Parental Recognition of Early Signs of ASD in Venezuelan Children

Background:

It has been suggested that parents of children with ASD notice abnormalities during the first 2 years of life. Most common concerns are related to language and speech delays, as well as lack of social responses.  It is of relevance to explore how consistent early signs of ASD and parental recognition are among countries.

Objectives:

The current study provides data on the age of diagnosis of ASD, on the first concerns according to parents report, and also on the age of onset of those symptoms. 

Methods:   106 children between 2 and 7 years of age( (mean age 4.55 years)  underwent a comprehensive evaluation as part of an epidemiological  study of autism in Venezuelan children.  The assessment protocol included the Raven progressive matrices test, and the Autism Diagnostic Observation Scales–G, Parents were interviewed with the Vineland Adaptive Behaviors Scales Expanded  and Autism Diagnostic Interview-Revised (ADI-R)  . Information regarding the age of parental recognition, as well as the description of the first signs was ascertained using the ADI-R.

Results:

38% of parents reported that the first concerns were present before the first birthday, while 58.4%  by 18 months; with a mean age for first concerns of 17 months.  Those first concerns were related mainly to delays in speech and language (49.4%), lack of response to name and environment (52.8), restricted interest and stereotyped behaviors (28.1%), other behaviors and medical problems (53.9%), and loss of skills (7.9%). When comparing children with autism and children with PDD-NOS, we found that speech delays and abnormalities in social interaction were more frequent in children with autism than in those with PDD but did not reach statistical significance. On the contrary, restriction of interests/stereotyped behaviors and medical problems were significantly more prevalent in the autistic children(p=0.05). Loss of skills, particularly loss of speech, was present only in the autistic group.  Although the mean age of first concerns was 17 months, the mean age at diagnosis was 53 months.

Conclusions:

Results of this study suggest that parents are aware of abnormal or atypical behaviors in their children during the first year of life, which does not differ from reports in other parts of the world. Consistent with previous reports, there is a wide gap between recognition of first signs and the final diagnosis, which might be affected by cultural factors related to availability of services, and the impact of having a child with developmental delays. In Latin cultures, behavior problems are usually attributed to poor parenting skills, so parents might take longer to reach for professional help. The symptoms that triggered parents´ recognition were mostly related to language and speech delay, and lack of response to name and environmental delays which have been the pattern described in studies carried in other countries. These results have clinical implications for screening, diagnosis, and intervention. Health authorities from Venezuela and from other Latin-America countries must develop public health policies to correctly identity and diagnose ASD children, and clinicians must actively search for them to provide the best-available treatment.