A Pilot Project of Early Detection and Diagnosis of Autism Spectrum Disorders in a Public Children Hospital in Buenos Aires, Argentina

Thursday, May 17, 2012
Sheraton Hall (Sheraton Centre Toronto)
2:00 PM
K. A. Gutson1,2, M. I. Colantonio Llambías3, A. Rattazzi4,5, N. Regatky6, M. G. Salamanco6 and I. M. Alfieri7, (1)Pediatría. Hospital General de Niños "Dr. Ricardo Gutiérrez", Universidad de Buenos Aires, Buenos Aires, Argentina, (2)PANAACEA, Buenos Aires, Argentina, (3)Mental Health, Hospital de Niños , Buenos Aires, Argentina, (4)INECO, Caba, Argentina, (5)PANAACEA, CABA, Argentina, (6)Promoción y Protección de la Salud, Hospital de Niños "Dr. Ricardo Gutiérrez", Buenos Aires, Argentina, (7)Mental Health, Hospital de Niños "Dr. Ricardo Gutiérrez", Buenos Aires, Argentina
A pilot project of early detection and diagnosis of autism spectrum disorders in a public children hospital in Buenos Aires, Argentina

Background: The use of autism screening tools in pediatric health check-ups of children between 18 and 24 months allow early identification of children with autism spectrum disorders (ASD). No studies in this respect have yet been published in Argentina.

Objectives: To facilitate the early identification of children at risk for autism spectrum disorders. Specific aims: 1) To explore the applicability of a standardized screening method for ASD in children attending a pediatric outpatient service; 2) To propose a procedure protocol for early diagnosis in children with ASD.

Methods: this is a prospective, cross-sectional, descriptive and diagnostic pilot study. A random sample of 100 children between 18 and 24 months of age without previous diagnosis of ASD or other developmental disorder who attended health check-ups at an outpatient service of a pediatric general hospital in Buenos Aires were screened. Parents completed the spanish version of the M-CHAT in the waiting room of the outpatient service. Posteriorly, a trained pediatrician administered the observational items of the CHAT (part B), checked M-CHAT responses and obtained a medical history of the child. Children who screened positive in the CHAT or M-CHAT, or who presented relevant clinical findings, underwent a diagnostic assessment using ADOS, ADI-R, a clinical evaluation, and VABS-II. Furthermore, they were evaluated by an interdisciplinary team constituted by a pediatrician, a child neurologist, child mental health professionals, a speech therapist, an audiologist and an ophthalmologist. Genetic testing was performed on patients diagnosed with ASD.

Results: Sample: 61 females, 39 males. 11 children screened positive (11%) 10 males and 1 female. Diagnoses: 3 Autistic Disorder, 1 PPD-NOS, 3 Developmental delay, 1 Speech delay, 1 Speech delay plus Reactive attachment disorder, 1 Reactive attachment disorder. 1 child did not receive the diagnostic assessment. 9 children screened positive in the M-CHAT and 2 children did by CHAT and clinical findings. Parents of 9 of the children were concerned about their child development previous to the screening, but only 3 had sought for medical assistance. However, none of the 3 received a proper response from health care system when they consulted.

Conclusions: The small sample size does not permit conclusions to be applied to the general population in Argentina. The implemented screening method was effective in our population as it detected all the patients who were later diagnosed with ASD. The study demonstrated the need to train pediatricians in the evaluation of early risk indicators, as in most cases, parental concerns existed prior to screening. As well, the study allowed the consolidation of a diagnostic interdisciplinary team in a public hospital setting. Data obtained in this study support the need for more research on ASD culturally appropriate screening tools and on early identification procedure protocols of at-risk children.

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