2011, Number 5
<< Back Next >>
Salud Mental 2011; 34 (5)
Autistic spectrum disorders: Diagnostic and therapeutic challenges in Mexico
Márquez-Caraveo ME, Albores-Gallo L
Language: English
References: 63
Page: 435-441
PDF size: 96.52 Kb.
ABSTRACT
Autistic Spectrum Disorders (ASD) are developmental disorders with impairments in three broad domains: social interaction, communication and stereotypic movements and repetitive behavior. Their symptoms are complex, bizarre and most of them persistent, causing maladaptive and poor psychosocial adjustment.
Early detection and diagnosis is a priority in ASD, parents are the first to notice early autism symptoms: 50% observe signs in the first 12 months of age. Despite initial observations of atypical development, there are significant delays in seeking proper medical attention and correct diagnosis; less than 38% of families receive their diagnosis through health services. Educational and health primary care providers need training in developmental milestones with focus on language and socio-communicative domains. Health policy planners should facilitate rationale referral when key symptoms such as language alterations are detected. The use of valid instruments and surveillance approaches versus awareness through red flag symptoms is discussed.
Psychosocial interventions are the most important treatment, with ABA and TEACHH techniques recommended; pharmacological treatment (atypical antipsychotics, antidepressants, drugs for hyperactivity, sleep problems and anxiety) must be directed to treat comorbid conditions and combined with behavioral interventions.
REFERENCES
World Health Organization. ICD-10: International Statistical Classification of Diseases and Related Health Problems: 10th revision. Geneva; 2007.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth edition, text revision. Washington; 2000.
Wing L. The autistic spectrum. The Lancet 1997; 350:1761-1776. Available at: http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=Lorna+Wing. Access date: June 29; 2011.
Scaife M, Bruner J. The capacity for joint visual attention in the infant. Nature 1975;253:265–266.
Bakeman R, Adamson LB. Coordinating attention to people and objects in mother-infant and peer-infant interaction. Child Dev 1984;55:1278-1289.
Mundy P, Sigman M, Kasari C. Joint attention, developmental level, and symptom presentation in young children with autism. Dev Psychopathol 1994;6:389–401.
Mundy P, Thorp D. Atención conjunta y autismo: Teoría, evaluación y neurodesarrollo. En: Asociación de padres de personas con autismo (APNA). Nuevos desarrollos en autismo: el futuro es hoy. Madrid: Gráficas Áreas Montano, S.A; 2005; pp. 123-169.
Mundy P, Sigmanm M, Ungerer J, Sherman T. Deûning the social deûcits of autism: The contribution of nonverbal communication measures. J Child Psychol Psychiatry 1986;27:657–669.
Reiss AL. Childhood developmental disorders: an academic and clinical convergence point for psychiatry, neurology, psychology and pediatrics. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19220592. Access date: April 01; 2011.
Kishore MT, Basu A. Early concerns of mothers of children later diagnosed with autism: Implications for early identiûcation. Res Autism Spectr Disord 2011;5:157–163.
Jónnsdóttir S, Saemundsen E, Antonsdóttir IS, Sigurdardóttir S et al. Children diagnosed with autism spectrum disorder before or after the age of 6 years. Res Autism Spectr Disord 2001;5:175–184.
Confederación de Autismo España e Instituto de Investigación de Enfermedades Raras (IIER). Informe sobre demora en el diagnostico en los TEA. Available at: www.isciii.es/htdocs/centros/enfermedadesraras/pdf/aut_isdd2.pdf. Access date: April 01; 2011.
Chakrabarti S. Early identiûcation of autism. Indian Pediatr 2009;4:412–414.
Rice C, Nicholas J, Baio J, Pettygrove S et al. Changes in autism spectrum disorder prevalence in 4 areas of the United States. Disabil Health J 2010;3:186-201.
Talero-Gutiérrez C, Rodríguez M, De la Rosa D, Morales G et al. Caracterización de niños y adolescente con trastornos del espectro autista en una institución de Bogotá, Colombia. Neurología 2011. Available at: https://docs.google.com/viewer?url=http://www.elsevier.es/sites/default/files/elsevier/eop/S0213-4853%2811%2900139-3.pdf&embedded=true&chrome=true. Access date: June 28; 2011.
Yeargin-Allsopp M, Rice C, Karapurkar T, Doernberg N et al. Prevalence of autism in a US metropolitan area. JAMA 2003; 289:49-55.
