Improving Treatment of Children with Autism Spectrum Disorder in Low- and Middle-Income Countries: The Role of Non-specialist Care Providers

Developmental disabilities including autism spectrum disorder (ASD) and intellectual disability (ID) have been ranked among the leading mental health-related causes of the global burden of disease with lifelong effects on children under the age of 10 years [1]. With under-five child mortality declining in resource-poor countries [1], an increasing number of children will live on to experience an increasing burden of neurodevelopmental disorders (NDDs) while the family shares a huge burden of care-giving [2]. Diagnosis of ASD in children is reported to co-exist with other conditions such as intellectual disabilities, epilepsy, tuberous sclerosis, attention deficit hyperactivity disorder (ADHD), and emotional disorders [3]. Many of these children show deterioration in social skills, declines in cognitive functioning, delays in language skills, and poor motor skills. In a systematic review published this week in PLOS Medicine, Brian Reichow and colleagues examine the benefits and adaptability of psychosocial intervention delivered by non-specialist care providers to the management of children with intellectual disability and ASD [4]. These findings are particularly important in lowand middle-income countries (LMICs) because of the serious shortage of specialists to deliver appropriate intervention services in the population of affected children living in these countries [5–7]. While pharmacological treatments, simpler to implement than behavioural interventions, are used for treating challenging maladaptive behavioural problems such as aggression and self-injurious behaviour, as well as co-existing psychiatric or medical conditions, medications do not correct core features of ASD [8]. The primary treatment option in ASD is individualized psychosocial interventions that encompass educational, socialization, behavioural, communication, play leisure and adaptive skill trainings targeted at core areas of autistic impairments [9]. According to the evidence identified by Reichow and colleagues, behavioural analytic techniques delivered by nonspecialist providers in community settings, including family members, are effective in addressing these impairments. Interventions provided by nonspecialist care providers could help alleviate the scarcity of specialist care by task shifting [10,11], and potentially also help reduce the risk of burn-out among existing specialists [12,13].