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Background: The diagnosis and treatment of Autism in Pakistan occurs in multiple settings and is provided by variety of health professionals. Unfortunately, knowledge and awareness about Autism is low among Pakistani healthcare professionals & the presence of inaccurate and outdated beliefs regarding this disorder may compromise early detection and timely referral for interventions. The study assessed the baseline knowledge and misconceptions regarding autism among healthcare professionals in Pakistan which can impact future awareness campaigns. Methods: Physicians (psychiatrists, pediatricians, neurologists and family physicians) and non-physicians (psychologists and speech therapists) participated in this study. Knowledge of DSM-IV TR criteria for Autistic Disorder, beliefs about social, emotional, cognitive, treatment and prognosis of the disorder were assessed. Demographic information regarding the participants of the survey was also gathered. Results: Two hundred and forty seven respondents (154 Physicians & 93 Non-physicians) participated in the study. Mean age of respondents was 33.2 years (S.D 11.63) with 53% being females. Reasonably accurate familiarity with the DSM IV-TR diagnostic criteria of Autistic Disorder was observed. However, within the professional groups, differences were found regarding the utilization of the DSM-IV-TR criteria when diagnosing Autistic Disorder. Non-Physicians were comparatively more likely to correctly identify diagnostic features of autism compared with Physicians (P-value<0.001). Significant misunderstandings of some of the salient features of autism were present in both professional groups. Conclusion: Results suggests that current professionals in the field have an unbalanced understanding of autism due to presence of several misconceptions regarding many of the salient features of autism including developmental, cognitive and emotional features. The study has clinical implications and calls for continued education for healthcare professionals across disciplines with regards to Autism in Pakistan.
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A survey of Autism knowledge and attitudes
among the healthcare professionals in Lahore,
Nazish Imran
, Mansoor R Chaudry
, Muhammad W Azeem
, Muhammad R Bhatti
, Zaidan I Choudhary
Mohsin A Cheema
Background: The diagnosis and treatment of Autism in Pakistan occurs in multiple settings and is provided by
variety of health professionals. Unfortunately, knowledge and awareness about Autism is low among Pakistani
healthcare professionals & the presence of inaccurate and outdated beliefs regarding this disorder may
compromise early detection and timely referral for interventions. The study assessed the baseline knowledge and
misconceptions regarding autism among healthcare professionals in Pakistan which can impact future awareness
Methods: Physicians (psychiatrists, pediatricians, neurologists and family physicians) and non-physicians
(psychologists and speech therapists) participated in this study. Knowledge of DSM-IV TR criteria for Autistic
Disorder, beliefs about social, emotional, cognitive, treatment and prognosis of the disorder were assessed.
Demographic information regarding the participants of the survey was also gathered.
Results: Two hundred and forty seven respondents (154 Physicians & 93 Non-physicians) participated in the study.
Mean age of respondents was 33.2 years (S.D 11.63) with 53% being females. Reasonably accurate familiarity with
the DSM IV-TR diagnostic criteria of Autistic Disorder was observed. However, within the professional groups,
differences were found regarding the utilization of the DSM-IV-TR criteria when diagnosing Autistic Disorder. Non-
Physicians were comparatively more likely to correctly identify diagnostic features of autism compared with
Physicians (P-value <0.001). Significant misunderstandings of some of the salient features of autism were present in
both professional groups.
Conclusion: Results suggests that current professionals in the field have an unbalanced understanding of autism
due to presence of several misconceptions regarding many of the salient features of autism including
developmental, cognitive and emotional features. The study has clinical implications and calls for continued
education for healthcare professionals across disciplines with regards to Autism in Pakistan.
Autism Spectrum Disorders (ASD) are pervasive and
lifelong neurodevelopmental disorders characterized by
impaired socialization, impaired verbal and nonverbal
communication, and restricted interests and repetitive
patterns of behavior [1]. It is believed to be one of the
fastest growing disabilities in children [2,3]. Although
knowledge and research on ASDs are on the rise world-
wide [4], most studies across different nations, have
reported wide variation among healthcare professionals
regarding diagnosis, treatment and prognosis of Autism.
An earlier survey by Stone et al. (1987) clearly demon-
strated that many professionals in various disciplines did
not possess accurate knowledge about Autism and its
manifestations in children and adolescents [5]. Autism
was thought to be a temporary disability and rooted in
emotional factors. Variations were also found between
the primary care providers (family physicians,
* Correspondence:
Child & Family Psychiatry Department, King Edward Medical University/
Mayo Hospital, Lahore, Pakistan
Full list of author information is available at the end of the article
Imran et al.BMC Pediatrics 2011, 11:107
© 2011 Imran et al; licensee BioMed Central Lt d. This is an Open Access artic le distributed under the terms of the Creative Commons
Attribution License (http://creative, which permits unrestricted use, distribution, and reproduction in
any medium, pro vided the original work is properly cited.
pediatricians & neurologists) and specialists (child psy-
chiatrists, speech therapists and psychologists) in a sur-
vey of autism knowledge in the United States[6]. Health
care workers (HCW) in Sub-Saharan African subcul-
tures were also found to have various misconceptions
regarding etiology, treatment and prognosis of Autism
spectrum disorders [7,8]. A survey conducted by the
African Network for the Prevention and Protection
against Child Abuse and Neglect(ANPPCAN) in 2007
showed low to moderate level of knowledge about aut-
ism among the various categories of healthcare workers
(HCW) with highest level of awareness in healthcare
workers of psychiatric facilities in the region [9]. Look-
ing at the studies from subcontinent, Indian psychia-
trists, psychologists, and pediatricians generally agreed
on characteristics required to diagnose Autism [10],
while in another study done in Karachi, Pakistan, Gen-
eral Practitioners who were less than 30 years of age
and five or fewer years after acquisition of their medical
degrees, were found to be more informed and accurate
in their understanding of Autism[11].
