Socioeconomic characteristics of autistic children: a comparative study

International Journal of Community Medicine and Public Health Hamid Z et al. Int J Community Med Public Health. 2020 Aug;7(8):2914-2920 http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040

DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20203363

Original Research Article

Socioeconomic characteristics of autistic children: a comparative study

Zoshita Hamid, Sarmin Sultana, Saika Nizam, Rabeya Yasmin, M. H. Faruquee,

Sk Akhtar Ahmad*

Department of Occupational and Environmental Health, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh Received: 08 May 2020 Revised: 12 June 2020 Accepted: 16 June 2020 *Correspondence: Dr. Sk Akhtar Ahmad, E-mail: anon@bdcom.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT Background: Prevalence of autism is increasing and growing as an important public health problem. Prevention of autism is still a complicated issue. Thus, the management and rehabilitation of autistic children socially could be the main option. For which the role of socio-economic factors of the autistic children needs to be considered. Methods: This was a cross-sectional comparative study conducted among the autistic and non-autistic children to compare their socioeconomic characteristics. A total of 90 autistic children from two specialized schools and age- matched 180 non-autistic children from nearby schools were included in this study. Results: Overall the mean age of the children was 8.01±2.974 years. More than fourth-fifths (84.4%) of the autistic children were male. In comparison to non-autistic children, significantly (p<0.05) autistic children had small family size (4.79) and higher family income (Taka=34588). Higher education of both father and mother was also found to be significantly associated with autistic children. However, logistic regression analysis revealed that post-graduate education of the father had the strongest (6.4 times) ability to predict the occurrence of autism. The mean age of the mother at birth of autistic children was significantly higher (31.16 years) and logistic regression analysis revealed that higher age of the mother at birth had 1.3 times ability to predict the occurrence of autism. Moreover, the analysis revealed that mothers who were housewife 2.3 times more likely to predict the occurrence of autism. Conclusions: The study revealed that some socio-economic factors were significantly related to autistic children compared to those of non-autistic children. Keywords: Autism, Autistic, ASD, Birth order, Higher education, Housewife, Socioeconomic

INTRODUCTION

Autism was first described as a severe case of schizophrenia by a German psychiatrist Eugen Bleuler in 1911. He defined Autism as the subject’s symbolic inner life which was not easily accessible by observers. Later Autism was completely transformed and used to describe the child development and defined as a lifelong, complex non-progressive neurological and developmental disorder typically appears during early childhood, usually before three years of age.1,2 The word autism indicates a

developmental disability, significantly affecting verbal and non-verbal communication and social interaction which can affect a person’s social skills, communication, relationships, and self-regulation. Autism is a spectrum disorder; it includes a certain set of behaviors, affects people differently and to varying degrees. Autism spectrum disorder (ASD) is a diverse neurodevelopmental condition characterized by repetitive or stereo behaviors and impairments in social behavior, communication, and interactions. Intellectual functioning in ASDs person is extremely variable and may have other co-morbid

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conditions, including epilepsy, anxiety, depression, and attention disorder.2-5

Studies suggested various factors including environmental and genetic factors that may cause a child to develop autism.4-6 The role of genetic factor has been mentioned as one of the important risk factors that likely to develop ASD. Consanguineous marriage and heredity are regarded as the common factor for the development of Autism among the offspring.6-8 Studies on environmental factors reported some environmental toxicant to have a link in the development of ASD. Some of these toxicants are pesticides, phthalates, PCBs, solvents, toxic substances in waste, air pollutants, and heavy metals. Drugs like valproic acid and thalidomide if taken during pregnancy also reported causing a higher risk of developing ASD.7-9

It has been reported that globally one in 160 children has an ASD and the estimated median prevalence of ASD was 62/10,000.5,10 According to CDC’s estimation ASD has been identified about 1 in 54 children and is more than 4 times common among the boys than that of the girls. In Asia, Europe, and North America the average prevalence of ASD has been identified between 1% and 2% of the individuals, while in India the prevalence was 10/10,000 (0.15%) and was higher among the children in rural areas.6,11,12 In Bangladesh, about 17 per 10,000 children (0.17%) are reported to be autistic and a total of 18 lakh children has been identified as autistic. The prevalence of Autism was found to be higher among the boys than girls and more common in urban areas of Bangladesh.13

