Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder with a growing worldwide health concern. The global prevalence is estimated to be as high as 1:100.(1) Very few studies have assessed the prevalence of ASD in South Africa. A study published in 2020 from a population of over a million children attending schools in the Western Cape found an overall prevalence of 0.08%, with a male-to-female ratio of 5.5:1.(2) They also found a 76% increase in autism spectrum disorder in schools between 2012 and 2016, with an average increase of 15.18% per year. However, the prevalence compared to world data was low, and the study authors suggested that this was due to an un-der-representation of autism spectrum disorder in schools in South Africa. Many workers in the field acknowledge that the prevalence in South Africa is most likely similar to that of developed countries.
Autism Spectrum Disorder predominantly impacts social behaviour and communication with wide-ranging func-tionality ranging from low functioning to high functioning. Currently, there is no recognized cause of autism, but based on current scientific evidence, certain genetic and environmental factors play a role. Many years ago, there was wide-spread concern amongst parents that vaccination, especially for measles, mumps and rubella, was causative for chil-dren developing ASD. A vast body of research using various methodologies conducted over many years shows that vac-cination for measles, mumps, and rubella does not cause autism.
While there is no cure for autism spectrum disorder, intensive, early treatment can make a substantial difference in the lives of many children. It has been shown that early evidence-based psychosocial interventions can improve the ability of autistic children to communicate effectively and interact socially. However, one of the challenges regarding ASD is the difficulty in diagnosing the condition in early childhood. A specific identifiable ASD heritable gene has not been identi-fied, and there is no medical blood test or marker to diagnose the condition. According to the Diagnostic and Statistical Manual of Mental Disorders 5, the diagnosis of ASD requires persistent deficits in areas of social communication and social interaction together with at least two elements of restricted and repetitive behaviours. However, there may be other biomarkers that could be helpful when ASD is suspected.(3)
In this journal issue, van der Net and co-authors present their data in assessing head circumference, a biological bi-omarker, in children with ASD. Brain enlargement is regarded as an ASD biomarker and one which can easily be as-sessed by neuroimaging. Head circumference measurement could be used as a proxy for brain enlargement. The authors demonstrate that measuring head circumference in individuals suspected of having ASD could be a highly cost-effective and non-invasive assessment tool to assist in earlier diagnosis, prompting early intervention therapy. Although this appears to be a small step in the early recognition of ASD, every small step advances our knowledge in the management of this complex and now increasingly frequent neurodevelopmental disorder.
Pravin Manga
Editor
Wits Journal of Clinical Medicine