Ignoring the Odds: The RISE in Autistic Spectrum Disorder in Libyan Children and EARLY TV Viewing "Libyan Vision"

Background:  There is a strong belief among most Libyan’s newly married couples that early TV viewing can be responsible for Autism in children. Anecdotal and clinical reports indicate that early use of television can be a clinically significant problem to the extent that it may lead to impairment of communication and socialization. However, this phenomenon has not been examined thoroughly in Arabic population.

It's estimated that approximately 7 out of every 1000 Libyan children has an autism spectrum disorder, according to Zeglam and etal’s study. Children with autism seem to be particularly drawn to certain channels and programs on satellite TV.

Objectives: to examine the prevalence of ADS in Tripoli, Libya and correlates of early TV viewing among a large nationally representative sample of children with ASD.

Methods:  

This was a large hospital-based study. The study's two-stage sampling involved first studying the prevalence of ASD; and then All the families of children with ASD attended between Jan.2015 and Jun.2015 (267 children) weighted to be nationally representative of children with ASD were asked two specific questions related to TV watching. All children enrolled in this category did met full DSM-V criteria for an ASD. We compared these children with those who are normal and attends mainstream nurseries.

We examined two dependent measures of TV use. A measure of duration of exposure and a measure of age exposure. Children were identified as having an ASD through screening of all children referred to the Neurodevelopment Clinic of Al-Khadra Teaching Hospital (NDC-KH), Tripoli, Libya between June 2011 and June 2015 with the diagnosis of speech and language disorders or behavioral difficulties. Children were reviewed, scored and classified by a clinician (AZ) as having ASD if they displayed behavioral abnormalities consistent with DSM-IV & V for diagnosing ASD. 

Results: Total number of children seen in all Pediatric clinics were 321251.Children diagnosed with ASD were 2170 which gives the prevalence of 7:1000.

Using Mann-Whitney test we found that 15% of infants and toddlers watched TV on an average of 2 - 4 hours a day while 46% watched TV for more than four hours (p-value < 0.001). 34% & 33% of infants and toddlers were put in front TV in the first six months and between six and 12 months of age respectively. Only 10% of children watched TV after first 12 months of age (p-value< 0.001).

Infants under age of 12 months watched an average of about 4 hours of TV a day.

Conclusions: Consistent with our expectations, we found a very high rate of use of TV among children with ASD. Our findings conclusively demonstrate that early exposure to TV can account for the rise in prevalence of ASD in Libya over the last five years. The current study is the first to examine the prevalence and correlates of TV use among a large nationally representative sample of children with ASD in Libya and probably in Africa. Our study has provided support that early TV viewing might be associated with autism.