Autism Spectrum Disorder Symptoms’ Perception: The Case of Andean-Ecuadorian Population

Background: Adult identification of red flag behaviours in young children, as potential symptoms of developmental disorders, may increase the probability of seeking professional attention for early detection, which has been associated with better health outcomes. Perceptions of symptoms may vary according to different cultures, locations, and socio-economic factors. Hence, studies conducted in different countries are important in order to identify particularities that need to be taken into account during the diagnosis process.

Objectives: Autism Spectrum Disorder’s detection is understudied in low and middle-income regions, such as Latin America. To our knowledge no studies related to ASD symptoms’ perception have been undertaken in Ecuador or neighbouring countries. This study’s aim is to analyse ASD behaviours that can be identified by general adult population as worrying symptoms that may lead them to seek for professional help.

Methods: We interviewed 54 subjects between 18 and 80 years old from different social classes and educational backgrounds, living in the Andean region of Ecuador. The questionnaire includes questions based on items extracted from screening and diagnosis tools, such as M-Chat and ADOS. Interviewers were asked to evaluate different behaviours present in children from 18 to 36 months as “normal”, “strange” or “worrisome” (semi-structured questions). Participants were also asked to give a possible cause associated to such behaviours (open-ended questions). Answers to possible causes could be classified in six main categories: (1) personality/circumstantial causes (“his character”, “is angry”, “is too young“); (2) developmental causes (autism, language difficulty or “disorder”); (3) physical deficits (mostly referred as auditory or visual difficulties); (4) psychological causes (emotional impairment such as “trauma” or “stress”); (5) rearing/familiar causes.

Results: Preliminary results indicate that, most of the proposed behaviours are considered strange and worrisome. However, certain red flags such as the presence of unusual finger movements are considered normal by more than 50% of interviewers. Furthermore, explanations to these behaviours are not always associated to developmental concerns, but can also be perceived as a sensory and physical impairment, or as difficulties inherent to the child’s personality that could improve with time.

Conclusions: Those findings suggest that adult perception of symptoms in Ecuadorian-Andean population could influence families' decision to ask for help and for a professional evaluation, which may increase the age of diagnosis. Being aware of these perceptions may also be informative during evaluation for ASD, as information from parents may not always correlate with the observation of a trained evaluator. Finally, as some of the red flags are being perceived as physical impairments, and some of the children presenting ASD symptoms may be addressed to practitioners in these fields, these findings highlight the importance of education on ASD identification among all health practitioners.