Barriers to Screening for Autism Spectrum Disorders (ASD) in Pediatric and Community Health Practices in Ecuador

Background:

An essential issue for early diagnosis of autism is the extent to which health professionals can be engaged in the screening process. Universal routine screening of autism and developmental delays is recommended by the American Academy of Pediatrics in the effort to enhance early identification of children needing services. Pediatricians and family physicians are among the first professionals able to identify developmental difficulties and provide effective recommendations. However, several barriers to screening in those settings have been identified in different countries. Among them, lack of knowledge about ASD, lack of confidence in identifying signs of autism, perception of autism as a condition that is not well defined, and misconceptions regarding the signs, symptoms and etiology.

Objectives:

We aim to address a critical gap regarding screening practices in Ecuador based on the hypothesis that, as in many parts of the world, children are not being routinely screened for ASD and that the absence of screening practices may result from poor acknowledgment of this condition. A better understanding of barriers to screening practices can be helpful to inform on professionals’ training needs, and provide a first step in improving detection thus improving the life of children and their families. Correct case identification may also raise visibility to improve resources for families in Ecuador.

Methods:

We interviewed 46 subjects, 29 medical doctors in Pediatrics and Community Health and 17 postgraduate students in a School of Pediatrics from different regions of Ecuador. Participants responded to an original questionnaire developed to assess (1) current barriers to ASD screening in pediatric and family physician settings, (2) auto-perceived knowledge and auto-perceived self-efficacy and (3) to inform on training needs among those professionals as well as on the preferred ways to receive it.

Results:

Preliminary results indicate that most endorsed barriers to screening for autism are lack of time to perform a screening, lack of resources to offer to autistic people, not knowing where to find adapted instruments and the feeling to be able to recognize symptoms without the need for a tool. A small proportion of participants consider they have enough training in detection and monitoring, and more than 90% of participants feel they could benefit from receiving training in the area of autism, especially in the identification of early signs. Around one third of participants report between 1 and 4 children identified with ASD during their professional practice, and 70% report not having identified children with ASD during their professional life, suggesting that children are not being routinely screened for ASD, which may result from poor acknowledgment of this condition.

Conclusions:

Those results suggest the presence of several barriers to screening in pediatric settings, such as lack of time and resources, lack of feeling of self-efficiency to discuss symptoms with parents or to refer a child for further evaluation, that are consistent with previous findings in High- and Low-Income countries. These findings highlight the importance of continuous education among health care professionals and inform about their needs in training and education in Ecuador.