Autism is on the rise in the Middle East and there is a massive shortage of trained professionals to work with these children.
True Prevalence Largely a Mystery; Awareness and Rates are Rising
There is a distinct lack of reliable numbers on diagnosis in the Middle East for autism and other related disorders, partially due to the lack of clinics and qualified medical personnel to work with them and diagnose them.
“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.
WHO estimates the prevalence of mental disorders in the Middle East to be between 11-40 percent, relative to 4.3-26.4 percent globally.
Limited Number of Autism Studies, Clinics and Resources
In a systemic review of the studies of autism in Arab Gulf Countries there were only 12 studies about autism conducted in the Middle East and only 2 of them looked at the prevalence of autism. While both reported relatively low numbers for autism, the systemic review noted that this is to be expected for countries that do not have a lot of resources available for diagnosis and treatment. There were a number of caveats about drawing too many conclusions from the limited data, explained here:
“Most reviewed studies shared 2 limitations. First, is the sample size, as numbers of cases and controls used were small and cannot be considered representative. Also, the recruitment of cases and controls was from specialized clinics/tertiary care institutions, which might be problematic when extrapolating results to community autistic children in GCC countries. Second, is that cases were recruited from pediatric wards, and none come from psychiatric clinics. The diagnosis of autism must include more comprehensive behavioral/psychological considerations to form a full picture about the disorder. The current study’s limitations were the small number of studies identified and absence of studies from 3 GCC countries, which precluded comparing prevalence of autism across countries.”- Systemic Review of Autism in Arab Gulf Countries
There is clearly a need for more healthcare professionals who can understand and treat autism.
New Board Certified Behavior Analysts (BCBAs) Soon No Longer an Option for Middle East
One of the top professional certifications in autism that has been very helpful in the past for many countries in the Middle East is Board Certified Behavior Analysts (BCBAs). While there are not a lot of them in these countries, they focus almost exclusively on autism. This means that each individual clinic will be seeing significantly higher numbers of students with autism than a clinic with mixed specialties or one that focuses more exclusive on speech therapy, occupational therapy or physical therapy. Unfortunately for many of these countries, the Behavior Anaylst Certification Board (BACB) just announced that it will stop accepting new applicants from outside the U.S. and Canada in 2023.
This means that while the people that have already started their training will be able to complete it, there will no longer be people in the Middle East being trained in ABA therapy.
This is somewhat problematic for the area.
“The demand for services far outweighs the ability of current qualified staff to meet the need. This will continue to increase…With a severe deficit in local professionals trained in ABA, the provision of ABA services is significantly restricted within all GCC states.”- Dr. Michelle Kelly
Kelly also notes that this lack of trained professionals tends to attract people of ‘varying qualifications’ for establishing treatment options and that licensing and regulation is only beginning in most of these areas.
In countries that typically do not have a lot of options in this area, ABA clinics have been a huge help to make highly qualified treatment available and to raise awareness in their communities.
As of 2017 here are the number of clinics that utilize Applied Behavior Analysis (ABA) therapy included:
- Dubai: 24 (Abu Dhabi: 8)
- Saudi Arabia: 7
- Qatar: 3
- Bahrain: 3
- Oman: 1
While these clinics play a large part in making diagnosis and treatment available throughout the Middle East, ABA is also only one type of therapy. There are other evidence-based practices as well and some forms of therapy will be more effective for some children than others.
Certified Autism Specialist™ offers Board Certified Alternative
A Certified Autism Specialist™(CAS) is a credential with a different approach, but with a similar focus. A CAS credential focuses specifically on autism, and the content for the CAS is put together and approved by members of a board of advisors compiled of people across a number of professional disciplines. The advisory board of IBCCES includes a BCBA, a speech-language pathologist, a psychologist, numerous researchers and academics in the field (2 of which are on the autism spectrum themselves) and a number of industry experts from various industries.
Who is the CAS Credential for?
There are numerous different tracks for different therapists and educators alike, this 14 credit hour online training program and certification helps to make autism-specific education much more accessible for people who are already working in a field with individuals on the spectrum but who do not have autism-specific training.
Outside of ABA related approaches, this is the norm across most healthcare and therapy positions.
The CAS Training is offered in both English and Arabic.
Advanced Certified Autism Specialist also Offers ABA Training
The Advanced Certified Autism Specialist is another option that builds upon the CAS and offers ABA training as well. This training includes both ABA specific training as well as more general autism training that is not ABA specific.
The training contains 21 credit hours of training.
This training is not meant to train an ABA therapist from scratch, but is meant to either reinforce or introduce the principles of ABA therapy along with other evidence-based approaches.
Small Number of Autism Centers Having a Big Impact; Overburdened
Dubai Autism Center- Doha, Qatar
There are a small number of autism centers throughout the Middle East that are having a very large impact on diagnosis, public perception, and effective integration.
While many countries are making large strides in the areas of diagnosis and treatment, they are still overburdened and cannot meet the growing need. The Dubai Autism Center has reduced its wait time for diagnosis down to 2 months, but it still has 200 children on the waiting list.
Many families who can afford it have looked for therapy abroad after being unable to get into local therapy centers and learning the importance of early diagnosis in outcomes.
Sara Ahmed Baker, head of the community service unit at the centre, said that Western countries have an edge with the amount of qualified professionals they have available, as it is expensive to attract those professionals and there is a distinct lack of locally-based programs.
“The awareness is there now – just having parents interested in autism is a success.”- Baker said.
Even though Qatar is not able to provide for everyone at this point they are making progress in the right direction and they have laws governing the care of special needs children. The United Arab Emirates have similar laws, but some other places like Egypt do not.
Lack of Government Support can be Problematic but is Slowly Changing
Egypt also has challenges finding qualified staff.
“No university in Egypt teaches autism,“ said Dahlia Soliman, the founder and president of the organization. “Cairo Medical School only has one paragraph on autism in the book they use.“
Soliman also mentioned another challenge: “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.“
This lack of support can make treatment very hard for most families, as treatment for even one child can easily cost $15,000-52,000 USD for just 10 months of therapy. Most families cannot afford those sums, leaving them to pursue other options or forego therapy altogether.
The need for more support has also been recognized in Saudi Arabia:
“Amr Mostafa, a psychiatrist at the King Faisal University, Saudi Arabia, argues that governments in the Arab world need to do more to support autistic children and their parents. They should provide the qualified teachers needed and help parents, especially since the financial burden of raising an autistic child can be very high.” -Mohammed Yahia
Every year World Autism Month events throughout the Middle East help to raise awareness and Baker receives a surge in phone calls and emails in the following months. 15 years ago almost no one knew what autism was in the region.
“We’re on the right path – now, we just need to move to a faster track.”- Baker said.
Learn More About Certified Autism Specialist or Advanced Certified Autism Specialist Certifications