The Use of Psychotropic Medication in Iranian Children with Developmental Disabilities.

The use of psychotropic medication in children is increasing worldwide. Children with developmental disabilities seem to be prescribed these medications at a higher rate compared to their non-disabled peers. Little is known about prescribing in non-Western, middle-income studies. In Iran, the file records of 1133 children, aged 2 to 17 years, assessed as having autism spectrum disorder (ASD) or an intellectual disability (ID) in Tehran City and Province from 2005 to 2019 were collated, and information from parental reports of medications was extracted. Upwards of 80% of children with ASD and 56% of those with ID were prescribed a psychotropic medication with around one quarter in each group taking two or more medications. The rates were higher among male children showing difficult-to-manage behaviors such as hyperactivity, but less so for children of fathers with higher levels of education. The lack of alternative management strategies may be a significant driver for the use of psychotropic medications in Iran and other Low and Middle Income countries, despite their known side effects, and their failure to address the developmental needs of the children. Rather, multi-disciplinary, behavioral, therapeutic, and educational interventions are required, but these are not available widely in Iran, although a start has been made.

Identifying children with autism spectrum disorders in Iran using the Autism Diagnostic Interview-Revised.

LAY ABSTRACT: The diagnosis of autism spectrum disorder is a challenging task. Most of the current assessment scales have been developed in the West. The present study examines the applicability of one of the most used scales (the Autism Diagnostic Interview-Revised) in a Middle-Eastern culture. Two studies were undertaken. In the first, the Autism Diagnostic Interview-Revised ratings given to 420 children with autism spectrum disorder, aged 4-11 years, and 110 typically developing children were contrasted. In Study 2, the Autism Diagnostic Interview-Revised ratings of 720 children with autism spectrum disorder were compared with those of 172 children with intellectual disabilities to find out whether the Autism Diagnostic Interview-Revised scale would discriminate between these two types of developmental disabilities. The studies confirmed the acceptability of the scale to Iranian parents and assessors. However, the summary scores used to determine whether a child was likely to have autism spectrum disorder were recalculated on the two domains of social communication and repetitive behaviours, which were identified in the statistical analyses that are recommended for the evaluation of assessment scales. Thus the translated scale with the modified domain scoring proved very suitable for identifying Iranian children with autism spectrum disorder. Having a common tool such as Autism Diagnostic Interview-Revised will strengthen the opportunities to undertake cross-cultural research into the impact of autism spectrum disorder on the child and families.

The Cognitive Profile of People with High-Functioning Autism Spectrum Disorders.

Several studies have examined the cognitive profile of people with high-functioning autism spectrum disorders (ASD) (IQ > 70), and its relationship with the symptoms of ASD and attention deficit hyperactivity disorder (ADHD), using the Wechsler Intelligence Scale for Children-IV (WISC-IV). However, no data exist on the similarities or differences in this profile in less affluent countries. The present study examined the cognitive profile and its relationship with the symptoms of ASD and ADHD in 30 subjects aged 6⁻16 years with high-functioning ASD and compared the results with those of 30 typically developing (TD) subjects. In line with previous research findings, the WISC-IV cognitive profile analysis of subjects with high-functioning ASD showed a good competence in Matrix Reasoning and weaknesses in Comprehension, but the main distinguishing point was the competence in processing speed in both groups. In the present study, the Verbal Comprehension Index correlated negatively with the communication symptoms, and the Working Memory Index correlated positively with the social symptoms in the ASD group. Given the similarities that exist between the results of the present research and previous studies, it may be concluded that there are similarities in the cognitive profile of individuals with ASD.

A national study of the prevalence of autism among five-year-old children in Iran.

In Iran, more than 1.3 million five-year olds have been screened for autism over three academic years, with the Social Communication Questionnaire (SCQ). The Autism Diagnostic Interview-Revised (ADI-R) is used to confirm a diagnosis of typical autism. The resulting prevalence of 6.26 per 10,000 for typical autism is in line with rates for certain countries but is lower than those reported recently for some Western nations. This may be due to the younger age range assessed but the suitability of the tools and aspects of Iranian culture could be other reasons for the lower prevalence. International comparisons of prevalence rates is fraught with difficulties, but it is a valuable endeavour as it can identify issues around cultural and societal perceptions of children's development.