Development of a Digitalized Bangla Autism Assessment System in Bangladesh (Preprint)

BACKGROUND The prevalence of Autism Spectrum Disorder is increasing due to various biopsychosocial and environmental factors that demands prompt and holistic initiatives for early diagnosis and appropriate interventions. However, most of the developing countries are in severe scarcity of culturally adapted and validated cost-effective tools and trained professionals. Bangladesh has established as one of the leading countries in autism care and awareness. However, the country also lacks valid, easily available and low-cost assessment tool that can be used from different part of the country OBJECTIVE This study aimed to develop a digitalized autism assessment system based on Bangla Autism Assessment Scale by translating, adapting and validating Indian Scale for Assessment of Autism in Bangladesh METHODS This multi staged mixed method study was conducted from 2018 to 2019. At first Bangla Autism Assessment Scale was developed from Indian Scale for Autism Assessment stepwise: forward translation, backward translation, expert committee review, pretesting. In the second stage a mobile application and website was developed following the user centered designing principles. In the third stage the usefulness of the mobile application and psychometric properties of the scale were assessed with 100 children from two special education schools in the Dhaka: Proyash Special School and Autism Welfare Foundation School. The diagnostic accuracy was measured against the diagnosis and severity assessment of a multi-disciplinary team using Diagnostic and Statistical Manual of Mental Disorder (DSM-5). Data was analyzed using SPSS-24. RESULTS More than 90% professionals considered the mobile application was helpful for them by reducing the total time for completing the assessment about 50% and also helped in error prevention such as missing any item or error in manual calculation of the test score. The tool revealed about 88% children were suffering from Autism among them 32% were suffering with Mild, 51% Moderate and 5% Severe level of Autism. We found the tool was 98% sensitive and 94% Specific in consideration of the Gold Standard of DSM-5 applied by expert professionals that was very satisfactory to use. CONCLUSIONS The Bangla autism assessment scale is a valid instrument for autism assessment and mobile application was useful. However, we recommend that the tool should be used by appropriate professionals after the first line screening to confirm the diagnosis and severity assessment.