**5. Comparison of indicators from study and study 2**

Finally a common set of 'best' indicators could be identified across the two studies al‐ though there was some variation in wording and overlap across the two chosen rating scales – see Table 6. Nonetheless these items reflect the three domains that typify autism although with more emphasis on social interaction and repetitive behaviours than on communication.

However on both scales there were additional items that served to distinguish children with autism (see Table 7) and depending on the intended purpose, these items could be used to supplement those listed in Table 6 for the purposes of screening children for au‐ tism (GARS items) or clarifying the diagnosis of autism from other developmental disabil‐ ities (ADI-R items).


**6. Discussion**

more improbable in a country such as Iran.

more specialist assessment for autism.

These two studies had a number of strengths. Sizeable samples of children with autism were recruited alongside those who were normally developing and those who had intellectual disability or another form of developmental disorder. In both studies, the selected items dis‐ criminated effectively the children with autism. Also the studies were located in Iran; a country on which relatively little published research exists. Equally there are some limita‐ tions that need to be acknowledged. No independent verification of the child's diagnosis of autism was possible and reliance was placed on either parental reports or data held by the ISEO. This issue may be of relevance also to children with ID in that some of them may have undiagnosed autism. However even within developed countries, it would have been a cost‐ ly, not to say difficult undertaking, to obtain independent verification of diagnoses and even

Indicators of Autism in Iranian Children http://dx.doi.org/10.5772/52853 43

A further limitation is that the first study was retrospective for parents in that their child had already been diagnosed and hence their ratings on GARS may have been influenced by the increased awareness they had about the indicators of autism which they may not have had prior to the diagnosis. Hence it would be important to replicate the study on a prospec‐ tive basis especially with parents who had limited contact with professionals or with parents who had lower levels of education. The latter recommendation arises from the finding in Study 1 that parents from two provinces had significantly lower scores on the 16 items. In these two provinces professional services are more limited with fewer parents availing of higher education. These factors were also proposed as reasons for the variations in preva‐

Nevertheless it would be a major undertaking to repeat the study with an unselected popu‐ lation of children although the existence of the Iranian national screening programme for autism on school entry makes this a possibility for five year olds. An alternative approach is to consider the items identified in these studies as the basis for a referral tool [26]. For exam‐ ple, when concern is expressed about a child by parents or preschool educators, or if a child is already experiencing problems, then these items might serve as a guide for primary health or social care personnel to help them decide as to whether a referral should be made for

However the issue of identifying children with autism in other cultures has to be set within a broader context than screening. First increased opportunities need to be provided to pa‐ rents - and to mothers especially – for them to become more knowledgeable about child de‐ velopment and indicators of potential problems particularly those of relevance to their culture. The desire for increased information about autism is a common request of parents in different cultures [34]. Modern technology provides a cost-effective means for doing this.

Second, the beliefs, knowledge and skills of professions involved in diagnosing develop‐ mental problems will need to be expanded in relation to autism so that they can undertake appropriate and thorough assessments of the children and devise relevant intervention pro‐ gramme for them and their families [35]. The development of an indigenous knowledge

lence rates of autism across Iran that has been previously reported [1].

**Table 6.** Items common to GARS and ADI-R that best discriminated Iranian children with autism


**Table 7.** Items particular to GARS and ADI-R that best discriminated Iranian children with autism