The occurrence of autism among the children is increasing worldwide, despite the race, ethnicity or socioeconomic status. The prevalence of autism in Bangladesh is though low compared to other countries but having an increased tendency of occurrence and becoming an important public health issue. Understanding of Autism in the community is a more socioeconomical problem than a medical problem. The community has a negative attitude towards autism and consider as a financial burden of the family and a social barrier; regarded as mental illness (Pagla) and believe as God-given curse. People do not want to spend much on the rehabilitation of autistic children.6,13,14 If autism is not addressed properly considering the sociocultural context, it will create a more social and economic burden in the community and in the country as well. To protect and to promote the management and rehabilitation of autistic children the socioeconomic factors should be given priority rather than addressing the causative factors. This study was an attempt to find out the socioeconomic characteristics of autistic children which can be utilized to undertake accessible and affordable management and rehabilitation measures for the autistic children.

METHODS

This was a cross-sectional comparative study conducted among the autistic and non-autistic children. The autistic children from two specialized schools (school for autistic children) located in Gulshan and Mirpur, Dhaka and non- autistic children from nearby schools (excluding English medium school) were included in the study. The non- autistic children were included as a comparative group. For each autistic child, two age-matched (±1 year) non- autistic children were selected. Ultimately a total of 90 autistic children and 180 non-autistic children were selected for this study. Either father or mother who was present during the data collection period was interviewed face to face by using a pretested questionnaire. Permission from the school authority was also sought to include their student in the study and to collect some related information from the school records. Data were collected from February to April 2019.

Inclusion criteria

Parents of the children aged >3 years and <15 years and who gave the consent to participate in the study were included in the study.

Exclusion criteria

Parents who were not available in the schools during the data collection period after repeated request and whose children were not co-operative were excluded from the study.

Statistical analysis

Statistical analysis of the collected data was done using the Statistical Package for Social Science (SPSS). Descriptive analysis of the variables was presented in frequency, percent and mean±standard deviation. For inferential statistics, Chi-square was done for univariate analysis between two categorical variables and t-test was done for computing differences between continuous and categorical variables. Finally, binary logistic regression was performed to test the association between autistic and non-autistic and socio-economic factors. Variables which were found significant in univariate test were included in the logistic regression.

A p value of less than 0.05 was considered as statistical significance ethical clearance of this study was taken from the Institutional Review Board (IRB) of the Bangladesh University of Health Sciences (BUHS), Dhaka. Parents of the participating students were assured that the information provided by them would not be disclosed. The parents were also encouraged to provide the truthful information and were informed that they have the autonomy to withdraw from the study at any time and their participation was voluntary. Necessary permission was also taken from the respective school authority.

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RESULTS

Of the total 270 students, 90 students were autistic and the remaining 180 were non-autistic children for comparison. Overall, the mean age of the students was 8.01±2.974 years and there was no significant difference in the mean age of autistic (8.37±2.951 years) and non- autistic children (7.83±2.978 years). More than half (53.3%) of the students were in the age group 6 to 10 years. Almost two-thirds (65.2%) of the participant students were male, and among the autistic children, male children were significantly (χ2=22.068; p=0.000) higher (84.4%). The mean family size of the autistic children (4.79±1.913) was significantly (t=-3.722; p=0.000) less than that of non-autistic children (5.49±2.284) and a higher proportion of the family size (55.6%) of autistic children was up to four (Table 1).

The mean age of the mother and father of the participant students was 37.69±5.676 years and 43.91±5.092 years respectively. Among the autistic children, the mean age of their mother (39.52±4.972 years) was significantly (t=3.842; p=0.000) higher than that of non-autistic children (37.69±5.676) but there was no significant difference in the mean age of their father. Regarding the educational status of the parents, it was found that a higher proportion of the father and mother of autistic children had postgraduate and graduate education (54.4% and 50.0% respectively). On the other hand, a higher proportion of father and mother of non-autistic children had a graduate level of education (51.1% and 55.2% respectively). The difference in the educational background of the parents of autistic and non-autistic children was statistically significant (χ2=37.099; p=0.000 and χ2=22.104; p=0.008 respectively) (Table 2).

