal studies of prevalence.
19. Psychiatric disorders in children with autism spectrum
disorders: prevalence, co-morbidity, and associated
factors in a population-derived sample.
• Simonoff E; Pickles A; Charman T; Chandler S; Loucas T; Baird G
• A subgroup of 112 ten- to 14-year old children from a population-derived
cohort was assessed for other child psychiatric disorders (3 months_
prevalence) through parent interview using the Child and Adolescent
Psychiatric Assessment. DSM-IV diagnoses for childhood anxiety
disorders, depressive disorders, oppositional defiant and conduct
disorders, attention-deficit/hyperactivity disorder, tic disorders,
trichotillomania, enuresis, and encopresis were identified
• Journal of the American Academy of Child & Adolescent Psychiatry.
47(8):921-9, 2008 Aug .
20. Psychiatric disorders in children with autism spectrum disorders: prevalence, co-morbidity, and associated factors in a
population-derived sample.
Simonoff E et al, Journal of the American Academy of Child & Adolescent Psychiatry. 47(8):921-9, 2008 Aug.
21. Fig. 1 Weighted rates of co-morbidity are shown for all of the disorders and for all of the main disorders, in which the latter includes ADHD,
oppositional defiant or conduct disorder, and any emotional disorder (separation anxiety disorder, generalized anxiety disorder, simple phobia,
social phobia, agoraphobia, panic disorder, major depressive disorder, and dysthymic disorder).
22. Conclusions
• Psychiatric disorders are common and
frequently multiple in children with autism
spectrum disorders. They may provide targets
for intervention and should be routinely
evaluated in the clinical assessment of this
group. J. Am. Acad. Child Adolesc. Psychiatry,
2008;47(8):921Y929. Key Words: autism, child
• psychiatric disorders, prevalence, Special
Needs and Autism Project.
23. The Co-Morbidity Burden of Children and Young
Adults with Autism Spectrum Disorders
• Study Design: A retrospective prevalence study was performed
using a distributed query system across three general
hospitals and one pediatric hospital. Over 14,000 individuals under
age 35 with ASD were characterized by their co-morbidities
and conversely, the prevalence of ASD within these co-morbidities
was measured. The co-morbidity prevalence of
the younger (Age,18 years) and older (Age 18–34 years) individuals
with ASD was compared.
• Isaac S. Kohane1,2,3*, Andrew McMurry1,2, Griffin Weber3,4,
Douglas MacFadden1, Leonard Rappaport5, Louis Kunkel6,
Jonathan Bickel2,7, Nich Wattanasin8, Sarah Spence9, Shawn
Murphy3,8,10, Susanne Churchill3
• 1 Center for Biomedical Informatics
PLoS ONE | www.plosone.org 1 April 2012 | Volume 7 | Issue 4 | e33224
24. Figure 1. Prevalence of co-morbidities of autism and prevalence of autism in these co-morbidities. Shown here is the prevalence of co-morbidities
for individuals with autism (denoted as p(Dx}Autism) where Dx is the co-morbidity) and the reciprocal prevalence of autism given the co-morbidity
(i.e. p(Autism|Dx)). The prevalence is reported for patients younger than 35 years old. These results are consistent with prior studies and
also reinforce that monogenic disorders associated with autism individually only account for a small fraction of the disorder. It also reinforces that
autism is present in over 5% of the individuals evaluated for CNS anomalies, epilepsy, muscular dystrophy, schizophrenia, Fragile X Syndrome and
Tuberous Sclerosis.
doi:10.1371/journal.pone.0033224.g001
25. Figure 3. Co-morbidities of ASD in younger (0–17 years) vs. older (18–34 years). All the co-morbidities’ prevalence were significantly different
(p,0.0001 by Chi square) except for bowel disorders, epilepsy, autoimmune disorders (excluding IBD and DM1) and sleep disorders.
doi:10.1371/journal.pone.0033224.g003
26. Child Psychiatry Service, SKMC Study
• Study Design: A retrospective prevalence
study was performed using EHR CERNER.
• Over 418 patient records between age 2-18
who attended treatment at the Child
Psychiatry Division between January and June
of 2012 were reviewed. Fifty five patient’s
records with ASD were selected. We identify
the rates and type of psychiatric and medical
• Co-morbidities associated with ASDs.
31. Conclusions
• The co-morbidities of ASD encompass disease
states that are significantly overrepresented in
ASD with respect to even the patient
populations of secondary and tertiary health
centers. This burden of co-morbidities goes
well beyond those routinely managed in
developmental medicine centers and requires
broad multidisciplinary management that
providers will have to plan for.
