Introduction According to the Centers for Disease Control and Prevention (CDC), the term developmental disability is defined as “a group of conditions due to impairment in physical, learning, language, or behavior areas” (CDC, 2013, p.1). Developmental disabilities can occur anytime in the first twenty-two years of an individual’s life, and usually last throughout a person’s lifetime. Developmental disabilities include limitations in function resulting from disorders of the developing nervous system. These limitations manifest during infancy or childhood as delays in reaching developmental milestones or as lack of function in one or multiple domains, including cognition, motor performance, vision, hearing and speech, and behavior. Autism is one of the five primary developmental disorders called Pervasive Developmental Disorders (PDD). Pervasive Developmental Disorders is a general which term includes a wide range of social and communication disorders, such as Autistic Spectrum Disorders, Childhood Disintegrative Disorders, Rett's Disorder, Asperger's Disorder and PDD-not Otherwise Specified (PDD-NOS) Disorders. These disorders show similar range of symptoms, but they differ in terms of when the symptoms start, how fast they appear, how severe they are, and their exact nature (Volkmar&Wiesner2009, p. 25). Autism is one of the five developmental disabilities of childhood included under the umbrella term ‘Pervasive Developmental Disorder (PDD)’ According to the report of National Research Council (2001), autistic children often have problems in communication, avoid eye contact, and show limited attachment to others. A child with autism appears to live in his/her own world, showing little interest in others, and a lack of social awareness. The focus of an autistic child is a consistent routine and includes an interest in repeating odd and peculiar behaviors. What is Autism? Autism is a most common pervasive, neurologically based developmental disability which causes severe learning, communication, and behavior disorders with age of onset during infancy or childhood. It is marked by qualitative impairments of problems with verbal and nonverbal communication, social and emotional functioning which makes it difficult for autistic people to understand the world around them. (American Psychiatric Association, 1994) Characteristics of Autism In spite of the fact that all individuals with autism are unique, there are still some common characteristics that these people encounter. These features also serve as a hallmark to diagnose the disorder. There are three distinguishing characteristics that all professionals in the field use, however a fourth feature can be considered though it is not as salient as the first three. These features are; impaired social development, language and communication, flexibility impairment or resistance to change 1. Impaired Social Development Impaired social interaction is one of the hallmark features of autism. Children with autism have difficulties of interacting both with peers and adults. From infancy to age years 3 they exhibit lack of social skills such as, disinterest in social games, having little attention for family members, having abnormal eye contact or limited attention to other people, poor playing skills, etc. Children with autism demonstrate rigidity and limitation in social interaction and have problems establishing relationships. This is because they are unable to process social information properly and to use appropriate social skills to create and maintain relationships. 2. Impaired language and communication About 40% of children with autism does not talk at all and others have echolalia or repeating what was said by others. Even if they can communicate, autistic children’s communication skills are limited to getting needs met rather than information sharing or complex interaction with other people. An individual with autism shows considerable difficulty in using languages as faculties of communication and interaction and information gathering and dissemination. This can include delayed development of spoken language, difficulty holding a conversation or repetition. (Ruble & Gallagher, 2004) 3. Flexibility Impairment or Resistance to Change Demonstrating unusual and distinctive behavior is one characteristic of autistic children. These stereotypic and unusual behaviors are typically exhibited through repetitive behavior like restricted range of interest and preoccupation with specific interest or objects or parts of objects (spinning of fan, turning of wheels on toys, etc), stereotypic and repetitive motor mannerisms, such as hand flapping, finger flicking, rocking, spinning, walking on tiptoes, spinning objects. Autistic children might repeat actions over and over again. They might want to have routines where things stay the same so they know what to expect.