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Awareness and Knowledge of Autism Spectrum Disorders among Primary School

Teachers in India

Article · April 2014

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 International Journal of Health Sciences and Research
www.ijhsr.org ISSN: 2249-9571
Original Research Article

Awareness and Knowledge of Autism Spectrum Disorders among Primary

School Teachers in India
Anil Shetty1, B Sanjeev Rai2
1
Associate Professor, 2Professor,
Department of Pediatrics, Father Muller Medical College and Hospital, Kankanady, Mangalore-575002. India.
Corresponding Author: Anil Shetty

Received: 20/02//2014 Revised: 19/03/2014 Accepted: 19/03/2014

ABSTRACT

Background: The incidence of Autism Spectrum Disorders (ASD) has increased in recent years. This is
because of greater awareness and newer, more effective diagnostic criteria. However in India and other
developing countries ASD is underdiagnosed and awareness is poor.
Objective: To assess knowledge and awareness about ASD among elementary school teachers and the
variables influencing that knowledge.
Methods: 326 teachers were given a self -report questionnaire and knowledge was assessed based on
their response. Socio-demographic history was also elicited.
Results: 95.7% of the teachers were aware of autism. Only 21% had adequate knowledge. 71 teachers
had prior training on ASD. Teachers with more experience and prior training performed better.
Conclusion: The teachers had poor knowledge of ASD. Teaching experience and prior training were
positively correlated to knowledge.

Key Words: Autism Spectrum Disorders, Teachers Knowledge, Developmental Disorders.

INTRODUCTION improved diagnostic tools. The overall

The incidence of Autism Spectrum prevalence of ASD among children born
Disorders (ASD) has increased steadily over between 1983 and 1999 and diagnosed by
the past decade; the incidence of Autism age 8 increased by 11.9% per annum, from 8
Spectrum Disorders is estimated to be 1-2%. cases per 10,000 births in 1983 to 46 cases
[1]
A systemic review of 40 studies revealed per 10,000 births in 1999. [4] Between 1991
that the prevalence of ASD was 20 per and 1997 there was a staggering 556%
10,000. [2] The incidence of autism is more reported increase in pediatric prevalence of
in males. Latest estimates indicate that the Autism with a male to female ratio of 3:1. [5]
prevalence of Autism Spectrum Disorders However in India, awareness and knowledge
could be as high as 1 in 54 boys. [3] There is of these disorders is poor among the lay
strong evidence to suggest that the increase public in general and the health and
in diagnosis and identifying children with education community in particular.
these disorders is due to greater awareness, Awareness is even lesser in non-
significant changes in the criteria and metropolitan cities because of a paucity of
International Journal of Health Sciences & Research (www.ijhsr.org) 80
Vol.4; Issue: 4; April 2014
trained personnel and specialized centers. teachers were ranked based on their
There are about 2.3 million children with knowledge and a score of above 8/12 was
Autism Spectrum Disorders in India. [6] deemed as good knowledge of ASD. The
Knowledge and awareness among primary symptoms and signs listed in the
school teachers may play a major role in questionnaire were adopted from two
early identification of children with ASD, diagnostic instruments used for autism,
unfortunately developmental disorders in namely the Autism Diagnostic Interview-
children are not a health priority and most Revised (ADI-R) and the Childhood Autism
teachers are not equipped with the ability to Rating Scale (CARS).
identify developmental disabilities. It is a
logistical challenge for health personnel to RESULTS
screen and identify ASD among millions of In our study the total number of
students; the people best suited for this respondents was 326, but only five teachers
onerous task are elementary school teachers. were males and since females outnumbered
Teachers interact with students on a daily males by a 60:1 ratio in the study, gender as
basis and are more likely to identify and a variable was not considered. Teaching
monitor subtle signs or symptoms. Limited Experience and prior training were the
research exists regarding the role of teachers variables considered. The teaching
in screening for Autism Spectrum Disorders. experience ranged from fresher’s to veterans
[7]
The purpose of this study therefore is to with more than 20 years’ experience; nearly
assess the knowledge and awareness of half the teachers had less than 5 years of
Autism Spectrum Disorders among primary experience this is shown on Figure 1. Figure
school teachers and to correlate their 2 shows the major source of information on
knowledge with variables such as prior autism for the teachers, almost one third of
training and teaching experience. the teachers cited Television as their source
of information others attributed books,
MATERIALS AND METHODS colleagues, movies and newspapers as their
A self- report questionnaire was source. Table 1 shows the number of
given to teachers in 32 primary schools, 326 teachers who received prior training on
school teachers were assessed on their autism and roughly 1 in 5 teachers had prior
knowledge of Autism Spectrum Disorders. training, 59 teachers had suspected autism in
Socio-demographic information such as their students at least on one occasion and
gender, teaching experience and prior had counseled a parent and referred them to
training was elicited. The teachers were a doctor or had informed a superior, 291
asked about any past suspicion of autism in teachers felt that training was required but
the classroom and their response to those ironically only 239 teachers expressed
suspicions in terms of reporting it to a willingness to attend such training sessions,
superior, parental counselling or referral to a this was probably because teachers who had
doctor. The source of their knowledge and been trained earlier did not wish to attend a
the factors influencing their perception of similar session again. Table 2 shows the
autism was assessed. The teachers were awareness and knowledge of the teachers,
asked about the need for a workshop/module 95% of the teachers were aware of ‘autism’
on ASD and their willingness to attend it. but among those aware 83% admitted that
The knowledge of autism among the their knowledge was inadequate. At least
teachers was assessed by their awareness 50% of the teachers identified 6 of the 12
about 12 symptoms and signs for ASD. The signs and symptoms correctly, the response
International Journal of Health Sciences & Research (www.ijhsr.org) 81
Vol.4; Issue: 4; April 2014
to the other 6 questions was less
encouraging. Table 3 shows the variables Teaching Experience
influencing knowledge. Teaching experience
< 2 Years
had a strong positive correlation with
2-5 Years
knowledge and the veterans clearly 23 52 78
outperformed the novices, the responses 42 5-10 Years
74
were graded into 4 categories, those who 57 10-15 Years
were not ‘aware’, a correct score of 1 to 4, 4 15-20 Years
to 8 and above 8, a score exceeding 8 was
> 20 Years
termed as good or adequate knowledge and
only 69 teachers qualified for this plaudit.
Prior training also had a positive correlation Figure 1: Teaching Experience in Years.
with knowledge and 31 of the 71 teachers
who had prior training had a score
exceeding 8. Source of Information

