Population-Based Indicators of Social Developmental Delay Relevant to Autism Spectrum Disorder and Association with Relevant Predictors in a Central American Country Restricted; Files Only
Bonnett, Michaela (Spring 2023)
Abstract
Objective
Despite autism spectrum disorder (ASD) being detected globally, many low- and middle-income countries (LMIC) do not have information about domestic ASD prevalence, hindering efforts to build efficient detection and assistance infrastructure. Many LMICs have completed UNICEF’s Multiple Indicator Cluster Survey v6 (MICS6), containing an Under 5 questionnaire (U5) with questions about young children’s development like those present in ASD screeners. The MICS6 may be utilized to create a population-based screener similar to a level-1 ASD screener focused on early social, communication, and behavioral development. The objectives of this study are to, using this tool, describe prevalence of potential social developmental delay associated with ASD, identify which characteristics of interest associated with ASD may be acting as predictors, and define any associations additional socio-economic variables may have with potential social developmental delay.
Methods
Analyses were performed on data from 1723 4-year-old respondents to the U5 of the Honduras 2019 MICS6, with consideration for complex survey design. A 10-point measure (Social developmental delay proxy score (SDDPS)) was created, with a cut-off set at ≥3. Descriptive analyses described the distribution of the SDDPS while linear and Poisson regressions described the association between three characteristics associated with ASD (early education attendance, sex, and urbanicity) and the SDDPS. Socio-demographic variables included in the analyses were age in months, sex, urbanicity, caretaker’s education level, translator usage, mother’s age, number of siblings, stunting, and wealth.
Results
A nationally representative 4.6% of 4-year-old children scored above the cut-off. Of the three associated characteristics, only urbanicity predicted on average a 0.13-point lower score on the SDDPS (p=0.017) compared to rurality. Among the additional socio-demographic variables, on average higher parental education was associated with a 0.14-point lower score (p=0.049) and children with one more sibling were 16% more likely to score above the cut-off compared to those with one fewer sibling (p=0.027).
Conclusions
The SDDPS found a prevalence within the expected range and defined several associations similar to those observed with ASD. While promising for its utility for detecting social developmental delay potentially indicative of developmental delays and differences associated with ASD among young children, further validation is necessary.
Table of Contents
Abstract iv
Acknowledgements vi
Introduction 1
Literature Review 2
Autism Spectrum Disorder 3
Prevalence of Autism Spectrum Disorder 4
Prevalence of Autism Spectrum Disorder in the United States 4
Global Prevalence of Autism Spectrum Disorder 5
Autism Spectrum Disorder in Honduras 6
Diagnosing and Detecting Autism Spectrum Disorder 7
Diagnosing Autism Spectrum Disorder 7
Screening and Detection of Autism Spectrum Disorder 7
Common Symptoms of Autism Spectrum Disorder 9
Social-Emotional Reciprocity 10
Non-Verbal Communicative Behaviors 10
Developing, Maintaining, and Understanding Relationships 10
Restricted, Repetitive Patterns of Behavior, Interests, or Activities 11
Barriers to Detection and Diagnosis of Autism 11
Education of the parent or caretaker 12
Income or Socioeconomic Status 12
Geography 13
Race and Ethnicity 13
Health Insurance 14
Evaluation at a Health or Education Source 15
Type of Symptoms and Co-occurring Intellectual Disability 15
Biological Sex of the Child 16
Nutrition and Stunting 16
Number of Siblings 17
Early Intervention 17
Early Intervention Techniques 18
Impact of Early Intervention 19
Delivery of Early Intervention in High-Income Countries 20
Delivery of Early Intervention in LMICs & Honduras 20
Conceptual Framework 21
Model 1: Early Childhood Education Attendance 22
Model 2: Child’s Sex 23
Model 3: Urbanicity 24
Data 25
The Multiple Indicator Cluster Survey, Round 6 (MICS6) 25
Survey Design 26
Honduras MICS6 Under 5 Questionnaire Dataset 27
Language/Ethnicity 29
Socio-Demographic 29
Physical Characteristics 30
Education 30
Early Childhood Development Index (ECDI) 31
Child Functioning 33
Use of MICS6 in the Detection of Developmental/Intellectual Delay 35
Methods 36
Social Developmental Delay Proxy Score (SDDPS) 37
Missing values 38
Coding of the outcome response variable “Social10”, the SDDPS 39
Descriptive methods 40
Analytic methods 41
Results 42
Descriptive 42
Analytic 45
Linear Regression 45
Poisson Regression 47
Discussion 48
Strengths and Limitations 51
Strengths 51
Limitations 52
Conclusions 53
Implications 53
Future Research Needs 54
References 56
Annex 65
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