Table 1: Distribution of studied children by age, sex and family size.

Table 2: Distribution of parents by their age and education.

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Table 3: Distribution of the parents by their occupation and income.

Table 4: Distribution of studied child by birth order and siblings.

Table 5: Distribution of parents’ demographic characteristics before the birth of studied children.

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The occupation (Table 3) of a higher proportion of the father of both autistic (50.0%) and non-autistic children (68.9%) was service followed by business (19.4%) among non-autistic children and professional occupation (26.7%) among autistic children. The professional occupation was the engineer, advocate and physician. The difference in the occupation of the father of autistic (50.0%) and non- autistic children were significantly different (χ2=11.958; p=0.003). On the other hand, majority of the mother of both autistic (72.2%) and non-autistic (90.6%) children were housewife. However, the working mother was significantly (χ2=15.352; p=0.000) higher among the autistic children (27.8%) than that of non-autistic children (9.4%). The autistic children significantly (χ2=36.308; p=0.000) had a higher range of monthly family income (Taka 31000/- and above) than that of non-autistic children. However, the mean monthly income of the family of autistic children was Taka=34588±14367 and that of non-autistic children was Taka=27333±17195, and the difference was statistically highly significant (t=3.446; p=0.001) (Table 3). Table 4 shows the distribution of studied children by birth order and siblings. According to birth order, the majority of the autistic children (52.2%) and non-autistic children (75.6) were in the first position and the difference was statistically significant (χ2=14.958; p=0.000). Almost two-thirds (63.8%) of the studied children had one sibling and comparatively one sibling was significantly (χ2=6.910; p=.032) more frequent in non-autistic children (66.1%).

Table 5 shows that distribution of parents’ demographic characteristics before the birth of studied children. The

mean age of the father (36.36±4.931years) of the autistic children before their birth was found higher than those of non-autistic children but significantly not different. However, the mean age of mother (31.16±4.813 years) of autistic children was found significantly (t=3.003; p=.003) higher compared to that of non-autistic children (28.94±6.038). Further, it was found that only 7.8% of the mother of autistic children was below 25 years of age and remaining were more than 25 years. Regarding the occupation of the parents, it was found that almost all the father continuing the same occupation which was before the birth of studied children. However overall, 21.4% of the mothers were working mother and among the mother of autistic children more than three-fourths (35.6%) were working mother.

Among the mother of non-autistic children, most (86.1%) of them were housewife. The difference in mother’s job between autistic and non-autistic children was statistically significant (χ2=10.539; p=0.001). The duration of the job of both father and mother of autistic and non-autistic children before their birth had no significant difference. Logistic regression analysis (Table 6) was performed to predict the likelihood of occurrence of autism, the influence of family income, family size, educational status, age and occupation of father and mother before the birth of studied children, and the birth order were analyzed (Table 6). The combined effects of these predictors could significantly (χ2=81.404; p=0.000) able to explain the development of autism. The analysis revealed that independently the father of the studied children who had post-graduate education, significantly (p=0.024) 6.4 times more likely to develop autism.

Table 6: Logistic regression predicting likelihood of development of autism.

χ2=81.404; p=0.000.

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However, the education of the mother was a non- significant predictor. But the age of the mother before the childbirth was a positive and significant (p=0.002) predictor and indicating that every one-year increase in mother age the likelihood of developing autism increased by 1.3 times. On the other hand, that the age of the father was a negative and significant (p=0.003) predictor and indicating that every one-year increase of father age the probability of developing autism increased by 0.79 times, inversely the probability of development of autism decreased by 1.25 times. Further, the analysis revealed that the housewife mother was a significant (p=0.04) predictor of autism and 2.3 times more likely to developing autism than, working mother. On the other hand, it was found that the occupation of the father was a non-significant predictor for autism. The first birth order of the studied children was found to be a significant (p=0.000) predictor and had 3.4 times more ability to predict the likelihood of occurrence of autism. Regarding the family size, the analysis revealed that more the family size (6 and above) significantly (p=0.004) 0.33 times less the ability to predict the likelihood of developing autism than the lesser family size.