In Pakistan, child psychiatric services are still in their
infancy. There are no formal referral pathways to psy-
chiatric centers for children. The diagnosis and treat-
ment of Autism occurs in multiple settings and is
provided by variety of health professionals including
family physicians, pediatricians, neurologists, psychia-
trists, psychologists and speech & language therapists.
Most of these health professionals have little or no for-
mal training in child and adolescent psychiatry [12,13].
Thus many questions regarding this puzzling disorder
remain unanswered in Pakistan. Unfamiliarity with
DSM-IV TR diagnostic criteria of Autistic Disorder and
the presence of inaccurate and outdated beliefs held by
Pakistani healthcare professionals may have delayed the
positive effects which early interventions have been
shown to have upon the prognosis [14,15]. To date, little
research has been published from developing countries
regarding the above mentioned issues. The present
study seeks to address this knowledge gap in Pakistan.
The Institutional Review Board of King Edward Medical
University, Lahore, Pakistan approved this study. The
study was conducted between August 2009 and January
2010 in Lahore, which is the second largest city of Paki-
stan. Respondents were recruited in two ways. All psy-
chiatrists, psychologists, neurologists, pediatricians, and
speech & language therapists with minimum of six
months of clinical experience in all five teaching hospi-
tals within the public sector in Lahore were invited to
participate in the study. In addition, family physicians
were recruited by distributing the questionnaire in two
consecutive Continuing Medical Education meetings
organized by Pakistan Academy of Family Physicians
(Lahore Chapter). The speech therapists who partici-
pated were also recruited from an Institute in Lahore,
Pakistan which at the time of study was the only one
providing a qualification course in speech therapy in the
The survey form used, comprised of four sections
(Additional file 1). The first section queried participants
about their background and experience with autism.
The second listed ten behaviors or characteristics of aut-
ism according to DSM IV-TR diagnostic criteria.
Respondents were asked to rate the characteristics as
Necessary,Helpful but Not Necessaryor Not Help-
fulfor the diagnosis of Autistic Disorder. Among the
items of each of the three options, only the category of
Necessarycomprised factors representing the correct
diagnosis of Autism. The three categories were mutually
exclusive. When multiple categories were assigned to
the same item, those responses were discounted.
The third segment was a modified version of a section
of Autism Survey as developed by Stone et al. [5] which
has been shown to demonstrate rigorous psychometric
properties [16]. Twenty-two beliefs regarding social,
emotional, cognitive, treatment and prognostic aspects
of Autism were presented. Some items of the standar-
dizedAutismSurveyweresubstituted with more com-
mon mistaken notions regarding Autism in Pakistan.
These were established while piloting the four section
questionnaire. The respondents were instructed to rate
each statement either as Agree,orNot Sure,or
The final part of the survey queried various treatment
options considered helpful by the professionals.
The data was analyzed by using SPSS Version 17.0
[17]. Descriptive statistics of socio-demographic infor-
mation were gathered. For the purpose of analysis,
healthcare professionals were separated into two groups;
Physicians (family physicians, pediatricians, psychiatrists,
neurologists) and non-physicians (psychologists, speech
and language therapists). For all purposes, a p-value of
<0.05 was considered statistically significant.
The total number of surveys distributed was three hun-
dred and twenty-five. Two hundred and sixty three were
returned representing a response rate of 80.9%. Sixteen
questionnaires were incomplete and excluded. The final
total of respondents numbered two hundred and forty
seven. Mean age of respondents was 33.2 years (S.D
11.63) with 53% being females. Physicians were hundred
and fifty four (48 family physicians, 63 pediatricians, 36
psychiatrists and 7 neurologists). Non-physicians were
ninety three (79 psychologists and 14 speech therapists).
A significantly higher number of physicians than non-
Imran et al.BMC Pediatrics 2011, 11:107
Page 2 of 6
physicians had encountered youths with Autism in their
clinical practice, i.e. 77 compared with 58 (P value =
0.042). About 70% of both groups were practicing for
less than five years. An increase in the number of years
of practice was directly related to a larger number of
affected youths seen (P value <.001).
Table 1 compares the rankings of the relevance of var-
ious aspects/behaviors when considering a diagnosis of
Autistic Disorder as considered by Pakistani physician
and non-physician groups.
Table 2 shows the responses of Pakistani physicians
and non-physician groups regarding general beliefs
about Autism, its prognosis and treatment.
Regarding interventions, psychotropic medications
were considered helpful by 70% of respondents. 27.1%
regarded mood stabilizers as useful; psychostimulants
were endorsed by 24.8%, followed by antipsychotics,
23.1%; antidepressants, 18.3% and hypnotics, 4.2%.
Speech therapy and special educational interventions
were found helpful by 75% and 68% of respondents
Based upon our review of the relevant medical literature,
the current study is the first to examine the knowledge
of standardized diagnostic criteria of Autistic Disorder
and the beliefs about the disorder held by Pakistani
healthcare professionals from various disciplines. In gen-
eral, the different professionals appear to have a similar
impression of the disorder as represented by the social
deficits, communication difficulties and restricted inter-
ests demonstrated by children with Autism. An impor-
tant finding is that the early onset of the disorder, that
is before 36 months of age; (a diagnostic hallmark of
Autism) is either unknown/undervalued and/or not
applied in the diagnostic process. Studies have found
parents of children with Autism noticing and then
voicing their concerns to health professionals, when
their children were between the ages of fifteen to nine-
teen months [18,19]. However this recognition does not
necessarily translate to an early diagnosis by the health-
care professionals. One of the main presentations of
Autism is speech delay but that is not considered atypi-
cal in Pakistan at thirty six months or beyond, resulting
in many children being assessed, referred and diagnosed
far beyond early childhood. Accounting for this lack of
emphasis on early age of presentation may be the lack
of understanding of typical presenting complaints, reluc-
tance and fear of labeling a child at an early age, and/or
the overlap of symptoms of autism with other comorbid
disorders such as cognitive delay. Changing the negative
opinions and beliefs of HCW regarding autism should
encourage appropriate help seeking behaviors among
parents leading to encouragement of early interventions
which are essential for favorable prognosis.
