Screening for Autism in Santiago Chile: Community Perspectives
2015; Volume: 8; Issue: 4 Linguagem: Inglês
ISSN
2374-0833
AutoresMaria I. Eugenin, Rosario Moore, Javiera Martínez-Gutiérrez, Carolina Pérez, Patricia M. Valenzuela,
Tópico(s)Family and Disability Support Research
ResumoIntroductionAutism spectrum disorders (ASD) have become a major healthcare concern, particularly because the prevalence has dramatically increased over the past two decades. Current prevalence is estimated at 1 every 68 children, and because ASD is 5 times more frequent in males, it can be expected to reach 1 in 42 boys (1, 2).Prompt detection is important, because it allows for early referral to therapeutic interventions that can significantly improve long-term outcomes as well as to identify common comorbidities. As an example, early intensive behavioral intervention (EIBI) can improve communication skills, social relatedness and decrease repetitive behaviors (3). Early intervention strategies, combined with social support for the families can have a positive impact on the development of children with autism, improving their psychosocial adjustment (4, 5).ASD can be difficult to detect in young children and there are no biological markers to aid in diagnosis. During the first year of life, ASD infants usually appear to develop normally to parents and healthcare providers, achieving most gross-motor developmental milestones and even some basic language skills (6). Early signs and symptoms can be subtle, non-specific, and appear gradually (7). Parents' first concerns have been reported at 19 months of age; only 30% perceive concerning signs before the first year, whereas 80% notice them by the second year of age (8). Moreover, retrospective studies have shown that parents are able to recognize signs of ASD far earlier than their healthcare providers (9). Unfortunately, most children are not diagnosed until age four, particularly among families with low socio-economic status and underserved communities (10).Since 2006, the American Academy of Pediatrics has recommended routine developmental screening and standardized autism-specific screening at 18 and 24-month well-child care visits (11). Several tools have been developed for this; however the Modified Checklist for Autism in Toddlers (M-CHAT) is an instrument with good psychometrical characteristics and has been extensively studied and applied (12-15).In Chile there are no universal screening practices for ASD, therefore there is virtually no information available about the importance of this disorder (16). The aim of the present study was to determine whether M-CHAT is a feasible screening tool for risk of ASD in toddlers from two different medical centers (middle-low income and very low income), as well as to identify parents' perceptions and observations about this instrument in Chile.MethodsWe conducted a descriptive study in two primary healthcare centers in Santiago, Chile: San Joaquin Medical Center and Juan Pablo II Medical Center.San Joaquin (SJ) medical center, located in the municipality of SJ, has a population of 84,936 and a poverty rate of 7.4% (compared to 10.6% in the city of Santiago) (17). SJ medical center is a university-affiliated private medical center that concentrates a medium-low income community, where patients with both private and public healthcare insurance can attend. Patients usually come from different areas of Santiago and sometimes even from other cities. Juan Pablo II medical center is located in the municipality of La Pintana (LP), which has a population of 200,365 and a poverty rate of 17.2% (17) (the poorest in the province of Santiago)(18). Patients with public healthcare coverage receive cost-free services in their corresponding outpatient center. This is a university-affiliated public healthcare center that attends about 10% of LP's population.Informed consent was requested before participation in the study. This project was approved by the Ethical Review Board of the School of Medicine of Pontificia Universidad Catolica de Chile (for SJ) and by the Ethical Review Board of the Southwest Metropolitan Healthcare Service (for LP). This study included both quantitative and qualitative methodologies. …
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