Table-1: Teacher Training & Autism.

Variable Yes No 21 Books
41
Prior Training on Autism 71 (21.8%) 255 (78.2%) 83 Colleagues
Suspected Autism in students 59 (18.1%) 267 (81.9%)
Need for training for teachers 291 (89.2%) 35 (10.8%) Television
on Autism 105 62
Willingness to attend training 239 (73.3%) 87 (26.7%) Movies
session
Newspapers

Figure 2: Major Source of Information on Autism.

Table -2: Knowledge of Symptoms & Signs.

Aware Unaware
Aware of the term ‘Autism’ 312 (95.7%) 14 (4.3%)
Adequate Inadequate
Grading of Knowledge 55 (16.9%) 271 (83.1%)
Sr. No Signs & Symptoms Aware Unaware
1 Look at other children when interacting with them or make good eye contact. 197 (63.2%) 115 (36.8%)
2 Make good and appropriate use of hand and body gestures when having 125 (40.2%) 187 (59.8%)
conversations.
3 Fails to show interest in other children or no interest in interacting with other children. 270 (86.5%) 42 (13.5%)
4 Have emotional reciprocity ( Awareness about others being happy, sad, angry etc and 115 (36.8%) 197 (63.2%)
responding appropriately).
5 Language development is delayed. 187 (59.8%) 125 (40.2%)
6 Has repetitive behavior (flapping hands, body rocking repeatedly) 176 (56.4%) 136 (43.6%)
7 Does not respond to name. 94 (30.1%) 218 (69.9%)
8 Does not respond to emotional cues, i.e. to affection. Does not like to be cuddled or 229 (73.4%) 83 (26.6%)
hugged
9 Inappropriate attachment in certain toys or objects (prefers to play with same toy for 135 (43.3%) 177 (56.7%)
hours)
10 No perception of fear or danger, ex: Crosses road without looking. 124 (39.7%) 188 (60.3%)
11 Upset at even minor changes in routine, obsessed with the same routine. 177 (56.7%) 135 (43.3%)

12 Repetitive phrases at odd or inappropriate times, like singing an advertisement jingle 93 (29.8%) 219 (70.2%)
suddenly.

