Cargando…
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...
Autores principales: | , , , , , , , , , , |
---|---|
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 |
_version_ | 1783640865043906560 |
---|---|
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. |
format | Online Article Text |
id | pubmed-7827839 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT ivanovivan theroutetoautismspectrumdiagnosisinpediatricpracticeinbulgaria AT pachevailiyana theroutetoautismspectrumdiagnosisinpediatricpracticeinbulgaria AT timovaelena theroutetoautismspectrumdiagnosisinpediatricpracticeinbulgaria AT iordanovaralitsa theroutetoautismspectrumdiagnosisinpediatricpracticeinbulgaria AT galabovafani theroutetoautismspectrumdiagnosisinpediatricpracticeinbulgaria AT gaberovakaterina theroutetoautismspectrumdiagnosisinpediatricpracticeinbulgaria AT petkovaaneliya theroutetoautismspectrumdiagnosisinpediatricpracticeinbulgaria AT kotetarovvasil theroutetoautismspectrumdiagnosisinpediatricpracticeinbulgaria AT panovamargarita theroutetoautismspectrumdiagnosisinpediatricpracticeinbulgaria AT tonchevnikolay theroutetoautismspectrumdiagnosisinpediatricpracticeinbulgaria AT franzlauren theroutetoautismspectrumdiagnosisinpediatricpracticeinbulgaria AT ivanovivan routetoautismspectrumdiagnosisinpediatricpracticeinbulgaria AT pachevailiyana routetoautismspectrumdiagnosisinpediatricpracticeinbulgaria AT timovaelena routetoautismspectrumdiagnosisinpediatricpracticeinbulgaria AT iordanovaralitsa routetoautismspectrumdiagnosisinpediatricpracticeinbulgaria AT galabovafani routetoautismspectrumdiagnosisinpediatricpracticeinbulgaria AT gaberovakaterina routetoautismspectrumdiagnosisinpediatricpracticeinbulgaria AT petkovaaneliya routetoautismspectrumdiagnosisinpediatricpracticeinbulgaria AT kotetarovvasil routetoautismspectrumdiagnosisinpediatricpracticeinbulgaria AT panovamargarita routetoautismspectrumdiagnosisinpediatricpracticeinbulgaria AT tonchevnikolay routetoautismspectrumdiagnosisinpediatricpracticeinbulgaria AT franzlauren routetoautismspectrumdiagnosisinpediatricpracticeinbulgaria |