DISCUSSION

Since the 1960s the concept of autism has been transformed from the psychological aspect to neurodevelopmental disorders. Last few decades various researches have been done on autism to find out its etiological factors, determinants, recognition features, social and cultural understanding and issues; and the role of environmental and genetic factors, as a result, significant advances have been developed in the comprehensive care including the early diagnosis of autism. However, the prevalence of autism is increasing, the families and the community facing the big challenges and implies as a social and financial burden, despite the intensive activities on awareness and social responses done in the recent past. On the other hand, the exact etiology of the autism is still not clear, the genetic and environmental factors in the causation remain to be understood completely.1,4-7,15 Thus, for early and effective interventions for the management of autism at family as well as at the community level, in this study the non- genetic risk factors particularly the socioeconomic factors have been assessed.

Several epidemiological studies have been conducted in Bangladesh and elsewhere to find out the potential socioeconomic risk factors for autism.6,12-16 In the current study also a number of socioeconomic factors were found to be significantly associated with the occurrence of autism while comparing those factors with non-autistic children. Most of the autistic children of the studied specialized schools participated in this study and it was found that more than fourth-fifths of them were male. In different studies also autism was more frequently found among male compared to female but the difference was small.6,10,14-16 In this study, the difference in the

proportion of male and female was large, which was also found in another study, might indicate a gender disparity to bring the female autistic children to the specialized school.17

Logistic regression analysis revealed that among the socioeconomic predictors, the father having a post- graduate level of education independently had the strongest (6.4 times) ability to predict the likelihood of developing autism. Though the mother with higher education was not a significant predictor but was found to be significantly associated with the autistic children. Studies elsewhere also revealed that autism was more common among the children whose parents had higher education.6,13,17 However, in a study it was found that mothers of autistic children were less educated than that of the father.18 In the current study, most of the mothers were found to be a housewife and the analysis revealed that independently housewife had a strong (2.3 times) ability to predict the occurrence of autism than the mothers who were working mothers. This study further revealed that more than one-fourth of the father of autistic children had professional occupation which includes engineering, physician and advocates and similarly more than one-fourth of the mothers were working mother. Studies conducted elsewhere in relation to the occupation of the parents of autistic children revealed that the autistic children were more frequent among the parents who had technical jobs like engineering, physician and accounts.19-

21 Nonetheless, in a study, it was also reported that one- third of the mothers of autistic children were homemaker.19 Regarding the age of the mothers at birth, this study found that the birth of autistic children was significantly more frequent with the higher age of the mother. The logistic regression analysis revealed that mother with higher age had 1.3 times more ability to predict the occurrence of autism than that of the mother who had a lower age at birth. In the studies, it was also reported that higher the age of mother, more the chance of occurrence of autism.6,7,13 On the other hand, the current study revealed that the father with an increased age had less ability to predict the development of autism, which requires further investigation. Regarding the birth order of the children, the current study revealed that the autism was significantly more frequent in the first birth order and among one sibling. The logistic analysis revealed that the first birth order had a strong (3.4 times) ability than that of second birth order to predict the likelihood of developing autism. In the studies, also the autistic children were reported to be more common in the first birth order but the role of birth order in developing autism yet to be clearly understood.6,22-24

Limitations

The sample size was not calculated because of the small number of autistic children in the schools. Thus, on the basis of criteria, the convenient sampling method was used to include the parents of both autistic and non- autistic children. Occupations of the parents were diverse

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and some small in number for which the occupations were combined to make that valid for statistical analysis. The parents particularly the mother had a tendency to conceal their age. However, that was overcome to some extent by cross-checking the mothers.

CONCLUSION

The study revealed that parents with higher educational background, higher monthly income, small family size, housewife and higher age of mother at birth independently had strong likelihood in developing autistic children in comparison to those of non-autistic children. Moreover, it was found that autistic children were more frequent with first birth order and one sibling.

Funding: No funding sources Conflict of interest: None declared Ethical approval: The study was approved by the Institutional Ethics Committee