Differences between the groups were shown by discre-
pant views about the relevance of particular characteris-
tics used when diagnosing Autism. The discrepancy in
knowledge found among healthcare workers was not
totally unexpected due to health service structure in
Pakistan. This is also consistent with the results of pre-
vious studies documenting some differences and misper-
ceptions about various aspects of autism across
disciplines [5,6,11,20,21]. Since child specialty centers in
Pakistan are few, many of the children with Autism and
intellectual disabilities are first referred to special educa-
tion centers by various professionals, usually without
comprehensive assessments and standardized diagnostic
evaluations. Youth in the Autism spectrum are more
likely to be brought to psychiatric facilities to treat
externalizing behaviors and aggression, intellectual
delays affecting motor, feeding, or late onset of develop-
mentally appropriate self-care functions or epilepsy.
These difficulties are considered to be areas of practice
Table 1 Comparative Percent Rankings of Characterstics as NecessaryFor Diagnosis of Autism Among Physicians
and Non Physicians Group.
Rank PHYSICIANS Percentage Rank NON -PHYSICIANS Percentage
Diagnostic characteristics Diagnostic characteristics
1 Social interaction difficulties 73.2 1 Social interaction difficulties 95.7
2 Lack of social responsiveness 71.1 2 Lack of social responsiveness 92.4
3 Lack of eye contact 68.0 3 Rigid or stereotyped play activities 90.2
4 Language delays 65.4 4 Lack of eye contact 88.2
5 Rigid or stereotyped play activities 59.7 5 Need for sameness, resistance to change in routines 85.7
6 Onset of symptoms before 36 months 56.2 6 Language delays 78.7
7 Need for sameness, resistance to change in routines 53.6 7 Preoccupation with objects. 72.7
8 Unusual mannerisms such as finger flicking 47.6 8 Peculiar speech characteristics 69.2
9 Peculiar speech characteristics 43.5 9 Onset of symptoms before 36 months 59.1
10 Preoccupation with objects. 41.1 10 Unusual mannerisms such as finger flicking 54.9
Imran et al.BMC Pediatrics 2011, 11:107
Page 3 of 6
of psychiatrists and psychologists in Pakistan. Family
physicians and pediatricians in most cases have no for-
mal child psychiatry exposure during their training and
feel less confident in assessing and managing these chil-
dren. Similar to the global trend, in Pakistan, family
physicians and pediatricians are typically the first medi-
cal professionals to whom parents will express their
concerns regarding the childs development. The need
for these medical practitioners to be equipped with
more knowledge about Autism cannot be over empha-
sized in order to aid early diagnosis and interventions
[22,23]. On the other hand majority of psychologists
and speech therapists have internships in special educa-
tion centers during their training and therefore perhaps
are more aware of the typical presentations and diagnos-
tic criteria of Autism. Our results differ in this respect
to a study done in Nigeria in which undergraduate med-
ical students were more likely to recognize symptoms
and signs of autism compared to nursing and Psychol-
ogy students [24].
Respondents in our study also shared several miscon-
ceptions regarding autism across social, emotional,
cognitive and general descriptive features of autism,
which are consistent with previous studies showing sig-
nificant differences in healthcare professionals, parents,
teachers and medical studentsknowledge regarding
possible causes, cognitive profiles, treatment and prog-
nosis of autism[5,24-26].
DSM IV-TR diagnostic criteria require delays and
impairments being present in the first 36 months of life
and respondents in this study were likely to agree that
Autism is a developmental disorder, but also classified it
as an emotional disorder. The mistaken overlap of these
pathophysiologic distinct categories may be linked to
the relative low incidence of recognition of impairments
in early life as one of the features for diagnosing Autism.
Non Physicians were again more likely to consider aut-
ism as a developmental disorder. The participating
health professionals were also likely to endorse the out-
dated view that the cause of social withdrawal in Autism
was a parental bonding and child attachment difficulty.
Even though the etiology credited once to aloof, reject-
ing parenting, now this has been shown irrelevant by
researchers in the field [27].
Table 2 Comparison Of Physicians and Non- Physicians Regarding General Beliefs about Autism.
Beliefs Physicians
N = 154
Responses (%)
Non -Physicians
Responses (%)
1 Autism can occur in mild as well as extreme form 84.8 93.4 .004*
2 Children with autism usually grow up to be schizophrenic adults 24 17.4 0.306
3 Autism is an emotional disorder 40.4 23.9 .001*
4 Most children with autism are also mentally retarded 34.9 46.7 0.17
5 It is difficult to distinguish between autism and childhood schizophrenia 37.9 28.6 0.077
6 Autism occurs more commonly among higher socio economic and educational levels 25.7 20.7 0.667
7 Autistic childrens withdrawal is mostly due to cold, rejecting parents 42.5 35.6 0.424
8 Most children with autism have special talents or abilities 55.9 69.2 0.061
9 Autism is a rare condition in this country as compared with the West 33.6 36.4 0.852
10 Autism is under-recognized and often missed in general practice 85.5 70.1 .003*
11 There is a lack of awareness regarding autism among professionals in Pakistan 86.7 76.1 0.072
12 Autism is a communication disorder 56 46.7 .022*
13 Children with autism do not show social attachments, even to parents 57.8 74.2 .009*
14 It is impossible to tell if a child has autism before four years of age 23.1 27.2 .001*
15 Autism exists only in childhood 43.1 50.5 .028*
16 Even with early intervention, the prognosis for independent community functioning of
individuals with autism is poor
32.9 46.7 .028*
17 Autism is a developmental disorder 51 71 .009*
18 With the proper treatment, most children with autism eventually outgrowautism. 49.3 44 0.469
19 Autism is a lifelong condition 44.6 51.6 0.561
20 Children with autism are untestable.34 20.2 .003*
21 Parental counseling on training techniques is one effective treatment of autism. 76.2 96.8 .001*
22 Dietary intervention is one of treatment options 35.6 50 0.038
(% given are the respondents answering in affirmative)
Imran et al.BMC Pediatrics 2011, 11:107
Page 4 of 6
Outdated views regarding the course of Autism were
also observed with the majority believing that Autism
exists only in childhood and many children will outgrow
the disorder with proper treatment. This is similar to
results reported by previous studies [5].
