Exploring autism spectrum disorder in African children using multiple case study methodology.

Abstract

Despite the sharp global increase in prevalence, there is a paucity of South African research into autism spectrum disorders (ASD), so little is known about how ASD manifests in African children. This qualitative multiple case study explores six family units with a boy child with ASD (ranging in age from six to eleven years). The sample was recruited from five public schools for learners with special education needs (LSEN) in KwaZulu-Natal. The methodology incorporated (i) in-depth individual interviews with the parents to obtain an understanding of their experiences of raising a child with ASD, and (ii) the administration of the Autism Diagnostic Observation Schedule (ADOS) to the children to confirm the diagnosis, contextualise parental accounts, and to observe the children’s responses to the ADOS activities. The findings indicate that the parents experienced a difficult help-seeking journey, which began when they first noticed signs of atypical development (most frequently related to delayed speech development and lack of social interaction), to the time when the diagnosis was made. Lack of awareness of ASD, at both the community and primary healthcare levels, made the journey unnecessarily prolonged. Most of the participants in this sample explored cultural factors that could account for their child’s difficulties and engaged in various rituals to appease ancestors. Initially, African cultural beliefs strongly influenced their views about the causes of ASD, but over time, they drifted towards a Western perspective. Since there are no physically detectable features associated with ASD, the parents experienced much criticism in response to the child’s challenging behaviours in various social and religious contexts. The ADOS observations provided insight into South African children’s responses to the tasks, suggesting more universality into the way in which ASD manifests than had been expected from an African worldview perspective. This small qualitative study is critiqued and suggestions made for future research focal areas.