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Tackling autism in the Middle East

Treatment for autism in the region has progressed, but lack of awareness and support services remains a challenge.

Last updated: 15 Apr 2014 10:23
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Instructors at Shafallah Center say a structured environment reduces the anxiety of students with autism [Jassim Mater/Al Jazeera]

Doha, Qatar - In many ways, it resembles a normal classroom - teachers, students, and all the materials you would expect at a school. Subjects include music and physical education, with some students studying additional topics such as computer science and Islamic law. 

But this classroom is somewhat different. Class sizes are smaller, with one teacher for every two students. The students themselves are a bit different, too. Children at the Shafallah Center for Children with Special Needs in Qatar have autism, a developmental disorder characterised by various abnormal behaviours. 

"A lot of professionals say 'an autistic child'. Here, we say a 'child with autism'," said Abdullah Itani, a trainer at the centre. "The child comes first."

The hallmarks of autism aran impaired ability to communicate and socialise, and a narrow range of repetitive behaviours and activities.

The Shafallah Center, opened in 1999, has graduated a number of students who now work in banks, post offices and telecom companies, as well as operating a kiosk in Doha's Villagio Mall. "We try to teach the child to be adaptable to any environment, and many of them enter the workforce," Itani said. "Our goal is for students to graduate from the centre and become happy members of society."

The WHO said the global median rate of autism prevalence has been estimated at 62 per 10,000, although some studies have placed it substantially higher. And for the Middle East, it may be an even bigger concern.

'Complex emergencies' 

Autism is one of many mental disorders that can be affected by living in a volatile environment - which is the case in much of the Middle East. "Available scientific evidence suggests that various factors, both genetic and environmental, contribute to the onset of autism spectrum disorders by influencing early brain development," said Khaled Saeed, a regional adviser for the WHO's Eastern Mediterranean offices. "Rates of mental disorder are significantly higher in countries with complex emergencies."

The awareness is there now - just having parents interested in autism is a success.

- Sara Ahmed Baker, head of community service unit at Dubai Autism Centre

"For example, 37.4 percent of Iraqi schoolchildren were estimated to be suffering from mental disorders; 54.4 percent of Palestinian boys and 46.5 percent of Palestinian girls were estimated to have emotional and behavioural disorders." 

Although autism-specific statistics on the Middle East are lacking, WHO estimates place the 12-month prevalence of mental disorders for the region between 11-40 percent, well above the global average of 4.3-26.4 percent. 

Saeed added that the gap between the care needed for mental health issues and what is available is wider in poorer countries than in their affluent counterparts. "Autism spectrum disorders impose a huge emotional and economic burden on families. Caring for children with these disorders is demanding, especially where access to services and support is inadequate," Saeed said.  

Services are lacking in many more affluent Middle Eastern countries as well.

Fast expansion 

In the United Arab Emirates, the Dubai Autism Center has helped autistic children in the region since its establishment in 2001. 

"When the centre first opened, there was no perception of what autism was, total ignorance," said Sara Ahmed Baker, head of the community service unit at the centre. "There were children diagnosed incorrectly as mentally retarded, not being diagnosed, characterised as naughty at school because of their behaviour, or kept from society because of a positive diagnosis." 

The centre has diagnosed 110 individuals with autism this year, a number that has grown by almost 20 children each year. 

Since treatment can help individuals with autism lead fuller lives, Baker says the more parents know about autism, the more likely they are to seek a proper diagnosis for their child. "The awareness is there now - just having parents interested in autism is a success," Baker said. 

By the end of 2003, the Dubai Autism Center had 36 individuals on its books. It now runs at full capacity with 53 students, but still falls short of the needs of the community, with more than 200 children on its waiting list. 

Baker said families that can afford it often seek therapy abroad, or through private clinics in the UAE - centres that charge 55,000 ($15,000) to 190,000 dirhams ($52,000) for 10 months. "We can't make parents wait three to six months for us to even see the child, especially when we tell them early diagnosis can make a difference," she told Al Jazeera.

The centre has reduced its wait time for diagnosis to two months, which compares favourably with many countries in the Western world. The wait in the United Kingdom for diagnosis is six months to a year, while it's a full year in Canada, according to Baker. And even then, she said, it can take another three years to start treatment in many Western countries.

"We've had parents from the UK, for example, tell us that we're better than the services in the UK," Baker said. "But for us it's not enough to be better than the UK or some other country, because it's about serving everyone's needs." 

But Baker said Western countries do have an edge in the presence of qualified professionals. It is expensive to attract those professionals to the region and, combined with a lack of education programmes in the field, is one of the major reasons for the dearth of support services. 

Stumbling blocks

The problem is even more pronounced in unstable, impoverished Egypt. 

The Egyptian Autistic Society was founded in 1999, but its founder says it struggles to find staff and must also contend with a legal void regarding autism. "No university in Egypt teaches autism," said Dahlia Soliman, the founder and president of the organisation. "Cairo Medical School only has one paragraph on autism in the book they use." 

Many children with autism are capable of eventually entering a mainstream setting [Jassim Mater/Al Jazeera]

The society has set up a partnership with Helwan University that will see an increasing number of students with training in autism, working for them, but it still falls woefully short of the demands of an autistic population that Soliman estimated at more than one million. 

To compound the problem, Soliman told Al Jazeera: "There is no legal recognition of autism - that means no military exemptions, no legal right for us to be in schools, and no legal backup for us." 

Legal support is available for those with autism in the UAE and Qatar, with laws governing the care of special-needs children. Baker said private schools in the UAE have been doing well in their approaches to autism, and public schools are improving. Last year, the Dubai Autism Centre trained a number of public schools in how to deal with students with the condition. 

"Not everyone can be mainstreamed, though," said Baker. "Some may disturb other students when in a classroom setting, and many need extra therapy outside the classroom." 

The way forward 

During World Autism Month, planned activities to raise awareness across the Middle East include fundraising walks, broadcasts on major regional channels, and covering major landmarks in blue light. Events will continue throughout the month - and they seem to be working. 

"In April, everyone notices something is different, and calls and emails shoot up in the following months," Baker said.   

According to her, the added attention to an issue completely unknown in the Middle East a mere 15 years ago can only help. "We're on the right path - now, we just need to move to a faster track."

Follow Jassim Mater on Twitter: @Jassim41

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Al Jazeera
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