While not corroborative with the previously noted
survey misconception, study respondents endorsed that
a child with Autism is more likely to grow up to be an
adult with Schizophrenia, consistent with speculation of
Autism as an early form of Schizophrenia [27]. This
finding may support that respondents have difficulty dis-
tinguishing between Autism and Childhood-Onset Schi-
zophrenia. This response further supports that
healthcare professionals in Pakistan feel less comfortable
in diagnosing children with Autism. Recent research on
the other hand shows less likelihood of the presence of
autism symptoms in patients with schizophrenia [28].
Overall, the results of our study have significant clini-
cal implications. The fact that more than a quarter of
study participants were not likely to endorse the need
for speech therapy and special education services, they
were also less likely to advocate for these much needed
services for children with Autism in Pakistan.
In order to improve child mental health in Pakistan,
physicians and other relevant professionals working in
large cities do have a significant role to play in disse-
minating accurate information and providing training
to other healthcare workers about Autism. The need
to improve the areas of knowledge gaps identified by
this study cannot be overemphasized. Some of the
ways to help with this huge task may be to incorporate
important aspects of child developmental disorders in
undergraduate and post graduate medical curriculum.
The visits to special schools especially for pediatricians
and family physicians during their training could be
beneficial. Various conference forums and the effective
use of media to promote evidence based medicine and
the erosion of myths about Autism held by the general
population and in particular among the healthcare pro-
emphasis is needed to implement policies to change
the negative attitudes of health professionals regarding
various aspects of autism to promote care for children
with Autism Spectrum Disorders in this region. It
should include continuous medical education of Pedia-
tric and Psychiatric nursing staff as well because they
are expected to provide counseling to families of these
Several limitations exist with the design of the cur-
rent study and must be considered when interpreting
and placing value on the results obtained. The largest
limitation was the sample size. Although several efforts
teaching hospitals in public sector in Lahore as well as
approaching health care professionals at various con-
ferences, the resulting number of participants was still
somewhat low. It is possible that the results do not
reflect the perspectives of the professionals as a whole.
Also the survey developed for the present study was
based on several examples from the literature, but the sur-
vey itself was not validated. There is the possibility that
questions were confusing despite the fact that the study
questionnaire was piloted among a group of healthcare
professionals and the identified deficiencies eliminated.
Generalization to other settings is another limitation.
Regarding a weakness in study design, (since it has
been shown that persons generally answer in the affir-
mative when not sure about a particular item), asking
respondents to list behaviors or characteristics they use
in diagnosing autism rather than presenting a list upon
which to comment, may have led to a more accurate
knowledge of diagnostic criteria of Autism, rather than
a possible overestimate.
Another difficulty encountered was the absence of an
expert group in the study, included in previous studies
[5,10,32], introducing a weakness for comparison.
Although there are many highly qualified professionals
in Pakistan, without dedicated Autism centers and stan-
dard criteria for determining health professionalsexper-
tise in Autism, it was difficult to establish such a group
for comparison in this study.
Despite the limitations of the study, the results provide
an important overview of the diagnostic practices and
knowledge of Autism from a low income developing
country with absence of child mental health policy.
have an unbalanced understanding of autism due to pre-
sence of several misconceptions regarding many of the
salient features of autism including developmental, cog-
nitive and emotional features. The study has clinical
implications and calls for continued education for
healthcare professionals across disciplines with regards
to Autism in Pakistan.
Future studies are needed which should include multi-
ple sites across Pakistan encompassing both urban and
rural settings with a larger sample size. These studies
can provide baseline data to guide policies and planning
of healthcare delivery to children with Autism and other
developmental disorders in Pakistan.
Additional material
Additional file 1: The Autism Survey Questionnaire. The survey form
used in the study.
Imran et al.BMC Pediatrics 2011, 11:107
Page 5 of 6
List of Abbreviations Used
(ASD): Autism Spectrum Disorder; (DSM- IV): Diagnostic and Statistical
Manual of Mental Disorders, 4
edition.; (HCW): Health care Workers.
We would like to thank Dr Tamara Daley for forwarding us a copy of
questionnaire used in their autism study conducted in India, and Dr.
Wudarsky for reviewing the manuscript.
Results of this study were presented as a Poster at the 57
Meeting of American Academy of Child & Adolescent Psychiatry in New
York, October 26 to 31, 2010.
Author details
Child & Family Psychiatry Department, King Edward Medical University/
Mayo Hospital, Lahore, Pakistan.
Academic Department of Psychiatry &
Behavioural Sciences, King Edward Medical University/Mayo Hospital, Lahore,
Riverview Hospital for Children and Youth, Department of Children
and Families CT, Yale Child Study Center, Middletown, CT, USA.
of Psychiatry& Behavioural Sciences, King Edward Medical University/Mayo
Hospital, Lahore, Pakistan.
Academic Department of Psychiatry &
Behavioural Sciences, King Edward Medical University/Mayo Hospital, Lahore,
Department of Physiology and Cell biology, University of Health
Sciences, Lahore, Pakistan.
NI: Conception & design, data analysis and interpretation, article drafting.
