Open Access Austin Journal of Autism & Related Disabilities Research Article Autism Treatments used by Parents in Abu Dhabi, United Arab Emirates Kelly MP*, Tennant L and Al-Hassan S Emirates College for Advanced Education, United Arab Abstract Emirates Although autism is on the rise, there is a paucity in the literature examining *Corresponding author: Michelle P Kelly, Counseling, the treatment of autism in the United Arab Emirates in the Middle East. This Health and Special Education Division, Emirates College research analyzed treatment choices for children with autism by parents living for Advanced Education, P.O. Box 126662, Abu Dhabi, in Abu Dhabi. Respondents (n=119) completed a bilingual survey listing 128 United Arab Emirates different autism treatments and indicated if they had never used, used in the past, or were currently using each treatment. The most commonly used Received: May 31, 2016; Accepted: June 26, 2016; treatment was speech and language therapy, following by technology-based Published: June 27, 2016 treatment and applied behavior analysis. On average, respondents were currently using 7.06 treatments, with one parent reporting the current use of 28. The implications of these findings for future research in the Middle East were discussed. Keywords: Autism; Treatment; Evidence-based; Intervention; Parents; United Arab Emirates Introduction Ain region, and 0.3 million in the Western region). The UAE national population made up 20.19% of the total population. In 2012, the Autism is a developmental disability that is manifested during prevalence rate for autism was estimated to be 1 in 80 Emirati males the first three years of a child’s life and persists throughout the and 1 in 240 Emirati females, in the Emirate of Abu Dhabi including lifespan [1]. Autism is on the rise with an “incredible” increase in the Al Ain region [11]. prevalence rate [2]. According to the Center for Disease Control and Prevention [3], approximately 1 in every 68 children (1 in 42 boys) The increasing awareness of autism has led to parents seeking has been diagnosed with autism. Hahler and Elsabbagh reported that treatments, interventions, and therapies for their children with globally, there are over 52 million individuals with autism, which autism. However, as the number of children diagnosed with autism indicates about 1-2% of children worldwide [4]. Unfortunately, there continues to rise steeply, so too does the number of treatment options, is limited research literature that targets the population of autism in including culture-specific interventions such as Epsom salt baths and Arab countries [5]. This is particularly the case with studies related to hijama [5]. According to the National Standards Report [12], families treatment outcomes and service delivery within the region [6]. Few and professionals are often in a situation where they have to choose researchers have explored the prevalence of autism in the Middle from a huge number of treatments. The information provided about East and specifically in the United Arab Emirates [5,7,8]. The UAE is these treatment options may be confusing and not fully supported by bordered by the Arabian Gulf and the Gulf of Oman, and is located research, which makes the treatment selection a complicated process. between the Sultanate of Oman and the Kingdom of Saudi Arabia. The National Autism Center [13] recently published a report The UAE is comprised of seven emirates: Abu Dhabi, Dubai, Sharjah, that addresses the need for evidence-based practice guidelines for Ajman, Umm Al Quwain, Ras Al Khaimah and Fujairah and has a autism and reports the findings and conclusions from the National total population of about 8.19 million, of which 16.5 % are nationals Standards Project. The primary goal of this NAC project was to [7]. provide critical information about which interventions have been Eapen, Mabrouk, Zoubeidi, and Yunis conducted a prevalence shown to be effective for individuals with autism. A review of 389 study with a representative random sample of 694 three-year-old studies published in peer- reviewed journals between 2007 and 2012 children in the UAE [9]. In the first stage of the study, a questionnaire was conducted to evaluate educational and behavioral intervention identified 58 per 10,000 children to have signs of autism. In the second literature for individuals with autism below and above the age of 22 stage, a clinical interview was used and the weighted prevalence was years. approximately 29 per 10,000 children with a diagnosis of pervasive The autism interventions were classified as established, emerging, developmental disorder. There are many centers for individuals or unestablished [13]. It was revealed that for individuals under the with special needs in the