Knowledge, Attitudes, and Practices of Family Physicians Related to Autism Spectrum Disorder in Romania: A Preliminary Analysis

Background: Autism spectrum disorder (ASD) is typically diagnosed in early childhood, and studies show that early intervention leads to better prognosis. Family physicians can assist by recognizing symptoms and providing timely referrals to the appropriate health care providers. Data on ASD from middle income countries such as Romania are lacking. Prior studies have identified the need to integrate mental health practices into primary care in Romania to reduce barriers to care. In 2011, a nation-wide program was initiated to increase ASD awareness, which included continuing education courses about ASD for family physicians.

Objectives: To assess the knowledge, attitudes, and practices regarding ASD of family physicians in Romania.

Methods: Investigators at the University of Texas Health Science Center at Houston and “Carol Davila” University of Medicine and Pharmacy (UMF) developed, translated, and administered a questionnaire to a cross-sectional convenience sample of n=383 family physicians in Romania to assess their knowledge, attitudes, and practices regarding ASD.

Results: A majority of participants were women (77.2%) and an average of 49.9 years old. All participants graduated from medical school in Romania, and 57.4% attended “Carol Davila” UMF. Participants practiced medicine 23.6 years on average and 51.6% reported that they had completed continuing education courses since 2015. Most participants practiced in Bucharest (60.2%), had patients from urban settings (72.5%), and reportedly spent an average of 16.7 minutes with each patient. A majority strongly agreed/agreed that children with ASD are detached from their family and peers (74.4%), children can grow out of ASD (74.5%), children with ASD require special education (95.2%), there is a stigma against ASD in the community (59.5%), diagnosing a child with ASD will lead to discrimination against the child and their family (50.4%), and there is generally a negative opinion toward children with ASD (63.5%). A majority disagreed/strongly disagreed that ASD is a possible result of neglect by the parents (57.5%), ASD is a precursor for schizophrenia (53.4%), and children with ASD deliberately misbehave (71.4%). Most participants correctly identified the symptoms necessary for ASD diagnosis, including impaired social interaction (88.3%) and communication (84.9%) as well as restricted and repetitive behavior (65.9%). A majority also recognized many symptoms that are often associated with ASD including lack of eye contact (87.5%), language disturbances (90.4%), hypersensitivity (75.8%), and anxiety (58.4%).

Conclusions: We found that a majority of participants agreed with true statements, disagreed with common misconceptions, correctly identified diagnostic criteria and common comorbidities related to ASD, and agreed that there is a stigma against ASD in their communities. However, up to 1/3 were “undecided” or responded “do not know.” These preliminary results suggest that most family physicians in Romania are receiving adequate education about ASD to recognize the symptoms, though a sizable proportion of family physicians may be unable to recognize ASD, and there may be stigma against ASD in Romania. In future analyses, we will assess which factors are associated with higher knowledge of ASD among Romanian family physicians. However, there are many limitations in this study and results should be interpreted with caution.