MRC: conception & design, data collection, analysis. MWA: Design of the
study, manuscript writing, critical revision. MRB: Study plan, write up and
critical revision. ZIC: literature search, data collection & interpretation. MAC:
Design, data analysis, manuscript writing.
All the authors read and approved the final draft of the article.
Competing interests
The authors declare that they have no competing interests.
Received: 19 August 2011 Accepted: 22 November 2011
Published: 22 November 2011
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Pre-publication history
The pre-publication history for this paper can be accessed here:
Cite this article as: Imran et al.: A survey of Autism knowledge and
attitudes among the healthcare professionals in Lahore, Pakistan. BMC
Pediatrics 2011 11:107.
Imran et al.BMC Pediatrics 2011, 11:107
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... Several studies from different countries have assessed the knowledge, attitude, and practices of physicians and health workers regarding ASD with different tools and methods of evaluation. For example, a study from Turkey used a questionnaire with open-ended questions [11]; some studies from Pakistan [12,13] and Turkey [14] used Likert-scale questions; a study from Nepal used focus groups and semi-structured interviews [15]; and another from Nigeria used multiple choice questions where the correct choice for each question received a score of one (1), while the other two incorrect choices received a score of zero [16]. All of these studies noted a deficiency in physicians' competency regarding ASD. ...
... All of these studies noted a deficiency in physicians' competency regarding ASD. Studies from Pakistan [12,13] reported a significant degree of misconceptions regarding ASD among general practitioners and physicians. In addition, Minhas et al. highlighted a high degree of stigma, lack of available services, and the limited levels of ASD knowledge in general physicians in Pakistan and India, which takes a significant toll on parents, and reduces their faith in the medical professional's competence and ability to help children with ASD [17]. ...
... Often, knowledge of healthcare professionals, including physicians, is assessed via questionnaires without any established construct validity. The common methodology weakness for the aforementioned studies is the use of a total score (or percentage of a specific response) to represent ASD knowledge among physicians and practitioners, without identifying underlying sub-constructs for the total score, nor providing evidence for validity of the construct for the overall knowledge score, or the knowledge sub-scores [12][13][14]16]. However, more recent studies have reported information on psychometric assessments and internal consistency [20,21]. ...
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Background: Lack of physicians' knowledge regarding mental health, including Autism Spectrum Disorder (ASD) could have adverse effects on affected individuals' health and quality of life. The purpose of this study was to provide construct validity for a modified questionnaire in order to determine the self-reported competency for underlying sub-constructs in ASD, make inferences on perceived competence in ASD based on a sample of Romanian physicians, and identify physicians' characteristics associated with these sub-domains of competency. Methods: For this survey, we modified a questionnaire that was used in Pakistan and Turkey, and administered it to a sample of 383 practicing physicians in Romania to assess their perceived competency regarding ASD. Exploratory factor analysis on 12 knowledge questions revealed five sub-domains: stigma, potential causes, children's behavior, misconceptions, and educational needs associated with ASD knowledge. Using General Linear Models, we determined physicians' characteristics that predict the total competency score and various competency sub-scores. Results: Seventy-five percent of the responding physicians were female and 30% had over 30 years practicing medicine. The majority (73-94%) of physicians have correctly responded to some basic questions regarding knowledge about ASD. We also found that younger physicians were more knowledgeable about potential causes of ASD than older physicians (Adjusted Mean Score (AMS): 2.90 vs. 2.18, P < 0.01), while older physicians knew more about the behavior of children with ASD (AMS: 0.64 vs. 0.37, P = 0.02). We found a significant interaction (P < 0.01) between television as source of ASD knowledge and city where the clinic is located in relation to knowledge of the physicians regarding stigma related to ASD. However, the total score was not associated with the variables associated with sub-domains. Conclusion: Using factor analysis, we demonstrated construct validity of five sub-domains related to Romanian physicians' knowledge about ASD that include stigma, potential causes, behavior in ASD children, special education needs, and misconceptions related to ASD. The lack of significant association of the knowledge of physicians on ASD neither with the Psychiatry nor the Pediatric ward rotations at medical school may support the need for improving the curriculum on ASD in Romanian medical schools.
... Although the recognised prevalence of autistic individuals is increasing 1 , with a figure of > 1% for the adult population in England 2 , there is still limited understanding of the condition and acceptance by the public 3,4 . There is a disproportionate amount of research focusing on children 5 , and a common misunderstanding is that autism, a lifelong neurodevelopmental condition 6 , is only present during childhood 5,7 . Autism in adulthood is accompanied by mental health problems, in a high proportion of cases 8 . ...
... 'inevitable features of dog ownership' (123, 9.9%), 'social interactions with others' (109,8.8%), ' educational impacts' (90,7.2%), 'play related' (33, 2.7%) and ' dog's health' (32, 2.6%). ...
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Mental health problems and suicide are more frequent in autistic adults than general population. Dog ownership can improve human well-being. This study aimed to generate a framework of well-being outcomes for dog-related activities in autistic adults and compare it to the framework generated for a general adult population. Thirty-six autistic dog owners (18–74 years old, 18 males) from diverse UK regions were interviewed and transcripts thematically analysed. 16.7% reported that their dogs prevented them from taking their own lives, mainly due to the dog's affection and the need to care for the animal. Close dog-owner interactions (e.g., cuddling, walking, dog's presence) were the most frequent activities improving emotions/moods and life functioning, whereas routine-like activities (e.g., feeding the animal) particularly enhanced life functioning. Well-being worsening was mainly linked to dog behaviour problems, dog poor health/death and obligations to the dog. Despite some negatives associated with ownership, having a dog could improve the well-being of many autistic adults and assist suicide prevention strategies in this high-risk group. The framework was consistent with that generated previously, indicating its robustness and the potential opportunity to focus on dog-related activities rather than the vague concept of “ownership” when considering the impact of ownership on well-being.