(Gray, 2000) Causes of Autism Autism is a complex brain disorder that affects a child’s ability to communicate, respond to surroundings, or form relationships with others. In early times the cause of this complex brain disorder was believed to be parenting style (especially the mother’s styles). Careless and cold parenting were believed to contribute to the problem. However in the 1970s, studies began to show that autism was a brain-based disorder. The brains of individuals with autism appear to have some structural and functional differences from the brains of other people. (Volkmar & Wiesner 2009, p.27) More recent studies reported that children with autism were more likely have had problems either before birth or during and other reported associations of autism with a number of medical conditions that can affect brain development. Currently, there is growing evidence that autism isa genetic condition, and that there are likely several different genes involved environmental factors such as viral infections, metabolic imbalances, and exposure to environmental chemicals and harmful substances ingested during pregnancy are currently gaining wide attention in the causes of autism as well. Various studies have been done to identify the cause of the disorder and multiple theories have been proposed to date. However, the absolute cause of autism remains unknown. Diagnosis Getting a diagnosis for autism is not an easy task. “There is not a simple blood or laboratory test to determine who is autistic” (Volkmar & Wiesner 2009, p.26). Since the exact cause of autism is not known, the diagnosis mostly relies on observation and history. In order to diagnose autism accurately, the child should have a comprehensive evaluation by professionals in the fields of language development, behavioral, social, and cognitive skills in young children. Autism is thus diagnosed by multidisciplinary team which consists of psychologists, neurologists, psychiatrists, speech therapists, social workers and other professionals (Ruble & Gallagher, 2004). The American Psychiatric Association (1994) also specified three criteria that are used to make diagnosis for autism. These criteria are composed of the main distinctive characteristics of autism and include the following: Social interaction- severe abnormality of reciprocal social relatedness Communication- severe abnormality of communication development, and Behavior- restricted, repetitive behavior and interest Theories on Autism 1. Refrigerator Parenting Hypothesis (RPH) Kanner had originally suggested that autism was partly the result of ‘cold’, unemotional parenting, specifically by the mother. However, the prevailing current view is that parents behavior doesn’t initiate or in any way provoke autism. Indeed, any difference in parents’ behavior towards their autistic child is more likely to be caused by the autism than vice versa. Also, autism seems to strike indiscriminately. It’s no respecter of social class or family environment it can affect a child with extremely warm and loving parents and where there one no autistic siblings. 2. Genetic Theories (GT) Kanner suggested that autism has a genetic component. If one member of a twin pair is autistic, the probability that the other will also be autistic depends to a significant degree on whether they share all their genes or only half their genes (the same as ordinary siblings). Autism is the most strongly genetically influenced of all multi factorial child psychiatric disorder. 3. Theories of Mind (TOM) and Mind-Blindness The most influential theory of autism in recent years maintains that what all autistic people have in common (the core deficit) is mind-blindness. A sever impairment in their understanding of mental states and in their appreciation of how mental states. 4. Empathizing Systemizing (E-S) Theory The theory was developed by, Baron and Cohen. According to the E-S theory, Female brain is hard-wired for empathy (E-type), while male brains are hard-wired for constricting system (S-type). These differences are reflected in male /female difference from birth until the adult skills and occupations, according to which the autistic individuals have an extreme male brain. Criteria for Diagnosing Autism According to the new (2013) DSM-5 criteria for communication disorder the following points must be met:1. Persistent difficulties in the social use of verbal and nonverbal communication as manifest by deficits in the following: Using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context; Changing communication to match context or the needs of the listener, such as speaking differently in a classroom than on a playground, communicating differently to a child than to an adult and avoiding use of overly formal language. ; Following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction; Understanding what is not explicitly stated (e.g. inferencing) and nonliteral or ambiguous meanings of language, for example, idioms, jokes, metaphors and multiple meanings that depend on the context for interpretation. 2. Deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance. 3. Onset in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities). 4. Deficits are not better explained by low abilities in the domains of word structure and grammar, or by intellectual disability, global developmental delay, Autism Spectrum Disorder, or another mental or neurologic disorder. DSM-5 Criteria for Autism Spectrum Disorder 1. 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: Deficits in social-emotional reciprocity Deficits in nonverbal communicative behaviors used for social interaction 3. Deficits in developing and maintaining relationships 2. