Behavior Analytic Services Around the World — Bahrain
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As we explore the state of behavior analytic services for individuals with autism , I invited several colleagues from around the world to serve as guest bloggers.
So, I had this amazing opportunity fall in my lap — move across the world and help a center continue their mission of providing evidenced-based services and autism awareness to their community. International work has been a dream of mine. And it was all coming together — the unique opportunity of directing an autism center in Bahrain.
Bahrain is a group of islands in the Arabian Gulf, just east of Saudi Arabia with an estimated population of 1.6 million and only the quarter of the size of Rhode Island. It is an Islamic country with a conservative culture, but also with emerging relatively modern and open liberal values with a mixture of many cultures and religions. Importantly, Islam continues to influence most Bahraini’s day-to-day life; including food, routine, education, socialization, health, and more.
In my experience thus far, mental health and autism are still relatively poorly understood and not yet readily accepted within the community. This has resulted in varying layers of social stigma; both overt as well as more subtle biases and perspectives that prevent a more comprehensive inclusive landscape. For instance, parents experience judgmental stares in public, requests to leave public areas, the idea that their child’s behavior is due to parenting, and even the subtle non-invite to social gatherings.
As with any parent in the world, it is difficult to learn the news that your child is different, that your child won’t learn like other children, and that your child needs more support. Now, imagine living within a community that is not open and accepting of those differences, a community that doesn’t yet have the necessary resources readily available, and a community that is often advised by ‘experts’ to wait and see as their child may just ‘grow out’ of the challenges they are facing.
The widespread prevalence of pseudoscience and unregulated providers leave families vulnerable and allows them to invest their time and financial resources in a myriad of advertised treatments that are not evidence based. This creates a cycle of frustration, and mistrust that leads to less effective outcomes and more motivation to be protective and secretive of achild’s disability. In this prevailing socio-cultural environment and service delivery infrastructure, it is very hard for a family to feel truly supported and for a child to reach his or her full potential.
Of course, this cannot be changed overnight, but we, as clinicians, must continue to disseminate our science and autism awareness worldwide to reduce the stigma associated with disabilities to ensure children and adults receive effective interventions with real, life changing outcomes.
Some of the largest barriers are the lack of education, training, and resources in Bahrain. The only prevalence study known was conducted in 2013 and found 4.3 cases per 10,000 individual (Al-Ansari & Ahmed, 2013). Kelly et al (2016), reported that this is likely inaccurate because of the lack of trained clinicians within the country and those who receive diagnosis outside of Bahrain are not included. Additionally, the culture has an expectation to raise a “perfect” child, as your child is a direct reflection on you, as a parent. In my experience, most families will choose to avoid receiving a label to escape the social stigma. Equally, if they do attempt to receive a diagnosis from some local professionals, they are often not entirely reflective of the child’s actual functioning level. Many families are told something along the lines of “wait and he will grow out of it.” It should also be noted, there is no real benefit to receiving a diagnosis, as it does not result in any real level of funding or access to effective treatment. Thus, a diagnosis is a label without a solution.
The need for more qualified clinicians is high. As of now, Bahrain does not have a verified course sequence for behavior analysis at any local universities and only one special education program with a focus on autism and intellectual disabilities. This is one of the goals of a newly-established non-profit foundation called Omneyat, working towards increasing training opportunities and the number of board certified professionals in Bahrain. Within the Gulf Cooperation Council, there are only two verified course sequences — Saudi Arabia and the United Arab Emirates. Although the educational opportunities are limited, Bahrain has a total of 8 Board Certified Behavior Analysts and one Board Certified Assistant Behavior Analyst. Considering how small the country is, this isn’t terrible, but 6 of those individuals serve in one center which has pioneered providing ABA service in accordance with board guidelines and maintaining a favorable BCBA to client ratios.
Bahrain has recently started a movement toward more inclusion within the educational setting. However, support after pre-school is more difficult to find and schools often deny admission due to barriers in learning and lack of resources to support children with developmental delays. I have found a few schools who have been more open to collaboration and I am eager to see where these collaborations lead. As far as service providers, there are probably about 6 centers within the country who claim they provide ABA services. However, I am only aware of one who functions under the supervision of onsite BCBAs. Due to the increasing rates of autism and related disabilities, the high demand for services, and the high cost for existing services, only wealthy families can afford services.
Fortunately, in recent years, the Bahrain Society for Children with Behavioral and Communication Difficulties was established. This organization helps bring more awareness to the community by providing regular workshops and conferences based on a variety of approaches. Omneyat (previously mentioned) is a foundation promoting effective and evidence-based practice within Bahrain. They support the dissemination of scientifically sound information about autism, facilitate certification for local professionals, and provide treatment scholarships to underprivileged children. Organizations like these are the start of bringing more community awareness to ABA and autism.
My experience in this country so far has been one I will never forget. I enjoy learning about the cultural and religious influences and how these play a direct and indirect role in current practices and the future of autism awareness and evidenced-based practice. The need for more education, professional training, and resources is high, but these are all barriers that the United States has faced and still experiences to a certain degree. This gives me hope. Hope for change. Hope for acceptance. And hope that moving across the world will make a difference.