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The Route to Autism Spectrum Diagnosis in Pediatric Practice in Bulgaria

Diagnosis of autism spectrum disorder (ASD) before the age of three years is a challenge. Analyzing the present practice may help reaching that goal. Aim: To investigate developmental abnormalities and diagnostic pathway of ASD patients in pediatric practice. Methods: Retrospective cross-sectional s...

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Autores principales: Ivanov, Ivan, Pacheva, Iliyana, Timova, Elena, Iordanova, Ralitsa, Galabova, Fani, Gaberova, Katerina, Petkova, Aneliya, Kotetarov, Vasil, Panova, Margarita, Tonchev, Nikolay, Franz, Lauren
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827839/
https://www.ncbi.nlm.nih.gov/pubmed/33440823
http://dx.doi.org/10.3390/diagnostics11010106
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author Ivanov, Ivan
Pacheva, Iliyana
Timova, Elena
Iordanova, Ralitsa
Galabova, Fani
Gaberova, Katerina
Petkova, Aneliya
Kotetarov, Vasil
Panova, Margarita
Tonchev, Nikolay
Franz, Lauren
author_facet Ivanov, Ivan
Pacheva, Iliyana
Timova, Elena
Iordanova, Ralitsa
Galabova, Fani
Gaberova, Katerina
Petkova, Aneliya
Kotetarov, Vasil
Panova, Margarita
Tonchev, Nikolay
Franz, Lauren
author_sort Ivanov, Ivan
collection PubMed
description Diagnosis of autism spectrum disorder (ASD) before the age of three years is a challenge. Analyzing the present practice may help reaching that goal. Aim: To investigate developmental abnormalities and diagnostic pathway of ASD patients in pediatric practice. Methods: Retrospective cross-sectional study of 192 children aged 13 months to 17 years 11 months (average 4 years 9 months), investigated in an outpatient and hospital setting from January 2015 to June 2018 by a semi-structured history and clinical examination, and diagnosed with ASD by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Results: Behavioral peculiarities were detected in the history of the first two years of life in 74.8% of the subjects. The first developmental abnormalities were noticed by the parents at ages from 8 to 36 months (mean 15.6 months) and were predominantly in speech (in 94.6%) and non-verbal communication (11.3%). Developmental regression was reported in 42.1% of the patients occurring between the ages of 6 and 50 months (mean 17.9 months), affecting most commonly speech (88.4% of cases), non-verbal communication (29.2%), and behavior (12.8%). By history, the first manifestations of ASD were noticed at ages from 8 months to 84 months (mean 18.5 months), and were disorders of expressive speech (in 66.7% of cases), receptive speech (in 45.8%), non-verbal communication (35.4%), behavior (27.6%), play (8.9%), socialization (5.7%), and joint attention (2.1%). The most common motive for specialized consultation was delay in language development—in 84.6% of children. The age of ASD diagnosis varied between 12 and 132 months (mean 39.7 months), and the time period between first ASD manifestations and diagnosis was in the range of 0 to 79 months (mean 23.3 months). Many symptoms of abnormal social communication, unnoticed by parents, were detected objectively in more than 95% of the cases—absent or rare spontaneous or reciprocal smile; lack of sharing of interest or affect; abnormal eye contact; lack of finger pointing; lack of gaze to a pointed object; poor facial expressions; lack of imaginary play, etc. Conclusions: Almost two years are needed for diagnosing abnormal development in other domains besides speech in ASD patients. Diagnosis before the age of three years can be achieved by focusing parents’ and pediatricians’ attention on social communication and behavior in patients with speech delay or developmental regression.
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spelling pubmed-78278392021-01-25 The Route to Autism Spectrum Diagnosis in Pediatric Practice in Bulgaria Ivanov, Ivan Pacheva, Iliyana Timova, Elena Iordanova, Ralitsa Galabova, Fani Gaberova, Katerina Petkova, Aneliya Kotetarov, Vasil Panova, Margarita Tonchev, Nikolay Franz, Lauren Diagnostics (Basel) Article Diagnosis of autism spectrum disorder (ASD) before the age of three years is a challenge. Analyzing the present practice may help reaching that goal. Aim: To investigate developmental abnormalities and diagnostic pathway of ASD patients in pediatric practice. Methods: Retrospective cross-sectional study of 192 children aged 13 months to 17 years 11 months (average 4 years 9 months), investigated in an outpatient and hospital setting from January 2015 to June 2018 by a semi-structured history and clinical examination, and diagnosed with ASD by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Results: Behavioral peculiarities were detected in the history of the first two years of life in 74.8% of the subjects. The first developmental abnormalities were noticed by the parents at ages from 8 to 36 months (mean 15.6 months) and were predominantly in speech (in 94.6%) and non-verbal communication (11.3%). Developmental regression was reported in 42.1% of the patients occurring between the ages of 6 and 50 months (mean 17.9 months), affecting most commonly speech (88.4% of cases), non-verbal communication (29.2%), and behavior (12.8%). By history, the first manifestations of ASD were noticed at ages from 8 months to 84 months (mean 18.5 months), and were disorders of expressive speech (in 66.7% of cases), receptive speech (in 45.8%), non-verbal communication (35.4%), behavior (27.6%), play (8.9%), socialization (5.7%), and joint attention (2.1%). The most common motive for specialized consultation was delay in language development—in 84.6% of children. The age of ASD diagnosis varied between 12 and 132 months (mean 39.7 months), and the time period between first ASD manifestations and diagnosis was in the range of 0 to 79 months (mean 23.3 months). Many symptoms of abnormal social communication, unnoticed by parents, were detected objectively in more than 95% of the cases—absent or rare spontaneous or reciprocal smile; lack of sharing of interest or affect; abnormal eye contact; lack of finger pointing; lack of gaze to a pointed object; poor facial expressions; lack of imaginary play, etc. Conclusions: Almost two years are needed for diagnosing abnormal development in other domains besides speech in ASD patients. Diagnosis before the age of three years can be achieved by focusing parents’ and pediatricians’ attention on social communication and behavior in patients with speech delay or developmental regression. MDPI 2021-01-11 /pmc/articles/PMC7827839/ /pubmed/33440823 http://dx.doi.org/10.3390/diagnostics11010106 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Ivanov, Ivan
Pacheva, Iliyana
Timova, Elena
Iordanova, Ralitsa
Galabova, Fani
Gaberova, Katerina
Petkova, Aneliya
Kotetarov, Vasil
Panova, Margarita
Tonchev, Nikolay
Franz, Lauren
The Route to Autism Spectrum Diagnosis in Pediatric Practice in Bulgaria
title The Route to Autism Spectrum Diagnosis in Pediatric Practice in Bulgaria
title_full The Route to Autism Spectrum Diagnosis in Pediatric Practice in Bulgaria
title_fullStr The Route to Autism Spectrum Diagnosis in Pediatric Practice in Bulgaria
title_full_unstemmed The Route to Autism Spectrum Diagnosis in Pediatric Practice in Bulgaria
title_short The Route to Autism Spectrum Diagnosis in Pediatric Practice in Bulgaria
title_sort route to autism spectrum diagnosis in pediatric practice in bulgaria
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827839/
https://www.ncbi.nlm.nih.gov/pubmed/33440823
http://dx.doi.org/10.3390/diagnostics11010106
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