Clinical Practices Regarding Autism Spectrum Disorders among General Practitioners in Karachi, Pakistan and How They Compared to Practices in the United States

Background:   

The prevalence of Autism Spectrum Disorders (ASD) appears to be on the rise in developed countries, and has become a serious public health concern. In most developing countries, however, the nature and prevalence of factors associated with ASDs are unknown. As the first step in conducting population based epidemiological studies in Pakistan, we conducted a survey to assess knowledge, attitudes and practices of the General Practitioners (GPs) in Karachi, the largest city in Pakistan. It is important to better understand how the medical community of Pakistan conceptualizes this developmental disorder.
Karachi provided an ideal location for an exploratory epidemiological study in Pakistan. The study location provided diversity not only in culture but also in living situations. Pakistani's migrate to Karachi from all over the Country; similarly physicians from very different backgrounds practice in this metropolitan city.
Objectives:

1. To assess clinical practices of general practitioners as it pertains to ASD in Karachi, Pakistan.
2. To compare behavioral identifiers used to diagnose autism in Pakistan and how they compare with first line diagnostic surveys used in the United States (MCHAT and CARS).
Methods:
In a study period lasting from June 2007 through August of 2007, a sample of 346 physicians were systematically selected from a database of general practitioners. We implemented a survey to better understand their knowledge, attitudes and practices as it pertained to treating patients with autism spectrum disorders.
The survey instrument compromised of three major parts:
1.      Demographics: Included demographic information such as their age, sex, medical background, patient load, and area of interest in the field of medicine.
2.      Knowledge and Exposure: Exposure to the term "autism" and source of exposure. Whether they had a working knowledge of autism for diagnosis.
3.      Attitudes and Practices: Questions regarding their attitudes towards ASD and their diagnostic criteria. Finally, from a list of behavioral symptoms which behavioral observations are necessary, not necessary but helpful, or not necessary in diagnosing ASD.
Results:

Among the physicians interviewed only 42 % (n=146) had heard of the term “autism”.  Furthermore only 17% (n =60) of the total sample size indicated they had a working knowledge to diagnose ASD. Only subjects from this latter sample were asked questions regarding their practices.
Out of the physicians who made it to the practices section of the survey the vast majority correctly identified impaired social interaction and impaired communication as potential identifiers for ASD ( 92%,83%). On the other hand, 23% said “hearing voices” was “necessary” in making a diagnosis for ASD and 25% said it was “helpful but not necessary” for diagnosis. Similarly, 20% of this sample indicated that hallucinations were a “necessary” behavioral characteristic for diagnosing ASD.
Conclusions:

This investigation further uncovers the autism diagnosis and referral system in the cultural context of Karachi, Pakistan. It is most important to understand these criteria in order to effectively focus our attention in medical education and seminars for currently practicing physicians.