Beyond Sick and Well Visits: Pediatricians Knowledge and Beliefs about the Diagnosis of ASD

Background: Pediatricians play a central and crucial role in the evaluation and management of ASD. In average, they see a child for 11 well visits by age 36 months; which provides a venue for screening and surveillance of ASD. Even though, professional associations have been urging physicians to screen for ASD at 18 and 24 months; studies report mean ages of ASD diagnosis ranging from 38 to 120 months. Early identification is desirable because it is linked to better outcomes, and might improve the likelihood of referral to early intervention. Early diagnosis and timely referral have been related to the pediatricians’ knowledge about ASD’ symptoms. Latin American countries, in general, have limited access to diagnostic and treatment services; highlighting the pivotal role of pediatricians as diagnosticians of ASD. Studies on diagnostic practices of pediatricians and other physicians in Latin American countries are scarce, thus limiting information about health policies or capacity and training needs for these professionals.

Objectives: the primary goal of this study was to explore Venezuelan pediatricians knowledge and beliefs about the diagnosis of ASD.

Methods: Diagnostic criteria for autism spectrum disorders used by 75 Venezuelan pediatricians were examined using a 30 item- survey developed by Daley y Sigman (2002). The survey was translated into Spanish and back-translated to English, and later was validated by experts. The survey comprised three parts: 1.) pediatricians background and experiences with autism, 2.) a list of 18 characteristics or behaviors which included those required by the DSM-IV and some associated with other disorders, 3.) 2 open questions: “What other comments do you have about your experiences with autism in Venezuela?” and “What other behaviors or characteristics do you use in guiding your diagnosis?” (Daley & Sigman, 2002).

Results: The majority of the sample (92%) was working in urban health facilities. Participants had a range of professional and educational experiences; with a mean number of years of practice of 12.3 years (SD 6.2). Pediatricians in the sample reported a mean number of ASD cases during their career of 26.3 (SD 15.7). More than half of the Venezuelan pediatricians (54.7%, n=41) endorsed the necessary characteristics for ASD diagnosis. When asked about ASD etiology, 77.3% (n=58) exhibited average knowledge regarding the currently accepted ASD etiology (neurobiological and no caused by parents). In the comments section, common themes revolved around lack of awareness, underdiagnosis, and lack of enough trained professionals to handle ASD population in the country.

Conclusions: Venezuelan pediatricians consider the core features of autism as necessary for the diagnosis. They report seeing in their daily practice an increasing number of cases of ASD. These results provide a relevant analysis about knowledge, skills, and procedures that Venezuelan pediatricians used during the diagnosis process of children with ASD. Furthermore, it emphasizes Pediatricians’ role as a partner of the parents of children with ASD to offer early diagnosis and referrals according to the current professional's guidelines.