Early Identification of Autism Spectrum Disorders In Brazilian Day Care Centers

Background:  A recent systematic review of the Brazilian scientific literature on Autism Spectrum Disorders (ASD) demonstrated a significant increase in the Brazilian autism scientific production in the last two years. However, it also showed that most of these publications are not focused on matters that contribute significantly to improving public health and that studies related to early identification are extremelly rare in this country.

Objectives:  this research aimed at (1) identifying delays in the cognitive/motor development and early signs of ASD in children enrolled in public daycare centers in Southeast Brazil; (2) establishing associations between developmental delays / early signs of ASD and demographic / personal features; (3) identifying gaps in Joint Attention and verifying its eventual association with higher risk of ASD.

Methods:  Cross-sectional study including 92 children aged 16-to-24 months enrolled in five day care centers in a town from Southeast Brazil (Barueri, São Paulo State). This sample represented the universe of all children at day care units in the South of Barueri. Instruments: Pictorial Infant Communication Scales (PICS), Modified Checklist for Autism in Toddlers (M-CHAT), and Development Screening Test-II - DENVER II. Data were first managed in descriptive analysis. Further bivariate analysis with application of Chi-square and Fisher's Exact tests as well as calculation of odds ratio was carried out.

Results:  Prevalence of 28.3% for cognitive and/or motor development delay was observed. Developmental delays were more frequent in the area of language (54.48%), followed by personal-social (17.97%), fine motor adaptive (14.74%), and gross motor (12.81%) domains. Association between developmental delays / signs of ASD and demographic / personal data was statistically significant as to prematurity and lack of prenatal care. Five children (5.4%) were classified as probable cases positive for ASD according to M-CHAT. Bivariate analysis considering the results of both PICS and M-CHAT showed the following tested skills as more frequently associated with ASD: (1) to point to draw attention, (2) to point to indicate interest, (3) to share an event, (4) to deliver an object, (5) to ask for help, (6) to stare at an desired object.

Conclusions:  Evidences of developmental delay and early signs of ASD in children attending daycare centers were here found out, and can be helpful for future actions in health and education politics in Barueri, SP, Brazil.