Implementing the Early Start Denver Model in Senegal: Outcomes and Insights from a Low-Resource Context

Abstract

Background: Autism Spectrum Disorders (ASD) are characterized by significant challenges in social interaction and communication, accompanied by repetitive behaviors. Effective early interventions, such as the Early Start Denver Model (ESDM) are crucial but primarily studied in well-resourced Western countries. This study explores the adaptation and effectiveness of ESDM in Senegal, a low-resource setting, to adress gaps in autism care and intervention accessibility in Africa.

Subjects and methods: An observational study was conducted at Diamniadio Children's Hospital, Dakar, Senegal, from January 2019 to July 2021, focusing on children under 10 years suspected of having ASD. Diagnostic assessments were performed using the DSM-5 criteria with tools like the Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedule, Second Edition (ADOS-2). Interventions based on ESDM were adapted to local resources and involved regular family and patient engagement.

Results: Of the 114 children referred for ASD suspicion, 80 were diagnosed with ASD. Post-diagnosis, 30 children received follow-up care at the day hospital, and another 30 were managed via outpatient care. 20 children did not receive any follow-up care at Diamniadio Children's Hospital. Significant socio-economic disparities were noted, influencing access to and engagement with intervention programs. No significant differences were found in clinical characteristics between groups, but socio-economic factors significantly affected intervention access.

Conclusion: The adapted ESDM interventions show promise for implementation in resource-limited settings like Senegal, although challenges related to socio-economic disparities and service accessibility persist. Future research should focus on the integration of ASD services into broader health policies to enhance efficacy and accessibility.

Keywords: Autism Spectrum Disorder - Early Start Denver Model - Low-resource settings – Senegal - socio-economic disparities.