Mexican Pediatricians´ Role in the Early Identification and Intervention of Autism Spectrum Disorder

Background:  Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that usually manifests itself before age two. It principally affects a person’s social communication and behavior, but impairment in other developmental domains (e.g., cognitive, motor) is frequently observed. The presence of these behaviors at such an early age provides a knowledgeable health care practitioner with an opportunity to refer a young child to a specialist in ASD to conduct a comprehensive evaluation and diagnosis. In this study, we surveyed the knowledge of Mexican pediatricians with respect to early signs of ASD as well as their perception about the challenges of treating patients with autism.

Objectives:  N/A

Methods:  In order to address this question, we conducted face-to-face interviews with 400 pediatricians (33% female) in private practice in Mexico City (n=200), Guadalajara (n=100), and Monterrey (n=100). In order to qualify for the interview, the pediatricians had at least 10 years of clinical experience. Our interview included questions used in other studies with adaptation to the Mexican population, including questions about prevalence, behavioral characteristics and diagnostic criteria, early signs, effective interventions and treatment, and continuing education. Each interview lasted, on average, 40 minutes. Pediatricians were paid their hourly fee for participating in the interview.

Results:  Only 12% of the participants reported a number close to the actual prevalence of ASD in Mexico (1 in 115), with the remaining pediatricians reporting outdated data (between 1 in 300 and 1 in 1000). With regards to the male/female ratio, 43% of pediatricians reported the accurate 4 to 1 ratio. In relation to the diagnostic characteristics reported in the DSM-5, almost 50% of the participants correctly identified repetitive and restricted patterns of behaviors, 46% reported reactions to loud noises, 38% mentioned unusual responses to physical contact, 35% difficulties in social communication and social interaction, and 28% difficulties in the use of gestures for communication. When talking about early signs, 57% of participants correctly identified abnormal eye contact and playing alone, 47% language delays, and 39% repetitive motor movements. Only 18% of the participants reported reduced social response to name and 30% repetitive patterns of behavior as early signs of ASD. When asked about effective interventions and treatment, 36% mentioned that some form of therapy (language, behavioral and psychological) was the most effective intervention to improve the course of ASD and that follow up with neurologists and psychologists was also effective according to 34% of the interviewed. Finally, 56% reported that they participate in activities related to continued education, 40% in a Pediatrics National Conference (Mexico); however, this conference is not specific to ASD.

Conclusions:  Results indicate that Mexican pediatricians have limited knowledge specific to early identification and diagnosis of ASD. Given that early identification allows for the provision of early treatment, which has been demonstrated to improve the quality of life of children and families impacted by autism, it is of utmost importance that pediatricians obtain specialized training to better serve Mexican children at risk of ASD.