Bishop D. University of Oxford. How to choose between diagnostic tools? Discussion: a plea for efficiency. Available at: http://psyweb.psy.ox.ac.uk/oscci/. Access date: June 01; 2011.
Albores-Gallo L, Hernández-Guzmán L, Díaz-Pichardo JA, Cortés-Hernández B. Dificultades en la evaluación y diagnóstico del autismo. Una discusión. Salud Mental 2008;31:37-44.
Matson JL, Rieske RD, Tureck K. Additional considerations for the early detection and diagnosis in autism: Review of available instruments. Res Autism Spectr Disord 2011;5:1319-1326.
Akshoomoff N, Corsello C, Schmidt H. The role of the autism diagnostic observation schedule in the assessment of autism spectrum disorders in school and community settings. Calif School Psychol 2006;11:7-19.
Hedley D, Young R, Angelica M, Gallegos J et al. Cross-cultural evaluation of the Autism Detection in Early Childhood (ADEC) in Mexico. Autism 2010;14:93-112.
Albores-Gallo L, Roldan Ceballos O, Hernández-Guzmán L, Villarreal-Valdés G et al. Validity of M-CHAT in a large ASD sample. International Society for Autism Research: 11th International Meeting for Autism Research (IMFAR). San Diego California May 11-13: New research poster #128; p.122.
Al-Qabandi M, Gorter JW, Rosenbaum P. Early autism detection: Are we ready for routine screening? Pediatrics 2011;10:1-7.
Wong V, Hui L, Lee W, Leung L et al. A modified screening tool for autism (Checklist for Autism in Toddlers [CHAT-23]) for Chinese Children. Pediatrics 2004;114:166-176.
Aylward GP. Conceptual issues in developmental screening and assessment. J Dev Behav Pediatr 1997;18:240–249.
Baron-Cohen S, Cox A, Baird G, Swettenham J et al. Psychological markers in the detection of autism in infancy in a large population. Br J Psychiatry 1996;168:158–163.
Perera H, Wijewardena K, Aluthwelagem R. Screening of 18-24-monthold children for autism in a semi-urban community in Sri Lanka. J Trop Pediatr 2009;55:402-405.
Sacco R, Militerni R, Frolli A, Bravaccio C et al. Clinical, morphological, and biochemical correlates of head circumference in autism. Biol Psychiatry 2007;62:1038-1047.
Bertoglio K, Hendren R. Research: New developments in autism. Psychiatr Clin N Am 2009;32:1-14.
Dawson G, Rogers S, Munson J, Smith M et al. Randomized, controlled trial of an intervention for toddlers with autism: the early start denver model. Pediatrics 2010;125:17-23.
Howlin P, Magiati I, Charman T. Systematic review of early intensive behavioral interventions for children with autism. Am J Intellect Dev Disabil 2009;114:23-41.
Scottish Intercollegiate Guidelines Network (SIGN). [Online] 2007. Available at: http://www.sign.ac.uk/new.html. Access date: April 01; 2011.
Levy SE, Mandell DS, Schultz RT. Autism. Lancet 2009;374:1627-1638.
Seida JK, Ospina MB, Karkhaneh M, Hartling L et al. Systematic reviews of psychosocial interventions for autism: An umbrella review. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19191842. Access date: April 01; 2011.
Rogers SJ, Vismara LA. Evidence-based comprehensive treatments for early autism. J Clin Child Adolesc Psychol 2008;37:8-38.
Jordan R, Jones G, Murray D. Educational interventions for children with autism: A literature review of recent and current research. Available at: https://www.education.gov.uk/publications/eOrderingDownload/RB77.pdf Access date: April 01; 2011.
Diggle T, McConachie HR. Parent-mediated early intervention for young children with autism spectrum disorder. UK: John Wiley & Sons; 2009; pp. 1-30.
Lovaas OI. Behavioral treatment and normal educational and intellectual functioning in young autistic children. J Consult Clin Psychol 1987;55:3-9.
Basset K, Green CJ, Dazanjian A. Autism and Lovaas treatment: A systematic review of effectiveness evidence available at: http://www.chspr.ubc.ca/node/351. Access date: April 01; 2009.
Dawson G. Early behavioral intervention, brain plasticity, and the prevention of autism spectrum disorder. Dev Psychopathol 2008;20:775-803.