... Therefore, timely diagnosis, follow-up, and treatment of comorbidities by specialists capable of working with this group of patients can not only improve the quality of life of children with ASD, but also help save their lives. Previously, health care providers were shown to have a limited level of knowledge and awareness concerning ASD screening and the monitoring/treatment of co-morbid conditions [15][16][17]. Medical students and non-neuropsychiatric disciplines residents have generally exhibited limited awareness regarding the topic of childhood ASD, as indicated by other studies [18][19][20]. The consequences of the above findings can lead not only to delays in early interventions, which endanger productive results, but they also contribute to the deterioration of the somatic state of the health of children with ASD [21]. ...
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Background Autism spectrum disorder (ASD) is a complex developmental range of conditions that involves difficulties with social interaction and restricted/repetitive behaviors. Unfortunately, health care providers often experience difficulties in diagnosis and management of individuals with ASD, and may have no knowledge about possible ways to overcome barriers in ASD patient interactions in healthcare settings. At the same time, the provision of appropriate medical services can have positive effects on habilitative progress, functional outcome, life expectancy and quality of life for individuals with ASD. Methods This online survey research study evaluated the awareness and experience of students/residents ( n = 247) and physicians ( n = 100) in the medical management of children with ASD. It also gathered the views and experiences of caregivers to children with ASD ( n = 158), all based in Russia. Results We have established that the Russian medical community has limited ASD knowledge among providers, and have suggested possible reasons for this. Based on results from online surveys completed by students/residents, non-psychiatric physicians, and caregivers of children diagnosed with ASD, the main problems pertaining to medical management of individuals with ASD were identified. Possible problem solving solutions within medical practice were proposed. Conclusions The results from this study should be considered when implementing measures to improve healthcare practices, and when developing models for effective medical management, due to start not only in Russia but also in a number of other countries.
... This qualification gap is not restricted to therapists and teachers who deal with children. Dentists, doctors, nurses, teachers and any professional who has to assist people with ASD at different stages of their lives, will need adequate training that understands the technical and human issues of autism (Imran et al., 2011;Nascimento;Cruz;Braun, 2016;Silva;Chaves, 2014). ...
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Autism has been treated in a fragmented way by different research areas, and integrative studies are needed. Little is known about the effects of public policies on each other, as well as the effects of their lack of coordination. The objective of this work is to develop a broader and more integrated approach to the support processes offered to people with autism, contributing to the progress of public policies and research related to the issue. Through bibliographic review, an integrated model of processes was developed that can holistically follow people with ASD throughout their lives. The main processes identified are: Diagnose early; offer multidisciplinary treatment; provide inclusive formal education; prepare individuals to work; refer professionals to the job market; adjust the work environment; monitor the adaptation process; provide assistance and accompany the elderly. The paradigm according to which the needs of people with ASD are met universally, through integrated support processes, is still far from being realized. The present work, far from exhausting the question, aims to make it more evident.
... 42 Identifying nurses' knowledge gaps and equipping them with the necessary information is profound to mitigate the burden. 39,46 Therefore, this study tried to assess the knowledge of childhood autism among nurses working in governmental hospitals in Addis Ababa, Ethiopia ( Figure 1). ...
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Introduction: Autism is a neurodevelopmental disorder that occurs in the early childhood period and is characterized by altered social interaction, communication problems, repetitive, and stereotyped behavior. Genetic, environmental, or physical risk factors are associated with prenatal, natal, or postnatal complications, leading to the development of autism spectrum disorders. Prompt diagnosis and management should be an integral component of the care provision in countries like Ethiopia. Objective: This study aimed to assess knowledge of childhood autism among nurses working in governmental hospitals in Addis Ababa, Ethiopia. Methods: Institutional based cross-sectional study design was used. The sample size was calculated using the single population proportion formula, and the final sample size was 360. Final study subjects were selected by using the simple random sampling method. Data were collected using structured self-administered questionnaires and were then coded and entered into Epi-data version 3.1 and exported to SPSS version 21 for analysis. Descriptive statistics were utilized to show frequencies and percentages, and analysis of variance was carried out to compute the association between the dependent and independent variables. Independent t-test was also done to see the association between dependent variables and independent variables with two means. A p-value of less than 0.05 was considered statistically significant. Results: The mean score for knowledge-related items was 8.79 ± 0.4. In this study, out of 331 nurses, 180 (54.35%) had good knowledge. Significant mean score difference was observed among age distribution (F-Ratio = 2.8, p-value = 0.04), level of education (F-ratio = 13.97, p < 0.001) and work experience (F-Ratio = 3.07 p-value = 0.017). Conclusion: A significant gap was observed in the overall knowledge of childhood autism among nurses employed in the governmental hospitals of Addis Ababa. The respondents' knowledge level was significantly different among age group distributions, education levels, and work experience.
... utism spectrum disorder (ASD), being one of the fastest-growing disabilities in children, is an omnipresent, immutable neurodevelopmental disorder characterized by impaired socialization, impaired verbal and nonverbal communication, restricted interests, and repetitive patterns of behavior 1,2,3 . The global epidemiological data indicate that 1-2% of the world population is affected by ASD, which corresponds to about 50 million individuals with ASD around the world 4,5,6 . ...
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Autism spectrum disorder (ASD), being one of the fastest-growing disabilities in children, is an omnipresent, immutable neurodevelopmental disorder characterized by impaired socialization, impaired verbal and non-verbal communication, restricted interests, and repetitive behaviour patterns. A descriptive cross-sectional study was conducted from 30 October to 30 November 2019 among the MBBS students of 21 medical colleges in Bangladesh to assess their knowledge of autism. The 'Knowledge about Childhood Autism among Health Workers (KCAHW)' questionnaire containing 19 item questions divided into four domains was used. The total median score in the KCAHW questionnaire is 13 out of 19. The final total of respondents numbered 483. There were 215 (44.51%) male and 268 (55.49%) female students. Among 21 medical colleges, 10 are situated in the Dhaka district and 11 outside Dhaka; 14 medical colleges were public, and seven were private. The study shows that students' knowledge of autism spectrum disorder (ASD) is not up to the mark. While assessing the knowledge in each domain, Domain 4 (knowledge regarding nature, comorbidities, and onset) shows that only 32.6% of students of 4th phase and 21.5% of other phases have scored more than the median value, revealing that medical students were not familiar with nature, comorbidities, and the onset of ASD. It can be reliably diagnosed before two years of age, but the practical scenario is a different picturesque. Thus, medical students should have bona fide knowledge to diagnose this progressively prevailing disorder at the earliest possible time. We hope this study's aftermath will significantly impact the integrity and diversity of autism spectrum disorder.
