Prevalence and comorbidities of autism among children referred to the outpatient clinics for neurodevelopmental disorders

Abstract

IntroductionAutism spectrum disorders (ASD) is a neurodevelopmental disorder that has been rarely diagnosed in Sub-Saharan Africa. Although a proportion of children do present features of ASD in the Democratic Republic of Congo (DRC), little is known about it prevalence. Often, the co-morbidities constitute the upfront symptoms and therefore may it recognition and management difficult, aggravating as such the prognosis. The present study therefore aimed at studying the clinical profile of autism spectrum disorder (ASD) and the associated morbidities among children and adolescents in outpatient clinics in Kinshasa, the Democratic Republic of Congo.MethodsWe conducted a cross sectional study in the three outpatients centers receiving patients referred for neurodevelopmental disorders in Kinshasa, DRC, from June 2008 to June 2010. A total of 450 subjects aged from 1-18 years old were referred and included in the study. The clinical diagnosis for ASD was made using the DSM-IV-R and the ADIR. Co-morbidities were identified using DSM-IV-R criteria together with an extensive clinical interview and observation. All patients were subject to an intellectual quotient evaluation and an electroencephalogram reporting.ResultsOf the 450 subjects referred, 120 (29.3%) received the diagnosis of ASD, with boys outnumbering girls (OR 3:1. The mean age was 7.9 years (SD 3.4) (p< 0.001). Intellectual disability (75.83 %) and epilepsy (72.50%) were the main co-morbidities significantly associated with autism (p< 0.001). It was also found that co-morbidities were most frequent in subjects with an IQ<70 (p=0.05).ConclusionASD is frequent among patients referred for neurodevelopmental disorders in the three outpatients’ centers for neurodevelopmental disorders in Kinshasa. Males seem to be more affected than female. The main co-morbidities were epilepsy and intellectual disabilities. Our findings suggest that it is important to screen for ASD and co-morbidities among all subjects referred for neurodevelopmental disorders and to undertake survey on ASD in various structures of rejected children from the society in Kinshasa DRC. This will help to identify and manage ASD and associated co-morbidities at an early stage for a better prognosis.

The Female Autism Phenotype and Camouflaging: a Narrative Review

“…Randall et al 2016), and these tend to be higher than those estimated in low-income countries (Elsabbagh et al 2012). This could suggest that there are significant numbers of autistic people in other nations, including African and Asian nations, who are not recognised by or receiving support from medical or educational systems (Hossain et al 2017;Mpaka et al 2016); alternatively, there may be lifestyle factors in more developed nations which lead to greater incidence of autism.…”

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“…The other pitfall was that in our method we interrogated each disease term one by one, as if they were independent diseases. However, several of the diseases had high comorbidities, as previously reported (Blacher & Kasari, 2016;Lo-Castro & Curatolo, 2014;Mpaka et al, 2016). In fact, the gene panel used in this CAGI challenge was originally designed to study the genetics underlying the comorbidities of intellectual disability and autism spectrum disorders.…”

“…Many neurodevelopmental disorders have profound heritability, highly heterogeneous genetic causes, and significant comorbidities (Blacher & Kasari, ; Brainstorm et al, ; Lo‐Castro & Curatolo, ). For instance, researchers have found that intellectual disability and epilepsy can have larger than 70% co‐occurrence rates with autism spectrum disorders in some population (Mpaka et al, ). With prior knowledge of such disorders, the Padua Diagnostic Laboratory designed a gene panel primarily for studying the genetic mechanisms underlying the comorbidity of intellectual and autism spectrum disorders.…”

“…For instance, researchers have found that intellectual disability and epilepsy can have larger than 70% co-occurrence rates with autism spectrum disorders in some population (Mpaka et al, 2016). With prior knowledge of such disorders, the Padua Diagnostic Laboratory cases with neurodevelopmental disorders, as the data for the CAGI5 intellectual disability gene panel challenge.…”

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“…Por otro lado, la discapacidad intelectual implica la presencia de deficiencias en habilidades mentales generales que involucran el funcionamiento cognitivo y adaptativo (APA, 2014). Esta última y su comorbilidad con TEA puede ser estimada entre un 18 y 40 % (Mbeya Mpaka et al, 2016;Tonnsen et al, 2016). Al manifestarse en conjunto, el desafío terapéutico es más complejo, porque suele estar asociado a elevados índice de comportamientos restrictivos y repetitivos (incluyendo autolesiones), y mayores dificultades a nivel comunicacional (Fusar-Poli et al, 2017;Oliver, Licencce y Richards, 2017;Tonnsen et al, 2016).…”