Relationship Between the Quality of the Home Environment and Developmental Status of Children with Autistic Disorder in Jamaica

Relationship between the quality of the home environment and developmental status of children with Autistic Disorder in Jamaica

Background: At least two-thirds of children diagnosed with autistic disorder are known to have cognitive impairment, with some having severe and global developmental delay.  Intensive behavioural intervention and structured early intervention are known to impact developmental and behavioural outcomes positively.  In resource-limited countries, where such interventions may not be widely available and/or accessible, children with autism may be totally dependent on their home environment for stimulation.

Objectives: The aim of this study was to determine whether the quality of the home environment has an impact on the developmental status of children with autism. 

Methods: The Jamaica Autism Database (JAD) contains 500 children diagnosed at Jamaica’s main referral centre for autism, the University Hospital of the West Indies (UHWI), since 1999.  Ninety Eight (98) children under the age of 6 years, who were diagnosed with autistic disorder, using DSM IV criteria and a standardised tool, the Childhood Autism Rating Scale (CARS), since 2002, were included in this study.   We evaluated the impact of socioeconomic status (as measured by ten durable goods in the home), maternal age, maternal education and children’s demographic factors (age at diagnosis, gender) on children’s development.  Developmental Quotients (DQs) were assessed at the time of diagnosis by a single examiner, using four sub-scales of the Griffiths Mental Development Scales: Personal-Social (PS), Hearing and Speech (HS), Eye Hand Co-ordination (EHC) and Performance or Non-Verbal Reasoning (PE).  Data were analysed using descriptive statistics and Linear Regression Modelling.

Results: There were 83 males (84%), the mean age of the population was 4.7 years (SD 1.8).  Fifty-six (56%) of the mothers had secondary education or less; forty-four (44%) had tertiary education. The mean number of household possessions was 7.7(SD 1.6). Mean DQs for PS (55.5, SD 19.7), HS (42.6, SD 17.0), EHC (56.6, SD 18.8), PE (59.6, SD 22.3) were well below test norms of 80-100.  In the regression model, maternal education was positively associated with HS (B=-9.43, p=0.006), PS (B=-8.25, p=0.042) and PE (B=10.93, p=0.02). The number of durable goods was positively associated with HS only (B=2.44. p=0.034). No other factors were significant.

Conclusions: In resource-limited countries, the developmental status of children with autism is associated with the quality of the home environment, as measured by maternal education, and to a lesser extent, the physical resources in the home.  This is also true of typically developing children.  Though changes in maternal education, as measured by educational attainment, are not easily effected, improving the quality of the home environment by providing early intervention training and support to parents may improve the developmental status of children with autism, particularly those of low socio-economic status.