UAE, including eleven that implement age of 22 years there were: 14 established interventions (e.g., pivotal intervention based on the principles of Applied Behavior Analysis response training); 18 emerging interventions (e.g., music therapy); (ABA) [5]. and 13 unestablished interventions (e.g., gluten-free, casein-free Abu Dhabi is the federal capital of the UAE and is the largest diet). Behavioral intervention was the largest category of established of the seven emirates [10]. The population was estimated to be 2.45 interventions in this group. For individuals aged 22 years and above, million in 2013 (1.5 million in Abu Dhabi region, 0.65 million in Al only one established intervention (behavioral intervention) and one Austin J Autism & Relat Disabil - Volume 2 Issue 3 - 2016 Citation: Kelly MP, Tennant L and Al-Hassan S. Autism Treatments used by Parents in Abu Dhabi, United Arab Submit your Manuscript | www.austinpublishinggroup.com Emirates. Austin J Autism & Relat Disabil. 2016; 2(3): 1024. Kelly et al. © All rights are reserved Kelly MP Austin Publishing Group emerging intervention (vocational training package) were found with from the corresponding author of the original study [16]. Permission four unestablished interventions outlined (e.g., sensory integration was granted from this author to employ their survey for the current package). replication. Two versions of the survey were created with the same content in each. The hard copy of the survey was 13 pages long. It was Studies have investigated the types and number of treatments printed in color, and used both sides of each page. The online version including medications, therapies, and other holistic approaches used was created using eSurveysPro [17] online survey software. by parents [14]. Parents priorities are to seek for possible treatments rather than look for scientific studies or treatment efficacy. Meeting Survey development and editing the needs of children with autism imposes a huge emotional and The original survey was translated by the third author into financial burden on families [13]. Mackintosh, Goin-Kochel & standard Arabic. Many of the terms could not be translated into Meyers [15] found that parents experienced stress and frustration in Arabic and were provided in English only. The majority of these terms accessing services, and working with professionals. It becomes even were in the section listing biological treatments. Once the original more demanding for parents, especially in contexts where access to survey was translated into a bilingual document (with the English and services and support are inadequate. Therefore, it becomes imperative Arabic beside each other), it was distributed to five autism specialists to survey the kinds of treatments that parents have used for children from around the Cooperation Council for the Arab States of the Gulf with autism. (two of the specialists resided in the Kingdom of Saudi Arabia and Green, Pituch, Itchon, Choi, O’Reilly and Sigafoos [16] developed three of the specialists resided in the UAE). One of the specialists was an internet survey to identify which of the 111 listed treatments was bilingual and also checked the Arabic translations. The suggestions used by parents of children with autism with the majority of the and feedback from the specialists were incorporated into the survey. respondents (80%) living in the United States of America (USA). The current survey contained an extra section on assistive technology The treatments were grouped under several categories including: and additional options (e.g., occupational therapy, hijama), which (a) medications (e.g., antidepressants), (b) vitamin supplements, were absent from the original survey. (c) special diets, (d) medical procedures, (e) educational/therapy approaches (e.g., applied behavior analysis; ABA), (f) alternative Survey content therapy/medicine (e.g., acupuncture), and (g) combined programs The survey contained questions in four main sections related to (e.g., Eden program). Specifically, parents were asked to indicate the respondent’s child, the respondents themselves, non-biological whether they were: currently using the treatment with their child; treatments and biological treatments. A total of 128 treatments had used the treatment in the past, but were not currently using it; were listed. The 67 non-biological treatments were divided into the or had never used the treatment. Of the 552 respondents, on average following categories: (i) educational/therapy approaches (e.g., applied the parents reported using seven different treatments with one parent behavior analysis); alternative therapy/medicine (e.g., Epsom salt reporting the current use of 47 treatments. The most frequently baths); combined programs (e.g., Son-Rise