International Journal of Health Sciences & Research (www.ijhsr.org) 82

Vol.4; Issue: 4; April 2014
 Table-3: Variables influencing Teacher’s Knowledge. ASD were common. [11] In the present study
Teaching Criteria Awareness - correct score
Experience in Years Not 1-4 4-8 >8 only 69 of the 326 teachers had adequate
Aware knowledge of ASD. A study in Singapore
<2 7.7% 51.3% 32.1% 8.9%
2-5 6.7% 44.6% 36.5% 12.2% assessed knowledge of childhood
5-10 3.5% 42.1% 31.6% 22.8% developmental and behavioral disorders in
10-15 2.4% 33.3% 35.7% 28.6%
school teachers and 66 % had adequate
15-20 0% 21.8% 39.1% 39.1%
>20 0% 23.1% 40.4% 36.6% knowledge of Autism Spectrum Disorder.
[12]
Prior Training 0% 8.5% 47.9% 43.6% Teaching Experience in the present day
had a positive correlation with knowledge
DISCUSSION and this is similar to findings in a Scottish
Teachers could play a pivotal role in study. [13] In the present study 59 teachers
identifying children with developmental had suspected ASD in their pupils at least on
disabilities and counsel the parents and one occasion and subsequently informed a
guide them on referral. But at present there superior or counseled a parent. This results
is very little coordination between in an awkward situation for teachers,
educational and health personnel. A greater because often parents don’t agree with the
interaction between the health sector and teacher’s perception and there might be a
schools could have tangible benefits. A backlash. A study in Finland studied the
study on children treated for Autism with association between parents and teachers
medications revealed that less than half the rating of the Autism Spectrum Screening
teachers were aware that the children were Questionnaire (ASSQ). Agreement between
on medication, and among the teachers who informants was rare. [14] In another study,
were aware none of the teachers had ever forty seven teachers and forty seven parents
conferred with the treating physician and the of autistic children were surveyed regarding
article argues for greater coordination their views and beliefs about autism and
among teachers and treating doctors. [8] The both groups harbored some misconceptions
benefits could extend to the classroom too. and had discrepant views in crucial areas. [15]
In a study, the engagement and in seat Referrals of ASD suspected children should
behavior of autistic children in classrooms be to a qualified and competent specialist,
while seated on their regular seats was knowledge of both developmental
compared with being seated on therapy assessment and mental health is required. A
balls, and there was substantial improvement recent study conducted in Goa on the
when the ASD children sat on therapy balls. families of children with ASD revealed that
[9]
Teachers who have to deal with children professionals from the health, education, and
with ASD are under greater stress and religious sectors have a low awareness of
greater coordination could benefit teachers the unique needs of families living with
as well. An Iranian study revealed that ASD which leads to a considerable
teachers of children with autism experience economic and emotional burden on families.
[16]
significantly higher levels of burnout. [10] In A study in Singapore assessed the
our study a majority of the teachers were knowledge of childhood developmental and
aware of ‘autism’ but they admitted that behavioral disorders in 48 general
their knowledge was inadequate. There were practitioners and only over a third of the
several incorrect perceptions among the doctors achieved the pass rate. [17] Prior
teachers in our study. A cross sectional training also had a positive correlation with
study done in Oman among 164 school knowledge in our study, 91% of the teachers
teachers revealed that misconceptions of who had prior training exhibited good or
International Journal of Health Sciences & Research (www.ijhsr.org) 83
Vol.4; Issue: 4; April 2014
average knowledge. In a Greek study 35 CONCLUSION
regular school teachers and 29 special The teachers in the present study had
education teacher’s perceptions of Autism poor knowledge about ASD. Teaching
was evaluated, and the special education experience and training had a positive
teachers were more likely to correctly bearing on knowledge. Only one in five
identify the characteristics of autism. [18] teachers had prior training. Most teachers
Training therefore helps in improving the advocated training on ASD and expressed
ability to identify relevant cues and their willingness to attend training sessions.
tentatively screen children. A study This sentiment should be taken advantage of
conducted in Delhi assessed the effect of a and more teachers should be trained to make
self- instructional educational module on them more effective facilitators of
knowledge of primary school teachers identifying ASD and promoters of creating
regarding early symptoms of childhood awareness.
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How to cite this article: Shetty A, Rai BS. Awareness and knowledge of autism spectrum disorders
among primary school teachers in India. Int J Health Sci Res. 2014;4(4):80-85.

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Vol.4; Issue: 4; April 2014

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