Community perceptions of the causes of autism and help-seeking responses : a multi-site qualitative study across northern Uganda

Vincent, Jonathan and Kajjumba, Diana and Amone, Richard and Estlin, Edward John and Kosko Okello, Kennedy and Akello, Franceska and Okello, James and Idro, Richard and Abbo, Catherine and Ouma, Simple (2026) Community perceptions of the causes of autism and help-seeking responses : a multi-site qualitative study across northern Uganda. Autism. ISSN 1362-3613 (In Press)

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Abstract

Understanding the causes of autism in sub-Saharan Africa remains limited, contributing to stigma and delayed identification. This multi-site qualitative study examined community explanatory models of autism and related help-seeking practices in Northern Uganda. Data were generated through 25 semi-structured interviews and four focus group discussions (N = 64) across one urban and two rural districts in the Acholi sub-region. Participants included autistic young people, caregivers, health and education professionals, community, cultural and religious leaders, and government representatives. Data were analysed inductively. Four interrelated themes were identified: unknown causes; supernatural explanations; biopsychosocial attributions; and help-seeking pathways. Autism was frequently misunderstood and conflated with “mental illness” or general learning difficulties. Supernatural accounts, such as witchcraft, curses, and divine punishment, were prevalent and often gendered, with mothers disproportionately blamed. Biopsychosocial explanations included contraceptive use, obstetric complications, genetic factors, and post-conflict trauma. These causal beliefs shaped different help-seeking trajectories, typically prioritising religious and traditional interventions before biomedical care. Stigmatising interpretations were linked to social exclusion, neglect, physical abuse, and, in extreme cases, infanticide. Findings highlight the entanglement of cultural, spiritual, and biomedical models in a post-conflict, low-resource context. Interventions addressing misconceptions and maternal blame may reduce stigma, support earlier identification, and prevent avoidable harms.