Sandra still remembers how her younger brother, Dennis, was treated growing up.

At home, he was constantly beaten and punished for what everyone believed was stubbornness. He struggled to speak, avoided eye contact and reacted differently to everyday situations. To the adults around him, it looked like disobedience. To teachers, it was a lack of discipline. No one stopped to ask why he behaved the way he did.

It was not until years later, after Sandra came across an article on autism, that things began to make sense. The signs she had read about felt familiar. For the first time, Dennis was not just “difficult.” He was likely autistic.

Stories like this are common across Nigeria, where limited awareness means early signs of autism are often misunderstood or dismissed.

A widespread condition with limited recognition

Available research suggests autism is not rare in Nigeria, even though diagnosis rates remain low. Estimates indicate that about 1 in 150 to 160 children may be on the autism spectrum, pointing to a significant but under-recognised population.

Studies across different settings show consistently high levels of low awareness. In one survey among teachers, only about half correctly identified autism as a developmental condition, while others associated behaviours with poor discipline or behavioural problems.

Clinical and community-based research also shows that many families first respond to symptoms outside formal healthcare. Children are often taken to informal care providers or managed at home based on assumptions about minor illness or behaviour, delaying professional assessment.

Late diagnosis and gaps in access to care

Delayed diagnosis remains a major challenge. Research indicates that children in Nigeria are often identified years after early symptoms appear, missing the window for early intervention that improves communication and developmental outcomes.

Access to care is also uneven. Diagnostic services and therapy options are limited and mostly concentrated in urban centres. For many families, especially in rural areas, access is restricted by cost, distance and availability of specialists.

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The shortage of trained professionals further complicates care. Speech therapists, behavioural specialists and developmental paediatricians remain limited relative to the population that may need support.

Cultural perceptions continue to shape responses to autism. In some cases, developmental conditions are linked to spiritual or social explanations, which can delay clinical intervention and reduce willingness to seek formal care.

Public health authorities, including the National Agency for Food and Drug Administration and Control and other stakeholders, have continued to emphasise the risks associated with delayed or inappropriate treatment pathways, particularly where unverified approaches replace evidence-based care.

While awareness has improved in recent years, driven partly by advocacy and digital platforms, gaps in understanding and access remain significant.

World Autism Awareness Day highlights the scale of the issue, but the underlying challenge is more structural. Without earlier diagnosis, better awareness and improved access to care, many children like Dennis will continue to be misunderstood long before they are properly identified.

Cynthia Nwanonyiri