Smith M, Rogers S, Dawson G. The Early Start Denver Model: a comprehensive early intervention approach for toddlers with autism. En: Handleman JS, Harris SL (eds). Pre-school education programs for children with autism. Austin: Pro-Ed Corporation, Inc. 2008:65-101.
Ringdahl J, Kopelman T, Falcomata TS. Chapter 2. Applied behavior analysis and its application to autism and autism related disorders. In: Matson JL. Applied behavior analysis for children with autism spectrum disorders. New York: Springer; 2009; pp. 15-32.
Ospina MB, Seida JK, Clark B, Karkhaneh M et al. Behavioural and developmental interventions for autism spectrum disorder: A clinical systematic review. PLoS ONE 2008;3:3755.
Myers SM, Johnson CP. Management of children with autism spectrum disorders. Pediatrics 2007;120:1162-1182.
Carr EG, Dunlao G, Horner RH, Koegel RL et al. Positive behavior support: Evolution of a applied science. J Positive Behavior Interventions 2002;4:4-16.
White AH. Cognitive behavioural therapy in children with autistic spectrum disorder. En: Bazian LTD (ed). STEER: Succinct and timely evaluated evidence reviews. London: Bazian Ltd and Wessex Institue for Health Research and Development; 2004.
Case-Smith J, Arbesman M. Evidence-based review of interventions for autism used in or of relevance to occupational therapy. Am J Occup Ther 2008;62:416-429.
Simonoff E, Pickles A, Charman T, Chandler S et al. Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity and associated factors in a population-derived sample. J Am Acad Child Adolesc Psychiatry 2008;47:921-929.
West L, Waldrop J, Brunssen, S. Pharmacologic treatment for the core deficits and associated symptoms of autism in children. J Pediatr Health Care 2009;23:75-89.
Posey DJ, Erickson CA, McDougle CJ. Antipsychotics in the treatment of autism. UK. J Clinic Invest 2008;118:6-14.
Jesner OS, Aref-Adid M, Coren E. Risperidona para el trastorno del espectro autista. Oxford: John Wiley & Sons; 2008.
Malone R, Waheed A. The role of antipsychotics in the management of behavioral symptoms in children and adolescents with autism. Drugs 2009;6:535-548.
Reiersen AM, Todd RD. Co-occurrence of ADHD and autism spectrum disorders: phenomenology and treatment. Expert Rev Neurother 2008;8: 657-669.
Wirojanan J, Jacquemont S, Diaz R, Bacalman S et al. The efficacy of melatonin for sleep problems in children with autism, fragile X syndrome, or autism and fragile X syndrome. J Clin Sleep Med 2009;5:145-150.
Wasdell MB, Jan JE, Bomben MM, Freeman RD et al. A randomized, placebo-controlled trial of controlled release melatonin treatment of delayed sleep phase syndrome and impaired sleep maintenance in children with neurodevelomental disabilities. J Pineal Res 2008;44:57-64.
Jaselskis CA, Cook EH, Fletcher KE, Leventhal BL. Clonidine treatment of hyperactive and impulsive children with autistic disorder. J Clin Psychopharmacol 1992;12:322–327.
Fankhauser MP, Karumanchi VC, German ML et al. Double-blind, placebo- controlled study of the efficacy of transdermal clonidine in autism. J Clin Psychiatry 1992;53:77–82.
Walkup JT, Labellarte MJ, Riddle MA, Pine DS et al. Fluvoxamine for the treatment of anxiety disorders in children and adolescents. N Engl Med 2001;344:1279-1285.
Kolevzon A, Mathewson KA, Hollander E. Selective Serotonin reuptake inhibitors in autism: a review of efficacy and tolerability. J Clin Psychiatry 2006;67:14-407.
Buitelaar JK, van der Gaag RJ, van der Hoeven J. Buspirone in the management of anxiety and irritability in children with pervasive developmental disorders: results of an open-label study. J Clin Psychiatry 1998;59:56-59.
Alonso M, Estañol B, Garza S, Gavito J et al. Epilepsia. Primera edición. México: Programa Prioritario de Epilepsia; 2007.
Scottish Intercollegiate Guidelines Network SIGN 81. Diagnosis and management of epilepsies in children and young people. Available at: http://www.sign.ac.uk/new.html. Access date: April 01; 2011.
Caraveo-Anduaga JJ, Colmenares-Bermudez E, Martínez-Vélez NA. Síntomas, percepción y demanda de atención en salud mental en niños y adolescentes de la Ciudad de México. Salud Publica de México 2004;44: 492-498.