Introduction Early identification and intervention of childhood autism spectrum disorder (ASD) is recognised to have a valuable impact on a child’s life. Nurses who are adequately prepared with the necessary screening practices to do early identification of the children with risk for ASD and knowledge surrounding ASD may enhance the screening practices in the child care delivery system. Objectives This study was to discuss nurses’ knowledge and understanding about childhood ASD and its’ screening practices among nurses. Methodology The scoping review approach was adopted for the present study utilised by reviewing electronic databases from inception to 2021. Results The authors have searched 160 related studies from above-said database and found only 10 full-text studies based on the objective and research question. Based on the review, researchers understood that the Nursing Professionals have scant to moderate knowledge and understanding on childhood ASD and its ‘Screening Practices.’ Effective training programmes and continuing nursing education would hasten the early identification and intervention process in this arena.
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Aim: To study the knowledge and attitude of family medicine residents about autism spectrum disorder in postgraduate programs of family medicine in western region, Saudi Arabia. Methods: This cross-sectional study was conducted from January to February 2020 in Al-Madinah, Saudi Arabia. The data were collected through an online questionnaire. Results: Out of 246 family medicine residents, 126 (52.0%) were female, with average age 28.3 (3.1), 91 (37.0%) were R4 and 65 (26.4%) were R3, 112 (45.5%) encountered cases of autism, 13 (5.3%) attend training program, and 38 (15.4%) reported family history of autism. The mean knowledge score was 12.8 indicating average level of knowledge, where 99 (40.2%) had moderate level of knowledge, 79 (32.1%) had poor knowledge, and 68 (27.6%) had good knowledge, 33 (13.4%) had an awareness about specialized Centre for autism in Saudi Arabia, half of the residents had positive attitude towards autism, A significant highest score was found among those who were in higher level of residency (p=0.003), and those who didn't have a family history of autism (p=0.026). Conclusion: Family medicine residents showed average level of knowledge and attitude dealing with autism patients. Were, less than tenth attend training program in child mental health. and less than fifth had an awareness about specialized Centre for autism in Saudi Arabia. Recommendation: Decision makers and administrators in colleges and universities requested to give more attention to improve psychiatry curriculum including autism subject.
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Worldwide, mental disorders are on the increase (Gadit, 2007) and an estimated 10-20% of children have one or more mental or behavioural problems (Park, 2002). There is an urgent and serious need to pay attention to the mental health needs of children in low- and middle-income countries (Rahman et al , 2000). The initial survey for the World Health Organization's Atlas project (Sherer, 2002) showed that 41% of countries surveyed had no mental health policy and 28% had no separate budget for mental health.
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The ‘brain drain’, resulting from the recruitment by the UK of highly qualified mental health professionals from middle- and low-income countries, has been described as a serious problem effecting the service provision, training and research capacity of these countries (Doku & Mallett, 2003; Thara et al , 2004). Although this issue is important, the benefits of such migration are seldom highlighted. Professionals who migrate often invest in families and businesses in their home country and are a source of valuable foreign income. Many professionals undergo specialised training and gain experience not available in their home countries and then return to provide an enhanced level of service (Tareen, 2000). Such movement may also serve a catalytic purpose. An example of a sector that has gained enormously from the so-called brain drain is information technology in India, which is built largely around expatriates in the USA and their networks back home. The high profile of Indian information technology experts has encouraged a whole new generation to pursue excellence in this field.
Problem/Condition: Autism spectrum disorders (ASDs) are a group of developmental disabilities characterized by impairments in social interaction and communication and by restricted, repetitive, and stereotyped patterns of behavior. Symptoms typically are apparent before age 3 years. The complex nature of these disorders, coupled with a lack of biologic markers for diagnosis and changes in clinical definitions over time, creates challenges in monitoring the prevalence of ASDs. Accurate reporting of data is essential to understand the prevalence of ASDs in the population and can help direct research. Period Covered: 2008. Description of System: The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance system that estimates the prevalence of ASDs and describes other characteristics among children aged 8 years whose parents or guardians reside within 14 ADDM sites in the United States. ADDM does not rely on professional or family reporting of an existing ASD diagnosis or classification to ascertain case status. Instead, information is obtained from children's evaluation records to determine the presence of ASD symptoms at any time from birth through the end of the year when the child reaches age 8 years. ADDM focuses on children aged 8 years because a baseline study conducted by CDC demonstrated that this is the age of identified peak prevalence. A child is included as meeting the surveillance case definition for an ASD if he or she displays behaviors (as described on a comprehensive evaluation completed by a qualified professional) consistent with the American Psychiatric Association's Diagnostic and Statistical Manual-IV, Text Revision (DSM-IV-TR) diagnostic criteria for any of the following conditions: Autistic Disorder; Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS, including Atypical Autism); or Asperger Disorder. The first phase of the ADDM methodology involves screening and abstraction of comprehensive evaluations completed by professional providers at multiple data sources in the community. Multiple data sources are included, ranging from general pediatric health clinics to specialized programs for children with developmental disabilities. In addition, many ADDM sites also review and abstract records of children receiving special education services in public schools. In the second phase of the study, all abstracted evaluations are reviewed by trained clinicians to determine ASD case status. Because the case definition and surveillance methods have remained consistent across all ADDM surveillance years to date, comparisons to results for earlier surveillance years can be made. This report provides updated ASD prevalence estimates from the 2008 surveillance year, representing 14 ADDM areas in the United