Developing Autism Early Identification, Treatment and Research Strategies in Argentina

Background: The concept of public health is relatively new in Latin America where general knowledge about ASDs is poor.  In Argentina, most of the trained clinicians, diagnostic and treatment resources, and medical infrastructure are centralized in the capital, Buenos Aires, and knowledge and resources in the interior of the country are largely lacking.

Objectives: To conduct a pilot project to address ASD knowledge and resource gaps in Argentina and to build public health infrastructure for ASD across the country.  Specifically, we are 1) developing and solidifying collaborative relationships with stakeholders in Argentina who can influence infrastructure development for autism public health initiatives, 2) developing and conducting a community-based and culturally-sensitive early detection project in a representative mid-sized Argentine city to establish the screening prevalence of ASD among toddlers, and 3) developing a feasible, generalizable and cost effective model program of autism service delivery in the country.

Methods: This 2-year pilot project is an international collaboration between researchers and clinicians from the US and Argentina.  In the first year, we will identify additional stakeholders and conduct a needs assessment to identify knowledge gaps, resource needs, and priority research questions; conduct a structured survey among health and education professionals to examine knowledge about ASD, approaches to ASD diagnosis, and behaviors regarding referral to ASD services; and develop culturally-relevant strategies for raising autism awareness in Argentina.  In year two, the binational team will conduct an ASD screening project in a typical city in the interior of the country.  The general toddler population (18 - 36 months) will be screened with the M-CHAT (Spanish version) through the various healthcare and educational settings serving children <4 years of age.  Children who fail the screener will be referred for follow-up diagnostic assessment using AOSI for children <2 and ADOS  for children >2, Mullen Scales of Early Learning and VABS-II.  Children diagnosed with ASD will receive early intervention based on the Early Start Denver Model (ESDM). Following a “train the trainer” model, Argentine co-investigators will receive training on ESDM in the US, and then will conduct ESDM training in Olavarría for health professionals, who in turn will train parents.

Results: A summary of the results from the needs assessment, the development of the provider survey and strategies for the ASD awareness campaign will be presented.  We estimate a population of approximately 4500 children between 1-3 years of age available for the screening project.  

Conclusions: This project addresses significant barriers to early identification, diagnosis and treatment of autism in Argentina by increasing public and professional awareness of autism spectrum disorders, increasing knowledge of public health research methodology, and providing training and expertise to health providers and educators in early identification and diagnosis. It will build infrastructure in Argentina for early identification and population-based surveillance of children with ASDs which is necessary for future health planning initiatives, risk factor studies, and appropriate clinical interventions.  Through this effort, in-country and international relationships will be strengthened and expanded and the ASD research and clinical capacity in Argentina will be greatly enhanced.