**1. Introduction**

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28 Recent Advances in Autism Spectrum Disorders - Volume I

Suppl 1: S49-58.

Autism occurs in every country of the world. However its prevalence varies greatly across nations with higher rates being reported in more affluent, English speaking countries. The lower rates in less developed countries have been attributed to a lack of knowledgeable per‐ sonnel in child assessment and diagnostic services and their slow response to parental con‐ cerns [1]. While this is certainly a major impediment to early identification, other social and cultural factors may play a part. In particular, expectations of children's development and behaviours may mean that parents attach less significance to certain early indicators of Au‐ tism across different cultures [2]. If this were so, then screening and other assessment tools developed in Western countries may not be sufficiently sensitive to detect early signs of Au‐ tism in other societies [3].

This chapter summarises the findings from two studies in Iran that identified the items that best discriminated children who had a diagnosis of autism. In the first study, the Gilliam Autism Rating Scale - Second edition GARS ll [4] was used. Comparisons are drawn be‐ tween three groups of children aged 3 to 16 years: those with a compared diagnosis of Au‐ tism; children with intellectual disabilities and those whose development was considered to be normal.

The second study focussed on the Autism Diagnostic Interview- Revised (ADI-R) [5]. This tool was developed for use by clinicians to assist in making a diagnosis of autism usually after referral that follows from the use of a screening tool such as GARS. In all the perform‐ ance of 333 children (84%) with a confirmed diagnosis of Autism could be confirmed with those of 64 (16%) who were not given this diagnosis although they had screened positive.

The findings from these two major studies together identify those indicators of autism that appear to be more culturally specific to Iranian or similar cultures. However comparisons are drawn with similar data from other countries to underline the universality of certain au‐

© 2013 Samadi and McConkey; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

tistic traits [6]. Nevertheless the implementation of tools for the identification of children with autism has to be located within wider considerations; notably the education of parents and professionals around indicators of atypical child development and the possible environ‐ mental influences on children's behaviours.

60 per 10,000 in Sweden. However in London, a more thorough study reported a prevalence rate of 38 9 per 10,000 for autistic disorders and for other ASDs at 77 2 per 10,000; giving a total prevalence for all ASDs of 116 1 per 10,000 [18]. A regression analyses of the prevalence studies found that the most significant influence on ASD rates was the diagnostic criteria used, followed by the age of child when identified, the country of origin and urban/rural lo‐

Indicators of Autism in Iranian Children http://dx.doi.org/10.5772/52853 31

These same factors may also account for the variation in prevalence rates that have been re‐ ported within countries even when ascertainment method, age group and reporting period are similar. In the USA, the prevalence of all ASDs in eight year old children varied across eleven sites from 42 per 10,000 in Florida to 121 per 10,000 in Arizona and Missouri [19]. Us‐ ing special education data on students with ASD, Coo at al., [20] reported a prevalence of 43.1 per 10,000 among 4–9 years school children in the British Colombia Province of Canada

One explanation for differences in the prevalence and identification of ASD across cultures and regions is varying awareness of the criteria associated with a diagnosis of ASD [6]. More specifically, it appears that differences may be more likely to arise cross culturally due to various factors such as ''when a symptom is perceived, by whom, and what behaviour is noticed first, as well as whether it is perceived as problematic'' ([2], p. 538). Moreover cul‐ tural attitudes regarding typical behaviours and what is perceived to be normal or abnormal development for that culture would also have an impact on diagnosis of an ASD. Hence children may be more or less susceptible to a diagnosis of an ASD dependent on the cultural expectations of parents and indigenous professionals. Thus screening and other assessment tools for autism developed in Western countries may not be sufficiently sensitive to detect early signs of autism in other societies and could possibly underestimate the prevalence of

A two-stage process for identifying children with autism is operational in many countries [22]. The first stage involves a universal screening of all children and various tools have been developed for use with children at different ages. They consist of a series of items indi‐ cative of autism and use parents as the primary informants. For example the CHAT (Check‐ list for Autism in Toddlers) is a screening tool developed for use with infants aged 18 months developed in the UK [23] that has also been adapted for use in the USA (M-CHAT: [24]) and which has shown promise for use in Arab countries [25]. More recently, ten item screening tools have been developed for use with children, adolescents and adults based on the Autism Quotient developed in the UK [26]. Those individuals who screen positive – their scores exceed a designated cut-off point - are then referred for more detailed diagnostic

A range of diagnostic tools for autism also have been developed [27]. These are based on DSM-IV/ICD-10 criteria for autism and information about the child is usually obtained

whereas in Quebec it is reported at less than half this, at 21.6 per 10,000 [21].

**3. Screening and assessing children for autism**

cation of the sample [17].

the condition [3].

assessment.