States. In addition to prevalence estimates, characteristics of the population of children with ASDs are described, as well as detailed comparisons of the 2008 surveillance year findings with those for the 2002 and 2006 surveillance years. Results: For 2008, the overall estimated prevalence of ASDs among the 14 ADDM sites was 11.3 per 1,000 (one in 88) children aged 8 years who were living in these communities during 2008. Overall ASD prevalence estimates varied widely across all sites (range: 4.8-21.2 per 1,000 children aged 8 years). ASD prevalence estimates also varied widely by sex and by racial/ethnic group. Approximately one in 54 boys and one in 252 girls living in the ADDM Network communities were identified as having ASDs. Comparison of 2008 findings with those for earlier surveillance years indicated an increase in estimated ASD prevalence of 23% when the 2008 data were compared with the data for 2006 (from 9.0 per 1,000 children aged 8 years in 2006 to 11.0 in 2008 for the 11 sites that provided data for both surveillance years) and an estimated increase of 78% when the 2008 data were compared with the data for 2002 (from 6.4 per 1,000 children aged 8 years in 2002 to 11.4 in 2008 for the 13 sites that provided data for both surveillance years). Because the ADDM Network sites do not make up a nationally representative sample, these combined prevalence estimates should not be generalized to the United States as a whole. Interpretation: These data confirm that the estimated prevalence of ASDs identified in the ADDM network surveillance populations continues to increase. The extent to which these increases reflect better case ascertainment as a result of increases in awareness and access to services or true increases in prevalence of ASD symptoms is not known. ASDs continue to be an important public health concern in the United States, underscoring the need for continued resources to identify potential risk factors and to provide essential supports for persons with ASDs and their families. Public Health Action: Given substantial increases in ASD prevalence estimates over a relatively short period, overall and within various subgroups of the population, continued monitoring is needed to quantify and understand these patterns. With 5 biennial surveillance years completed in the past decade, the ADDM Network continues to monitor prevalence and characteristics of ASDs and other developmental disabilities for the 2010 surveillance year. Further work is needed to evaluate multiple factors contributing to increases in estimated ASD prevalence over time. ADDM Network investigators continue to explore these factors, with a focus on understanding disparities in the identification of ASDs among certain subgroups and on how these disparities have contributed to changes in the estimated prevalence of ASDs. CDC is partnering with other federal and private partners in a coordinated response to identify risk factors for ASDs and to meet the needs of persons with ASDs and their families.
Problem/Condition: Data from a population-based, multisite surveillance network were used to determine the prevalence of children aged 8 years with autism spectrum disorder (ASD) in six areas of the United States and to describe the characteristics of these children. Reporting Period: 2000. Methods: Children aged 8 years were identified as having an ASD through screening and abstraction of evaluation records at multiple sources, with clinician review of abstracted records to determine case status. Children whose parent(s) or legal guardian(s) resided in one of the six surveillance areas during 2000 and whose records documented behaviors consistent with the American Psychiatric Association’s criteria for diagnosing 1) autistic disorder, 2) pervasive developmental disorder-not otherwise specified, or 3) Asperger disorder were classified as having an ASD. Results: For 2000, across six sites, a total of 1,252 children aged 8 years were identified as having an ASD. The overall prevalence of ASDs per 1,000 children aged 8 years ranged from 4.5 in West Virginia to 9.9 in New Jersey. With the exception of one surveillance site (Georgia), no statistically significant (p<0.05) differences were identified in the rate of ASDs between non-Hispanic black and non-Hispanic white children. The ratio of male-to-female prevalence varied (range: 2.8:1.0–5.5:1.0). The majority of children with ASDs received special education services and had a documented history of concerns regarding their development before age 3 years. The prevalence of children with a previously documented ASD classification varied across sites, but the median age of earliest documented ASD diagnosis was similar across sites (age 52–56 months). For three sites with sufficient data on intelligence quotient (IQ), cognitive impairment (i.e., IQ of <70) was reported for 40%–62% of children whose conditions were consistent with the case definition for ASD. Interpretation: Findings from this first U.S. multisite collaborative study to monitor ASD prevalence demonstrated consistency across the majority of sites, with prevalence statistically significantly (p<0.001) higher in New Jersey. Average ASD prevalence across all six sites was 6.7 per 1,000 children aged 8 years. These results indicate that ASDs are more common than was believed previously.
There is an urgent need to pay attention to the mental health of children in developing countries. Professionals confronted with this task face a number of challenges. Services have to be planned in a rational way, keeping in mind the needs of local populations. These needs will often exceed the available resources, and it will be necessary to set priorities. Feasible and cost-effective models of service delivery then have to be developed to meet these needs. This annotation provides a framework within which mental health needs of children can be assessed, priorities established, and services organised. This is illustrated with examples of relevant activities undertaken in low-income developing countries over the last two decades.
Although recent research indicates the importance of early recognition and intervention for children with autism, it is clear that many families remain very dissatisfied with the diagnostic process. In order to improve this situation, it is essential that primary care practitioners, such as GPs, are fully aware of the core symptoms of autism. The present study reports on autism awareness amongst 250 medical students at different stages of their training. Differences between first-year and fourth-year students were compared with respect to their knowledge of various aspects of autism, including diagnosis, cause, symptomatology, treatment and outcome. Fourth-year students were significantly more likely to respond correctly to questions related to diagnostic criteria and core symptoms. However no significant differences were found between first-year and fourth-year students for other aspects, such as possible causes, IQ profiles, prognosis and treatment. These findings suggest that more emphasis needs to be placed on teaching medical students about autism if diagnosis and access to intervention are to be improved.