Regulation in Autism Care in Nigeria

Parents of children with autism often find themselves in difficult situations. They search for help, hoping to find someone who can support their child's development. In this search, they may find professionals who promise results but lack proper training or credentials.

Recently, during a training session, a parent shared her experience with a therapist offering services via Zoom. The parent described an intervention that seemed questionable. When I looked up the therapist's credentials with the Behavior Analyst Certification Board (BACB), the name was not listed. Someone was using a false identity to offer services. The parent did not report this incident.

This situation is not isolated. Across countries, families seeking autism services face a landscape where anyone can claim to be an expert. In many countries, there is no regulatory system to verify credentials, no standards to measure competence, and no systems to protect families from harm.

The current gap

Nigeria currently has no government-regulated system for autism professionals. Diagnosis and intervention rely on general medical or psychological licensing through bodies like the Medical and Dental Council of Nigeria (MDCN) for doctors or the Nigerian Psychological Association for psychologists. Some practitioners hold private or international certifications, such as the International Board of Credentialing and Continuing Education Standards (IBCCES) Certified Autism Specialist credential. However, this regulatory gap contributes to inconsistent standards and increases the risk of malpractice.

Research from Nigeria confirms these concerns. Studies by Bakare and colleagues at the Federal Neuropsychiatric Hospital in Enugu have documented limited knowledge about autism among healthcare workers (Bakare, Munir, Bello-Mojeed, & Taiwo, 2019). When healthcare workers themselves lack adequate knowledge, the situation becomes more concerning for unregulated practitioners.

The consequences of this gap are significant. Children with autism in Nigeria experience delays of approximately seven years between when parents first notice concerns and when a formal diagnosis is made (Bello-Mojeed, Munir, & Bakare, 2017). These years represent lost opportunities for early intervention, which research shows can improve outcomes for children with autism (Franz, Adewumi, Chambers, Villagomez, & Dawson, 2023).

What regulation could look like

A structured regulatory system would offer vital protections. Parents could verify that a professional has completed required training and supervised practice hours. They could check credentials through a public registry. They could understand what services different professionals are qualified to provide.

Consider what regulation typically includes: criminal background checks, signed codes of ethics, basic first-aid and child protection training, continuing education requirements, and license renewal processes. These elements exist to protect the people receiving services.

Senator Natasha Akpoti-Uduaghan's bill for the establishment of National and Regional Centers for Autism addresses part of this need. The proposed centers would coordinate diagnostic services, provide therapy, and offer vocational training. However, the question of who should staff these centers and what qualifications they should hold remains.

Nigeria has the capacity

Nigeria has top quality universities conducting research and training in areas related to autism. The University of Ibadan's Department of Special Education focuses on assessment and teaching of persons with special needs, rehabilitation, and inclusive education. Researchers at this institution have studied interventions for children with autism in Lagos State. The University of Lagos, University of Port Harcourt, Ahmadu Bello University, University of Calabar, and Rivers State University also have programs in special education, speech therapy, or related fields.

Federal Neuropsychiatric Hospitals in Enugu, Lagos (Yaba), and Calabar have child and adolescent units that provide services for children with autism and conduct research on neurodevelopmental disorders. These institutions represent existing capacity that could be strengthened through a regulatory framework.

A tiered system

A regulatory system could create clarity for professionals to enter the field at different levels based on their education and experience. Someone with a diploma might provide support services under supervision. Someone with a master's degree might conduct assessments and plan interventions. Someone with doctoral training might make formal diagnoses and lead teams.

The concept of different practice levels is not new. Many countries use tiered systems where professionals practise within defined scopes based on their training. A five-level system might include:

• Diagnostic experts who can make formal autism diagnoses, lead research, and train others
• Specialists who can conduct assessments and develop intervention plans under supervision initially
• Interventionists who deliver evidence-based therapies and monitor progress
• Support practitioners who implement established plans and assist with daily skills
• Technicians who provide basic support under direct supervision

Each level would require specific education, supervised practice hours, and demonstrated competence. Each level would have clear boundaries about what services the professional can provide. This clarity helps families know what to expect and helps professionals understand their responsibilities.

A public registry would also allow parents to verify credentials. Before starting services, a parent could check if someone is licensed, what level of license they hold, when their license was issued and expires, and whether any disciplinary actions have been taken. This information supports families to make informed decisions.

Recognising existing practitioners

The regulatory system must consider people already working in the field. Many practitioners have years of experience and have completed training programs, though these may not be formally recognized. A transition period would allow existing practitioners to register based on documented experience and recognized certifications, with requirements to pass a national examination that includes cultural competency.

This approach respects the work people have already done while ensuring everyone meets established standards going forward.

Why this matters now

Research shows that early intervention for autism can lead to improved outcomes and reduced long-term costs (Franz et al., 2023). However, early intervention requires professionals who know what they are doing. Families need to be able to find and verify qualified practitioners.

The establishment of autism centers, as proposed in Senator Akpoti-Uduaghan's bill, creates an opportunity. Prior to these centers developing, Nigeria may benefit from establishing a regulatory system that ensures the professionals meet clear standards. Universities could expand training programs to prepare the workforce. Federal or state teaching hospitals could continue their research and service provision within a structured system.

Parents should not have to wonder whether the person offering to help their child has the necessary training. They should not have to discover, as one parent did, that credentials were fabricated. They should be able to check a public registry and make informed decisions. Children with autism deserve services from professionals who have demonstrated competence through proper training, supervised practice, and ongoing education. A regulatory system would establish the foundation for quality autism care.