The Development and Impementation of ASD Diagnostic Procedures in Nigeria

Background: The field is only beginning to understand how to identify ASD in non-Western populations. Simply translating instruments is not sufficient (Hableton, 1996); rather, they must be adapted to ensure construct equivalence, or the degree to which the measured construct has equivalent meaning across cultures. Construct, method and item biases are all important to consider in the adaptation of measures (Van de Vijver, F., & Tanzer, N. K., 1998).

Objectives: The project objective was to better understand the local norms in Lagos, Nigeria, in order to help the team at The Learning Place Centre (TLPC) develop an ASD diagnostic procedure. The acceptability and utility of the diagnostic procedure was qualitatively evaluated

Methods: TLP Centre in Lagos, Nigeria is an urban school and community-based autism center. They sought out AACTION Autism for assistance in developing a multidisciplinary diagnostic clinic. In the first phase of procedure development, we gathered qualitative information about the families who use the TLP Centre This occurred in conjunction with the Nigerian’s team visiting Chicago. A culturally appropriate instrument (the Nigerian Autism Play Assessment- NAPA) was developed for use along with structured developmental interviews and medical history. The Nigerian team participated in general ASD training, as well as diagnostic evaluation overview. In the second phase, the team tested out the NAPA with 60 children ages 3-10 suspected of having ASD. The NAPA was refined based on feedback from TLP Centre staff.

The collected clinical information will be compared against DSM-5 and ICD-10 diagnostic criteria, and the team will arrive at diagnosis for each case. Reliability coders in the US, experienced ASD clinicians, will review the clinical reports (minus diagnosis) which includes data from medical and developmental histories, as well as the NAPA, and independently make the DSM-5 and ICD-10 diagnoses. 

Results: We will present the results of the acceptability and fidelity of implementation from the field test. It is anticipated that an approach comparing information obtained via developmental history, the NAPA, and medical history with DSM-5 and ICD-10 diagnostic criteria will be useful and acceptable to the team. The inter-rater reliability between the TLP Centre raters and USA-based clinicians will be reported. The key aspects of the Nigerian culture that related to diagnostic process will be discussed. 

Conclusions: Outcomes of the investigation will inform practices at the TLP Centre and throughout Africa, as the center actively participates in the Autism Society of West Africa meetings.

Hambleton, R. K. (1996). Guidelines for Adapting Educational and Psychological Tests. Retrieved from ERIC database.

Van de Vijver, F., & Tanzer, N. K. (1998). Bias and equivalence in cross-cultural assessment. European review of applied psychology, 47(4), 263-279.