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following: Stereotyped or repetitive speech, motor movements, or use of objects Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change Highly restricted, fixated interests that are abnormal in intensity or focus 4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities Symptoms together limit and impair everyday functioning. Autism in Ethiopia Similar to other African countries, Ethiopia has limited autism service provision. The detection of, and care for, children with autism in Ethiopia is further impeded by stigma surrounding mental health and misconceptions about the causes of developmental disability and mental illness. We recently examined the experienced stigma, explanatory models and unmet needs of 102 help-seeking caregivers of children with autism and/or intellectual disability (ID) in Ethiopia. Caregivers provided a mixture of biomedical (e.g. head injury or birth complications) and supernatural (e.g. spirit possession or sinful act) explanations for their child‘s condition. In recent years however, Ethiopia‘s mental healthcare system has become the focus of new initiatives. The National Mental Health Strategy (2012/13–2015/ 16) presents a plan for 20 scaling up mental healthcare and recognizes children with mental disorders as a vulnerable group. Training of mental health specialists is being expanded, with in-country psychiatrist, Ph.D., Masters and psychiatric nurse training programs, and basic mental health training for rural community based health workers. New initiatives from local nongovernmental organizations (NGOs) also contribute to an increase in autism awareness and service provision in Ethiopia. Although these developments are promising, existing services for children with autism have scarcely been documented. Moreover, little has been done to explore opportunities and challenges to expand services and the most effective ways for future service development. This paper aims to assess the current health and education service provision for children with autism in Ethiopia. It explores the unmet needs, future opportunities and stakeholders ‘views of the best approach to further develop services. Issue of developmental problems, delays and disorders are not very well researched. According to the World Report on Disability (2011), there were 15 million people with disability in Ethiopia. However, the available data do not provide sufficient evidence on the type and the prevalence of persons with disabilities by degree and specific category of impairment. This is because of the reason that the public associate developmental problems with spiritual evil and caused by ones sin most people do not let disabled persons to go out in public. This stereotypic attitude also forces families to hide disabled family members which in turn lead to inaccurate information and statistics on disabilities ( Tirusew, 2005). Case Study History: Sena Sena is a 15-year old girl who was diagnosed with ASD with an aggressive behavior both with herself and her widowed mother. Sena is in six grades and has seen a psychiatrist at Debre Berhan Referral Hospital for the past two years. Sena has difficulty maintaining a social interactions and she prefer to be alone and always upset and not prefer to be comforted by others even by her mother. She is the only child in the house and always with her mother after schooling. She has a communication and language skills problem. She is now in grade six and the result of all subjects are below 50 out of 100. She has no any interest in her education. Recently, she has fond of movies, and romantic films. She even stays nights to watch movies that are why always she quarrels with her mother. Her father, Ato Arron Asmare has passed away by high blood pressure (hypertension), when Sena was nine years old five years ago. For her, he is still in the office in his duties. Sadly, he was died on the day of Ethiopian New Year. May be because of this, she develops a habit of not communicating with her mother in holyday days. She is now a student of Mitson Academy. Mitson Academy is a fourth school for her. Because of her aggressive behavior and her inability to play with students, communicate with her teachers and even her unexpected mood she has experienced more confrontation with school officials not to stay in the school. References American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author Centers for Disease Control and Prevention (2013). Hearing loss in children. Gray.D.E. (1993).Perception of Stigma: The parents of autistic children. Sociology of Health & Illness, 15, 102-120. http://www.cdc.gov/ncbddd/hearingloss/facts.html. Kanner, L. (1943) ‘Autistic disturbances of affective contact’, Nervous Child,vol.2, pp.217–50 Wiesner L.A. & Volkmar F.R. (2009). A Practical Gide to Autism. Hoboken, N J: John Wiley and Sons. National Research Council. (2001). Educating Children with Autism. Washington, DC: National Academy Press. Retrieved from www.nap.edu/books/0309072697/html/R1.htm Ruble A. L & Gallagher T. (2004). Autism spectrum disorder: Primer for parents and educators. Washington, DC: National academy press. Retrieved from http://www.naspcenter.org Tirusew T. (2005). Disability in Ethiopia: Issues, Insights and Implications. Addis Ababa: Addis Ababa University printing press.
